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Why do we use yoga in pelvic health physical therapy? It’s simple really. It’s effective and efficient, because you can get 6 or 7 benefits from doing a single thing. It’s integrative and whole body pelvic healthcare.
Dustienne Miller and Dr. Ginger Garner sat down and had a beautiful conversation about why and how using yoga in pelvic health can be such a transformational tool for both the patient and the provider. Although they came from different professional backgrounds, they both have found immense benefits in using yoga in their physical therapy practices.
By tuning in, you’ll also learn their favorite go-to yoga treatments, the power of mindfulness, and how to down-train your nervous system for better health and well-being.
Yoga and pelvic health really do belong together in the world of physical therapy. Listen or watch this interview to learn how!
Dustienne Miller is passionate about combining her yoga teacher background with her specialization in pelvic health physical therapy. Before delving into the world of pelvic rehab she pursued a career in musical theater. While in NYC she worked as a backstage physical therapist on Broadway shows and began her journey in pelvic health.
Dustienne’s clinical practice, Flourish Physical Therapy, is in Boston where she treats orthopedics and pelvic health. She is also a professor of theatre jazz dance at the Boston Conservatory. She is a contributing author in two books (Healing in Urology; Yoga Mama). In 2012 she created a pelvic health yoga video series called Your Pace Yoga with the to goal to offer people strategies to help during pain flares. Her two-day continuing education class for rehab professionals, Yoga for Pelvic Pain, continues to be offered thru Herman and Wallace.
:00 Dr. Ginger Garner: Hey, you guys, I am back again with a special guest today, Dustyanne Miller. She is a physical therapist and a yoga teacher extraordinaire, among many other things, which we will get into. Welcome, Dustienne. Thank you.
0:17 Dustienne Miller: Thanks for having me, Ginger.
0:20 Dr. Ginger Garner: Yeah, I’m so glad that you’re here. We have kind of worked like in like parallel universes, you know, like the same public health universe, but using yoga and doing different things and being all over the place. And it’s, I mean, when have we been in the same room yet?
0:40 Dustienne Miller: Yes, at the Herman and Wallace party at CSM in
0:48 Dr. Ginger Garner: New Orleans. Yeah. Yeah.
0:50 Dustienne Miller: And I was like, you’re Ginger. It’s so nice to actually physically meet you.
0:55 Dr. Ginger Garner: Yeah. Oh, I remember that a long time ago. I want to take that Bruce Springsteen painting home with me. That seems like years ago. Oh, my God.
1:08 Dustienne Miller: It kind of was actually.
1:09 Dr. Ginger Garner: It really was. Yeah, that was pre COVID. And so it might be another lifetime. Well, I want to brag on you a little bit, so I’m going to read your bio first. I’ve picked all of the stuff that I think is just awesome. So you guys listen up to this. Dustienne Miller is quite passionate about combining her yoga teacher training and background with her specialization in pelvic health, PT.
Before diving into the world of pelvic rehab, she pursued a music career in musical theater. And she worked backstage as a physical therapist on Broadway shows in New York. And then, I’m getting this right, then you began your pelvic health journey after that into PT. And now she has Flourish Physical Therapy, which is based in Boston. And like many of us who started kind of ortho, I do my shoulders and head if you’re not [Yes, yes.]
We all started kind of ortho, and then we migrated somewhere along the way into pelvic health. One thing that I didn’t know was that you’re a professor of theater jazz dance at the Boston Conservatory. Yes. Yay. I’d love to be a fly on the wall. [I know, you could come over. I know.]
Well, actually, CSM is in Boston. Next.
2:30 Dustienne Miller: I know. I’m not going to be in town. Oh, no. Get out of town. I know. The one time it’s here. It hasn’t been here for like 20 years, I know.
2:37 Dr. Ginger Garner: Yeah, I really haven’t been to Boston the last time I was teaching yoga therapy there tons and tons of years ago. But you’re also a contributing author to two books, Yoga Mama and Healing and Neurology. In 2012, she created a great series that I’ve referred a lot of people to called Your Pace Yoga, which is pelvic health yoga series.
And then she also teaches her very famous two-day CE course for rehab professionals, Yoga for Pelvic Pain. Which is kind of like, you know, the bread and butter in the yoga and pelvic health world because, I mean, it’s such a great class. And she teaches that through Herman and Wallace. So welcome.
3:18 Dustienne Miller: Thank you so much.
3:21 Dr. Ginger Garner: I’m glad you’re here today. I first want to ask you about that story and that transition because now it piqued my interest of, I knew that you had that background, but I didn’t know the specifics. And so, set us up for this. You’re working backstage on Broadway shows as a PT. And then what made you shift towards pelvic PT?
