Pelvic Health and Hypopressives: Where Does Low Pressure Fitness Fit In?

October 10th, 2023

Want to try something new that may improve your pelvic health? Hypopressives, also known as Low Pressure Fitness, offers another dimension to pelvic health and overall wellness. This practice involves understanding and utilizing the concepts of breath, posture, and movement to create positive changes within the cavities of our bodies, particularly the intra-abdominal and intra-pelvic pressure.

Becky Keller, a pelvic physical therapist with over 20 years of experience, has been specializing in pelvic health for 14 years. In 2016, she discovered low pressure fitness and recognized its potential through it’s impact on her own health after a short weekend course.

The term “hypopressives” refers to the low-pressure nature of this approach. By understanding how the diaphragm works within our bodies and how it coordinates with other diaphragms, such as the pelvic diaphragm, you’ll begin to understand how pelvic health and hypopressives create a lovely partnership.

Low pressure fitness can bring about significant physiological changes that impact more than your pelvic floor, which is why Becky Keller also uses this to help people train in general wellness and fitness.

Are you intrigued by hypopressives and what they might be able to do for your pelvic health or overall health?

Give this podcast episode a listen or watch the YouTube video (link below).

You’ll walk away with many tips for your own personal health goals.

Watch The Interview: Pelvic Health and Hypopressives…

https://youtu.be/W5sK9k6PU00

About the Pelvic Health and Hypopressives Expert, Becky Keller

Becky Keller, PT, MSPT, PRPC is a physical therapist with over 20 years experience and has specialized in pelvic health physical therapy since 2009. She received the distinction of Pelvic Rehab Practitioner Certified in 2016. She currently sees pelvic health patients at Activcore Physical therapy and Performance in Princeton, NJ.

One of her passions is utilizing Low Pressure Fitness (LPF) hypopressives movement system for her pelvic health clients as well as for clients to improve their fitness and wellness. She has her LPF-certification, is a master coach for instructing the LPF professional courses to clinicians, fitness professionals and body work professionals throughout both the United States and International.

RESOURCES:

HR 2480 Congressional Bill Information – It takes 2 minutes to contact your congress member and ask them to cosponsor or simply support this bill. It will save moms’ lives and quality of life. Love your mom and take the 2 minutes, we thank you!
Additional information about Low Pressure Fitness and training opportunities can be found at Elevate Core Health
ActivCore – Becky Keller’s Information
IG Handles: @elevatecorehealth @lpf_usa @activcore.pelvic @drgingergarner

Podcast Transcript

00:00 Dr. Ginger Garner Welcome everyone. We are back again and I have a guest on that I’m very excited about for a bunch of reasons. One, the stuff she does, and if you can’t see me because you’re listening to the podcast, I’m doing my head thing. The stuff she does is incredible. It’s called low pressure fitness. Some of you may have heard of it. It’s called hypopressives. But if you haven’t, you got to listen to the whole thing.

So I want to jump right in and introduce my guest, Becky Keller. She is a pelvic PT. She has her master’s degree among other certifications, as well. It’s a list. So if you want to learn more, go to elevatecorehealth.com. But she has over 20 years of experience specializing in pelvic PT, since 2009. She currently sees pelvic health patients. So, she’s an active clinician, which I absolutely love. At Active Core Physical Therapy and Performance in Princeton, New Jersey, her passion is hypopressives, is the low pressure fitness kind of methodology or approach that she uses in pelvic health, for fitness, wellness, not just pelvic health alone. She has her certification. She’s a master coach. She teaches to PTs. So she’s like the therapist’s therapist. She does a lot of amazing things, not just in the U S but also internationally.

So welcome Becky.

01:30 Becky Keller: Thank you for having me Ginger.

01:32 Dr. Ginger Garner I am over the moon {singing}. Yeah. Okay. So we talked a little bit before and I know a little bit of her backstory, but I want you guys to hear it. So my very first question is Becky, tell me about, you know, your journey. Tell me about you first.

01:41 Becky Keller Okay. Yeah. So you’ve already kind of given a little intro. I mean, it’s a big part of me. I’ve been a physical therapist for about 20 years, I’ve been specializing in pelvic health for 14 years. And so it’s interesting because I know we’ve been both doing it for, for such a long time to see the evolution, to see how much has changed. I remember when I first started pelvic health so many years ago, talking to the doctors, talking to anybody that would listen to me and they’re like, you’re, do you do what? Like, what is that? Like, I can’t, I can’t picture how this works or what’s going on with that. So it has made such a huge evolution. Such huge changes in the healthcare landscape. And it really becoming more of a household name in many ways of understanding what pelvic health, physical therapy, pelvic health therapy could be and do for you. So I work with, with everyone. And again, I have been, you know, still treating and, and an active clinician for all this time.

Back in 2016 is when I basically got into hypopressives. And that is not a household name for many people. People have no idea what that is. The word literally means low pressure. And hypopressives to me are just a general generic term of how can we move? How can we breathe? How can we posture? How can we kind of go through life in a way that we’re mindful of changes within the cavities of our body? So changes with pressure, especially intra abdominal and intra pelvic. So I take a lot of these understanding and concepts and apply it into my day to day treatments with my clients, but have kind of really catapulted that beyond just pelvic health clients to be able to do general fitness and wellness with it as well.

So to me, it’s like, if you think about understanding how breath works and how the diaphragm works within our body and how it coordinates with the other diaphragms in our body, you can change so many physiologic aspects in one’s body. So it’s really amazing. So whether I’m helping improve someone’s just physical fitness, whether I’m helping improve their breathing mechanics, whether I’m helping improve their core strength, or maybe something more specific, I utilize the low pressure fitness.

Before I dive into my personal story with kind of how I got into this, I am a mom. So I have a 13 year old son, who talk about evolving. It’s kind of crazy how much they change from little kids to now, you know, going into eighth grade that I’m like, Oh my gosh, you’re growing up before my eyes. He’s almost six feet tall, just got his braces off the other day. So I was like, Oh, it’s amazing how much he’s changing and growing. But a great supportive husband who’s also a physical therapist too, as well just does something a little bit differently. I know. Yes, yes. Yes. So he also does sales. So he gives me a lot of the business aspect of things and a lot of help and support that way. I live in New Jersey love to travel, love to just explore new places, love the outdoors, love being outside and doing all that.

But let’s talk about my personal history with low pressure fitness, hypopressives. So back in 2016 was, I had heard about this, this course coming up. It was literally I had heard about it a week before the course was going to start. Normally, I vet courses out tremendously before I’m going to take them because they’re a lot of money, you want to invest in them, I want to see, hey, how is this going to help? But something told me, you know, just go ahead and take it. It was being hosted in New Jersey. So it wasn’t like I had to get on a plane and travel