3:45 Dustienne Miller: Yes. Well, our darling Stacey Futterman was working, yes, you know and love. She and I worked for the same company, HMD Physical Therapy, in New York City. And I was at a different office. And she came into our facility and did an in-service. And I thought, well, this is really interesting. And as a feminist, I had learned that some women had vaginal pain with intercourse. And then I learned that one of the leading causes of folks going into nursing homes was urinary incontinence.
So I was like, ding, ding, ding, this is super interesting. And then I started taking the courses and was mentored by her before I ended up working for Amy Stein as well. But it was just fascinating for me because you and I are the same generation. I don’t know about you, but in PT school, there was nothing said about pelvic health. It just wasn’t there yet. And now fast forward to folks are having either guest lectures or elective courses or residencies. So it’s incredible to see how quickly that has grown over the 20 year time.
4:55 Dr. Ginger Garner: Yeah, I’ve had several students come in already with the first level, for those of you who don’t know, PF1 is like your first level of pelvic floor training. That’s offered through a couple of different companies, but these students already have PF1 now, and an elective, and guest lectures. And so they’re fortunately going to come out really well equipped to just dive right in, which is great.
5:19 Dustienne Miller: Right. And then helping their ortho patients that by the way, oh yeah, I do leak when I do double unders or I do leak when I occasionally take a step off of a curb. So then being able to, even if they’re not treating pelvic health, they’ll at least know how to refer folks or do some kind of basic core save with pelvic floor engagement.
5:44 Dr. Ginger Garner: Yeah.
5:45 Dustienne Miller: Which back in the day just like wasn’t part of my vocabulary.
Dr. Ginger Garner: No, so many things weren’t. You know what we know so much now about the public pelvic girdle from hip arthroscopy, and that still needs to be that rehab, you know needs to be evolved quite a bit. And you know that combination of bringing sports med and pelvic floor together, but it brings up a really important point which is. You know, we have both been PTs for way over 20 years. We’ve been in this pelvic health and ortho space for a long time. And so we’ve seen an evolution of no training to now students coming out of their respective schools with some level of training that will require more advanced specialty training, but it’s better than it was 20 years ago.
However, what hasn’t changed are maternal health outcomes that are actually worse than they were 20 years ago. So there’s this dichotomy, right? Here we are improving our medical education training, and we’re more prepared than ever to treat pelvic health issues, but our pelvic health outcomes and maternal health outcomes are worse. So that means women and people that identify as female, they’re not getting to pelvic PT soon enough.
7:03 Dustienne Miller: Mm-hmm.
7:04 Dr. Ginger Garner: Mm-hmm. So let’s talk a little bit about that. What are some of the reasons that you see that people just aren’t getting to you soon enough?
7:12 Dustienne Miller: Yeah. Here in Boston, we are blessed with a lot of folks who are both in and out of network. So there is access for people who would need to use their insurance. And then there’s access for folks who may have an out-of-network plan or a cash base. That’s not the same for everywhere in terms of accessibility from a financial perspective and also from a practitioner perspective. That being said, most places in Boston are currently still wait-listed.
So even though there are so many more people that are trained in pelvic health, there still aren’t enough people to be providing the care that people know about, nevermind the care that people haven’t gone in, maybe like try to market to different sources because, like to get the word out more, I’m thinking about, I don’t know of any inpatient PTs that are doing inpatient postpartum immediate care here. I don’t know if you do in your neighborhood. No, but that would by incredible.
08:23 Dr. Ginger Garner: Yeah, that’s a really high need and it’s a good place to bring up the bill that’s currently sitting in Congress. Now, when you’re listening to this the session may be over and the bill may be dead. Yeah. However, we are still going to put it in the show notes because it should direct you to the new link because we are dedicated at Academy of Pelvic Health. I was fortunate enough to sit on the task force to help co-write the bill. So I say we, but I also say we collectively, like all pelvic health PTs that are advocating. We are not going to stop until this bill passes because it would provide that care that you’re talking about. That’s really missing, not just inpatient care, but also outpatient care.
So those of you who are listening, that means if you’re pregnant, if you are postpartum, your provider, physician, therapist, whomever it is, would be required by law to screen and refer you to pelvic PT, which doesn’t currently exist. There’s no standard for it. So the thing you mentioned about the inpatient care being so high, a need being so high, and there being little to no representation for that, I had Dr. Rebeca Segraves on, who spoke at CSM last year. And for those of you who haven’t listened to her podcast yet, flip on over and listen to her podcast, because you’re really going to be empowered with your, your rights, you know, what you have a right to plus she’s got some great resources there that she’ll point you to.
But yeah, I we don’t have it. We don’t have to like get back to your line of questioning. We don’t have any inpatient and we’re in North Carolina. So think about the Deep South and what’s available in the Deep South in terms of access to care, women having a right and full autonomy over their bodies and their choices, that’s becoming increasingly limited in the South. And we already had poor outcomes to begin with. So that’s an area that we really wanna see open up to access.
And one thing that Dr. Segraves is also working on I remember this from her lecture at our national PT meeting last year, which for those of you who don’t know, we call that CSM, combined sections meeting. You’ll hear me say that frequently during podcasts, that way you’ll learn about what it is, but she’s also advocating for this for abdominal surgeries.
I mean, a lot of, 33% of births are C-section. So that’s obvious, right? Mom’s need care for that. And people who give birth need care for that. But what about all the other people that go home that have abdominal surgeries? And they’re like, Yeah, okay, good luck. And they just cut through all the abdominal layers, which disconnects it from the pelvic floor, among other things. And then they’re given absolutely no instruction on scar care, you know, wound care, mobilization, getting back to, you know, activities, etc.
So that is a deep well to discuss of how women and people who identify as female and, and men too, you know, and trans individuals, everybody just, we’re not getting the pelvic healthcare we need. And oftentimes it comes across as even like gaslighting, like, you know, I’ve heard patients come in and I know you’ve heard this too, the classic, well, why would, and they’ve asked your practitioner for pelvic PT and, or OT and the practitioner’s like, well, why, why would you need that? You just gave birth.
12:12 Dustienne Miller: Yeah, right.
12:13 Dr. Ginger Garner: It’s like not, we don’t refer for that.
12:15 Dustienne Miller: Right. Or you don’t have leakage or you don’t have prolapse and you haven’t had a grade three or four tear. So, it’s fine. You’ll feel better once you’re done breastfeeding.
12:28 Dr. Ginger Garner: Oh, just that that actually makes my arms tighten up. And it makes me so angry and also super compassionate for the people that are sitting there listening to that drivel, you know, come out of a person’s mouth, it doesn’t even need to be the practitioner, it could be anyone saying, Oh, well, you’re not leaking, you must be fine.
12:50 Dustienne Miller: You know, or imagine having Oh, sorry, please.
12:53 Dr. Ginger Garner: Oh, well, or it can come from like support agents, like your own, I’ve had spouses say, well, our friends didn’t have this problem. Why do you have this problem?
13:03 Dustienne Miller: You know, I say, yeah. And I think that is the problem is the word problem because the challenge I think is it’s getting a lot better, but how do we frame postpartum wellness? Or actually human wellness, to be fair, for all things. But if we’re thinking specifically in the postpartum period, how do we reframe and rebrand that everyone who has gone through this experience deserves?
And, in my opinion, and I think you probably share, it needs to come in at least for one or two wellness visits? Yeah, even if they’re asymptomatic, because they’ve had all of these massive pressure changes in our abdominal pressures different, the body has different proprioception about where it is in space. We no doubt have orthopedic things going on with the feet, the hips, the back, the SI, et cetera. Thorax is a big place that we look at.
So how do we help people find their center again, which is also a language that you and I share around using yoga and mindfulness as a treatment method postpartum. Find your center again, know how to move from that space that has been different for nine months, as there’s a hormonal storm going on, increased stressors at home, you’re probably overwhelmed in the initial post period time emotionally. So biopsychosocial things are all different.
So I think if we can, yeah, oh, go ahead. Oh, I was just going to say, I think if we can, the more that we continue to do, and this has been, I’ve seen a massive change in this just from people connecting with other folks that are postpartum as well and support groups, destigmatizing that PT or OT postpartum is just if you have quote symptoms. And that also is changing, I think, in the residency programs, at least some of the folks that I’ve talked to, they’re learning more about it. Some of them have gone through PT OT postpartum as well. So it’s definitely a grassroots effort for sure. I think social media. It’s been helpful for that as well. And maybe we’ll catch up to France someday.
15:27 Dr. Ginger Garner: I know, they do so many things right. And one of them is actually postpartum care. You mentioned biopsychosocial and for our listener, biopsychosocial is just a whole person way of looking at you. It’s not just, oh, you’re postpartum, you had a baby or oh, you’re menopausal or you’re post prostatectomy or whatever it is. It’s a whole way of looking at you. Your biological needs, your psychological needs, and your social, spiritual, you know, relational needs. And so one of the things about this whole biopsychosocial approach that’s important, and is what is going to take us into our next segment, is the fact that people come in, and we were talking about postpartum, so we’ll stick with postpartum for a second.
People come in with these postpartum needs, and they usually, it’s been a circuitous route, particularly in North Carolina and the Deep South. They’ve had to jump through hoops. They’ve been gaslit. They’ve been told they didn’t need it. They’ve been questioned by their partner, maybe. They don’t have support. I have moms all the time bringing their babies in, which as a mom of three, I will take baby fix any day. Cuddling them up because my teenagers, yeah, because my teenagers, right?
[Yeah. Say no more. Yeah.]So these moms come in and oftentimes, you know, it’s birth can be a traumatic process, even if it is beautiful at the same time. I think Glennon Doyle calls it like life is brutiful. It’s brutal and it’s beautiful. And so I like the way she describes that. So even if the birth went well, right, and oftentimes they don’t because of the medicalization and so much happening, I think it’s important to note that moms, in addition to whatever support they have at home, the identity change, all of a sudden self-care while they’re trying to keep a new small human alive, they might be coming in to us with trauma from inside the system, like they’ve been traumatized by the system.
And so that’s a big, oh, I always try to be really sensitive to that. And for those of you guys listening, find a practitioner who’s doing that for you, that’s asking you, you know, how was your birth? Did you feel listened to? Do you have support at home? Do you feel safe at home? Do you feel safe talking to your practitioner about your needs? Do you feel heard, right? And then providing that safe space is, it’s, that’s kind of the biopsychosocial, you know, magic of care.
Which kind of leads us to like why you and I have both been using yoga for forever and ever. Yeah, forever and ever and ever. So that was my next question, is what was your transition into yoga because I think everybody knows by now like yoga is good for you. You don’t have to argue about it. There’s been enough books and papers written on it. And even if a book and a paper had never been written, just go feel it. You feel better, you know? So how did you drop into that space?
18:56 Dustienne Miller: Yeah. The yoga space. The yoga space, yes. I first started using yoga as a way to warm up my body before shows. and also as just another mobility thing for flexibility for dancing. And I went to Kripalu and I got trained there and I loved it there. And that’s where I really learned how to meditate deeper. And that became a very pivotal experience for me having then started to develop panic attacks in my 20s. I was able to then have a strategy of calming my nervous system down after the wave of the panic attack. Because I don’t know about you. Yeah, yeah, I like to sit and breathe during a panic attack is not a strategy that will work for me because it will just amplify the feedback I’m getting in my system. And then I will start to go into the place of diagnosing all the things that could be happening to me, from a cardiovascular perspective that are not happening.
So closing that loop of that, of that panic moment has been incredibly helpful. To the point where in my 20s, I went to the ER twice. And I have not had any problems. And thankfully haven’t needed any medication to navigate that time. It honestly feels like a very distant memory. Thank goodness. I’m sure as I’m perimenopausal now, that’s going to present in different ways. And I hopefully have the strategies now of noticing my nervous system when she ramps into the sympathetic override, working with it and having enough self-care laid out foundationally to navigate when things start to go haywire.
So all that to say that was my interest initially was from a musculoskeletal perspective. And then it morphed into the nervous system, spiritual perspective. And then it worked into because I wasn’t doing PT during that time when I was performing. And then when I turned 30, which is when I got back into physical therapy, and then I started integrating it into the pelvic health world because it just so beautifully meshes in there. When you’re working with vaginal pain or testicular pain or rectal pain, and there’s this compressive quality of the pelvic floor, and that’s maybe part of the pain driver, I think it’s so helpful to work with the idea of softening, the idea of warmth and loosening versus going after trigger points you know, that can work, but there’s another way that helps support the nervous system even more.
22:01 Dr. Ginger Garner: Yeah, it is what I always have felt like kind of yoga among other systems of medicine are indigenous to their particular regions of the world and to people and they were developed over centuries of time where it was experiential. You try something and it works or it doesn’t work and then it begins to work for hundreds and thousands and hundreds of thousands and millions of people. And so I think about the modality of yoga as not just being a modality, but being a way of breathing and living and moving through the world.
And so when you described dry needling, like a trigger point, you know, a tender point could work. It’s kind of the same thing as, yeah, you could like, point you could stick something, you know, you could take a pill or you could do a quick fix for something, but you still have to come back to the experiential point of changing your mindset. That does change our muscles, it does change the endocrine function, which means the hormonal function that our muscles and our body can have because every time we move, it’s an action in decreasing inflammation, or how we think increases, you know, inflammation, including, you know, what we eat.
So I try to, you know, look at it like that and explain it to people like that, too, you know, who may think, ah, yoga is just a bunch of breathing and movement. I already do Pilates, right? I already do. You know, I already run. I get my mind shift in my adrenaline high. But there is something very specific about yoga. As I kind of sometimes think of it as a kind of original system of lifestyle medicine.
23:55 Dustienne Miller: You know? Oh, yeah, for sure. Yeah.
23:58 Dr. Ginger Garner: So what are some of your favorite go to yoga? You know, I, I don’t want to say intervention. That sounds so clinical, antiseptic, and dry and boring. It’s like, okay, let’s talk about yoga. What do we like to do? What do you like to do for some of the most classic things that people come in with?
Cause I think that there’s still a misconception that, you know, going to a pelvic floor PT means they’re going to hand you a sheet of strengthening exercises and stretch your hamstrings and send you out the door with a pad on your back. And that’s so not it, because pain is so layered and complex. So what, so that means instead of working on what we call uptraining, right, and PT of strengthening and getting stronger, which is great, we want to do that. But a lot of times we need to address the trauma or the pain or whatever is keeping things uncentered, sideways, off balance, not feeling good. So what are some of the things that you like to do when people come in and they, and you know, they’ve, they’ve lost that center?
25:07 Dustienne Miller: Yeah. I think it looks different for, obviously it looks different for everyone, but when I think about this question, I think about how, if you were observing my, this is my practice. If you were here today with me and you were taking notes and you were to say what here was influenced by Dustienne’s yoga background and what was influenced by physical therapy school, I think it might look potentially different to people newer to yoga or brand new to yoga than it would to you. And this is kind of where my brain is going.
I think that one might think, oh, she’s doing a lot of fun salutations in her treatments. She’s doing, I have to come wearing, back in the day, unitards. Now I have to come in in yoga pants. I have to be a vegetarian. But how it might show up in my clinic is, how is the person, when they take a breath, how are they breathing? And this is also in the traditional physical therapy model. Are they getting a lateral ribcage expansion? Is one side staying stuck out or stuck in? But instead of me just noticing that, I’m asking the patient, if you feel comfortable, would you mind putting your hands on your body?
Helping them develop more interoception, proprioception, mindfulness. Because the more mindfulness they can reflect during the session and audibly speak out, I think the more empowerment they will have over their system and more self efficacy to then have the confidence that they can change their patterns that they can change if there’s a lot of muscular holding pattern. So I think mindfulness is a huge piece, especially when I’m working with people that are doing dilator training. Can we use the dilator as a biofeedback tool? Can you imagine softening around the dilator? What does it feel like? What are you noticing? And then maybe cueing back into the breath.
If we’re looking at a three-part breath for the folks on the call that are yoga practitioners looking at the Dhirga breath, I may not cue a traditional Dhirga breath if they’re already upper lung dominant breathing from the collarbone anyway. So it becomes a customized pranayama, for example. If I notice, oh, this person has a lot of neural tension, so maybe they have a lot of tightness down the back of the leg, maybe they have some sciatica, maybe I would be working in doing a rock back from all fours with softening breath, imagining the sit bones widening to create more space for the pelvic floor as they’re coming back, and then integrating movement with breath. And notice, does it feel different when you inhale on the way back? Does it feel different when you exhale on the way back?
And then grading that, so if we’re thinking of graded exposure being one of our methodologies, I guess, for lack of a better word, then we grade that up into maybe a sciatic nerve glide, and then maybe that goes into a downward facing dog. So it will be part of a home program that’s specific to that person, if the person is interested in looking at that lens. And usually they are, if they’ve come here, they usually are interested in that. And also I think it’s just such, in our culture now, mindfulness is so commonly practiced as well, that it’s not super foreign to my patient population, which is very different than other folks, I’m sure, around the country and the world.
29:10 Dr. Ginger Garner: Yeah. So let’s back it up for just a second. You started out with describing dilators. So, and then you went into Dhirga Pranayama, which we know as three-part breathing. Three-part breathing is where you start and you inhale kind of, and it depends. Some people start in the belly. I like to start it in the pelvis, inhale into the pelvis and into the belly. And then I, because of the altered breathing patterns that people often come in with. I don’t do the top part of the third breath and I keep it down here in the rib cage. So that’s three part breath, which you can easily find videos of online.
I know we both have videos of those, probably. I know I do on my YouTube channel. But let’s back that up. So let’s just say they came in with, and they needed use of dilators. What are some populations that would actually benefit from use of those dilators? And then let’s describe what that feels and looks like for their breathing before they may then go into something like a child’s pose.
30:21 Dustienne Miller: Sure. Great. So let’s kind of, let’s think about our postpartum population since we started talking about those folks. Yeah. So some people may have been told throughout their pregnancy, you should do Kegels, do a lot of Kegels. So you don’t have issues postpartum. And maybe they had more holding patterns, even prior to their pregnancy, for multiple reasons could be pelvic pain, endometriosis, constipation, bladder pain, hip dysfunction, back dysfunction, etc. trauma. Yeah, trauma. Yeah, 100% 100%.
And we know it can be all sorts of scary, physical, sexual, mental abuse, trauma, And it could be medical trauma from not, you know, being able to speak up and say, Hey, what do you think about I heard about pelvic PT, and then it’s, oh, you don’t you don’t really need that. That’s like a little “t” trauma that you had the courage to speak up. And then someone said, No, that’s not a good idea. So if there is any pelvic floor tightness, because the pelvic floor muscles are going from outside to inside, very often we can help get more comfort and more range of motion in the muscles, especially if we’re trying to do any sort of penetrative activity with a dilator for circumference.
And it’s, I don’t think of it as much as of stretching the tissue as much as offering the brain some feedback around how to soften around the dilator. So we know that with manual therapy, it’s the pressure, vibration, heat on the mechanoreceptors that create that change in the fascial system. So that’s why in my practice, I have had a lot of luck working with the mindfulness piece around if you’re going to use a dilator, notice what it feels like to put it right at the vaginal opening. Do you find that your pelvic floor is going into a kegel?
Great, good noticing. Is there another option? Can you soften and come back to that baseline? And then can you imagine, I have a little model here for the folks that are on video. Here is them.
32:42 Dr. Ginger Garner: I love that model. Mine’s falling apart, I need to order another one.
32:47 Dustienne Miller: Yes, it’s from Marie-Josie Faget up in Canada. So, sit bones are here. We can imagine that as you’re inhaling, that your sit bones are broadening and that the tailbone is reaching away from the pubic bone as you inhale. And I think that’s really helpful to have these bony landmarks in mind because the pelvic floor can be such this ethereal thing that we don’t see on a regular basis. Unlike the shoulder, if my upper trap is up and my shoulder’s up, I know it because I can see it in the mirror. It’s there. I can let that go. So having bony landmarks to palpate yourself can be helpful. And then we could use that with the dilators. We could use that if we’re thinking about softening in child’s pose, you could reach around, palpate where the sit bone is, where the pubic bone is, where the tailbone is, and then where that diamond shape of the pelvic floor muscles are, and then imagine softening with the breath to help create a new motor pattern of not holding.
And I’ve seen this in runners who maybe they don’t have vaginal pain or any pain with vaginal penetration, but maybe the obturator internus high up in the pelvic is tight and they may need to use the wand a little bit once a week just to kind of maintain a happy pelvis. We’re able to get the muscles released from the inside, just like we’re able to release them on the outside.
34:22 Dr. Ginger Garner: Yeah. And for those of you, curious about that. I hope that that explanation helped because you can already see that Dustienne mentioned the one little muscle called the obturator internus. It’s kind of a home wrecker for the pelvic floor and can be rightfully blamed for a lot of things. And it’s actually a hip muscle. So you can already see there’s this broad overlap between if you’ve had a hip scope or a hip replacement, or maybe you just had knee pain, it can track up, it can be internal, it can be associated with the hip that impacts the pelvic floor. So when you, even if you have an orthopedic injury and you’re not postpartum, or if you’re postpartum and you didn’t tear, you can still have these issues crop up that are really, there’s an intersectionality of them that almost requires that at some point in your life, you’re going to need pelvic PT or OT of some sort.
35:24 Dustienne Miller: Yeah. You have a foot injury and you start walking a different way for two months. And then once the foot hits the ground, all those forces go right up into the pelvis and above. We’re all connected. Yeah.
35:40 Dr. Ginger Garner: So when you come into something like child’s pose, you know, in yoga that Dustienne mentioned, and you’re using maybe a yoga breathing technique, I think we probably start with our basic gold standard, you know, diaphragmatic breath, get the ribcage moving, get the pelvic floor stretching. And then you might progress into something that looks like child’s pose or looks like a variation of downward facing dog. That is accomplishing so much at one time.
I really think of using yoga as a very efficient way of doing usually six or seven things at one time for relaxing, releasing, resetting, being curious about movement, decreasing fear of movement. I mean, the list of benefits go on and on, not to mention What you talked about in the beginning of, you know, in your own story of it re centering us in a way that calms the nervous system, much like if an infant is feeling a little sideways and is upset, we can swaddle them or bring their arms to midline. It’s just like a hug, like a long 20 second hug. It doesn’t matter if you’re a neonate, if you were just born yesterday, or you’re an adult. We all need that nervous system reset.
37:05 Dustienne Miller: It’s amazing how quickly, if you come into childhood, my preferred way is for my body, everyone’s different, is to stack my fist and put my forehead on my fist. And if your body doesn’t allow your, if your knees don’t allow you to do that, you can also do this over a chair with a bolster. There’s a lot of ways to make these postures work beautifully for you. But if you really close your eyes and then soften and take five breaths, you can feel this down regulation so fast in the, I know you know this Ginger. I’m just like reminding myself because it’s how many times I can’t tell you where I get to the end of the day and I think I haven’t done a yoga posture today. I haven’t stopped to meditate because I found that email more important in the moment. And it’s like these are such valuable, easy, free strategies that I think they just end up getting pushed to the back burner because you’re putting out other fires.
And I know for what I try to do here is whenever I wash my hands between patients, I try to notice the water, I try to feel my feet on the ground, I try to just be in my body. And it’s fascinating how quickly technology can take us out. So If anyone on the call is like, I hear you know that it’s I am definitely, you know, not practicing 100% the way that I like to be because I’m a human being and you’re not alone. Don’t feel ashamed if you fall off the wagon because it’s normal human nature.
38:44 Dr. Ginger Garner: The beautiful thing, though, is as because we all know about that negative self-talk, that self-destructive self-talk. As soon as you notice it, you’re already mindful.
39:10 Dustienne Miller: Yes, yes. And you can say, oh, thank you so much for letting me know. OK, I can let that float away like a cloud.
39:18 Dr. Ginger Garner: Yeah, yeah. So when you notice it, instead of like, moving into the typical realm, because I’ve done it, the typical realm of, oh, you didn’t do your 10 minutes of yoga or whatever a day. Instead of then moving into the continuing to beat myself up phase. Yeah, I stopped there and go, you noticed it. That is mindfulness. Full stop. Yes. I wonder what my next thought will be now. Yeah. Move on from there.
39:48 Dustienne Miller: And you avoid that second arrow of shame. Yes, great.
39:53 Dr. Ginger Garner: Yeah, yeah, yeah. And the other thing is, and this is very steeped in yoga philosophy. And the kleshas, you can look those up if you’re interested in learning more about them. But it’s very steeped in yoga philosophy, because it tells us that we don’t ever, like perfect anything. We don’t lose our, you know, ability to lose our patience, we don’t lose our ability to sometimes be self-centered or whatever that is, it’s a continuum that we come back to and then ask ourselves, I wonder what our next thought will be. I wonder what my next thought will be. Let me just take a long breath and come full circle again and realize, oh, I can respond better to myself or to someone else or in a situation.
And I think that’s the difference between going to a physical therapist who’s not integrative and is not using those techniques and one who is because it’s very psychologically informed. You know, we’re asking, we are asking you as, you know, if you are our patients who are listening, you know, if you are our clients who are listening, if you are someone we care about, right, and you’re listening, we would ask you those questions, right, to bring you back around. Because the other thing is we could design the coolest, most effective yoga program ever. But if you haven’t you know, if no one’s addressed how you’re going to do it, how you’re going to accomplish it, if you have the support system to do it, if you have the time to do it, the time, yep, then it’s ineffective, you know, right.
41:45 Dustienne Miller: Right. So I remember my, yeah, go ahead. My favorite, my number one favorite meditation teacher, Tara Brach, who’s just the coolest ever. She said when her kid was little, there would be days where she would collapse at the side of the bed, close her eyes, take a few breaths and say, okay, that was my practice for the day.
Because there are times when you just don’t have the bandwidth and the space and having the grace during those moments to be okay with that. That was a very beautiful offering, I think, to just to get out of that shame space of I should be doing, I should be doing more, I should be doing more, yeah.
42:28 Dr. Ginger Garner: I remember feeling the pressure of that when my kids were little and having to recalibrate everything I thought that I knew about yoga really in practice as one came along, then two, then three. And I had a less gracious response than Tara did. I remember finishing my practice. I actually got to practice, you know, it was, it was, it was strength based, but also very mindfulness. So I was sweaty, you know, and I was getting ready to do savasana. I’m like, I’ve got like five, 10 minutes for my kids, like all descend and that’s it. That’s no more. I’m like, dammit, we can swear by the way.
I said, dammit, I am recalibrating savasana. I’m not gonna lay here in that corpse pose for five or 10 minutes and then not take not get to take a shower tonight. Before the kids come in. I said, my savasana is going to be I’m taking a shower. I’m taking, you know, a bath. And I think I got in the bathtub that night and said that for 10 minutes, that’s my savasana.
43:36 Dustienne Miller: And mindfully, Yeah, that’s so beautiful. Yeah. What does my body need right now? What is going to support my body? Yeah, exactly. Yeah. And that idea of restorative wealth. Yeah, yeah, exactly. Why? Why put yourself through that?
43:52 Dr. Ginger Garner: Yeah. And and it was very practical too, because a lot of some of the, you know, a lot of the history, well, all of the histories of yoga, let’s just be real clear on that is patriarchal in nature. So we have subscribed to a system that was never evolved for women until we start breaking the rules and evolving it for women. And so I was still subscribing even then, like 20 years in at that time. This was over a decade ago. I’m still subscribing to that patriarchal, you must do it this way. And then you’ve got to do your, you know, savasana or whatever. At the end, I was like, that’s just BS, you know? Yeah.
44:29 Dustienne Miller: What do I need in this particular moment?
Dr. Ginger Garner: Yeah.
Dustienne Miller: Yeah. Yeah. Yeah.
44:37 Dr. Ginger Garner: All right, we could just keep on talking about that, but I think that was my next question, but I think we just did it. The next question was, are there any yoga myths that you’d like to break?
44:51 Dustienne Miller: Yeah, I think we kind of talked about that because kind of how one would expect if you come to PT with me, it’s going to be, you know, unless somebody is coming in specifically for a yoga home program, which I will do that. And I’ll collaborate with other PTs. I’m probably much like you, I’m very manual based, I’m looking head to toe, I’m looking at the neck, I’m looking at the jaw, looking at the feet, you know, so we’re not going to be doing, you know, the key to, to rehab is, in my opinion, is not just a yoga home program.
So But yeah, in terms of myths, I think that at least the way that I have grown my practice over the years has become more integrated into my day to day. Whereas in my 20s, I was doing, you know, 30 to 60 minutes a day. And that was great for me at the time. I’m in a different season of life. I like to integrate it when I’m with my patients. When I demonstrate, I demonstrate, I feel my body. I breathe while I demonstrate on my good days.
Yeah, if I’m not in my head too much, right, right. Yeah. And then there are the days, like I mentioned before, it’s like, how is it noon, and I haven’t done a downward facing dog, how is it five, and I haven’t stopped to do a 10 minute meditation at lunch. So there are those days that I, you know, I could have maybe had a different path that would involve more yoga. And there are days where I, my yoga practice for that day might be feeling my feet in mountain pose as I’m waiting in line at CVS or something.
I think it’s just about integrating your nervous system. I like to be, I like to notice trees. I like to notice beautiful architecture when I’m walking around the city. I like to take my earbuds out. I like to notice how I’m breathing and feeling. And so it’s really evolved to, I guess, more of a mindfulness practice with some asana and pranayama involved in a non-structured way.
46:55 Dr. Ginger Garner: You know, and that really speaks to two things. It is yoga being, because we’ve been talking about yoga being great for pelvic health specifically this whole time, but yoga is your self care too. For you as a person, if you’re going through pelvic pain, but also you as a practitioner. That’s what i absolutely love about it because i can integrate it into my day. When the kids were little, I’d do yoga with the kids and little tiny snatches of time. Now it’s in the clinic with patients in bits of time throughout the day. So that is a really good place, I think, to ask my last question. And that is, where can people find you on Instagram, on like your website, your resources? Because we can never have too many resources.
47:52 Dustienne Miller: Yes, yes. I will say I’ve been a bit negligent on the social media, but I do have some sites, Your Pace Yoga and Flourish Physical Therapy, both on Instagram, I’m on Facebook. I used to do Twitter, but I’m not really for many years.
My yoga videos, if anyone wants a home program, they’re about 20, 15 to 20 minutes, little nuggets that I developed for folks that maybe are looking to return to yoga or new to yoga and are maybe working with some vulvar pain or bladder pain. And those are all on my website, yourpaceyoga.com. And, um, Oh, I do have on Insight, on the Insight Meditation app, I have a sits bone meditation that I really like for folks who are, want to map around the sit bones to kind of notice what they’re, notice, bring more awareness into this body part, because awareness is the first step in terms of changing motor patterns. So that’s for free on Insight and you can even just like go on a browser to get to that.
49:03 Dr. Ginger Garner: There’s so much going on in that little area that you just pointed out.
Dustienne Miller: So much. Yeah.
Dr. Ginger Garner: Any awareness you can bring to that really changes your outcome for changing pain and stress too.
Dustienne Miller: Yeah. and spine and hip and beyond the pelvic floor. Yeah, it’s all connected.
49:23 Dr. Ginger Garner: So we will make sure all those resources are in the show notes for you guys. And my final question is, I would ask you, but I already know the answer to this.
What your favorite thing to do is like your fail safe chill pill, but y’all, we’ve been talking about it for a whole hour. So we know what our fail safe chill pill is. It’s yoga, but is there a favorite song or a book or something that’s like really resonating, you know, cause you know, with your musical theater backgrounds and everything, what’s doing these days?
49:56Dustienne Miller: I would throw out a shout out to restorative fish pose on a bolster, especially for folks that are on computers all day and or treating therapists. Something that comes to mind is the Julia Louis-Dreyfus podcast, where, I don’t know if you’ve heard that, where she interviews, it’s called Wiser Than Me, and she interviews all of these older women that are just nuggets of wisdom. That was phenomenal to listen to.
And I love PBS masterpiece shows. I’m super addicted to those. They’re really fun. And today at the conservatory, I’m teaching a combination to Transylvania Mania from Young Frankenstein, as we are in the Halloween vibe today. So that’s what I’ll be doing next.
50:46 Dr. Ginger Garner: Oh, fantastic. Yeah, I would love to be a fly on your wall.
50:51 Dustienne Miller: Oh my gosh, that would be so fun. And then you could bring all of your knowledge about the voice and pelvic floor to my students. They would, they would love that.
51:00 Dr. Ginger Garner: Yeah. Oh my gosh. Maybe we’ll get a chance to do that sometime. That’d be cool. I would love it. Thank you, Dustienne for being with us today and taking the time to be here. I appreciate it.
51:10 Dustienne Miller: Yeah. It was an honor for you to invite me and I really truly enjoyed our conversation. So thank you.
51:17 Dr. Ginger Garner: Me too. Yeah, a big old southern namaste. Thank you.
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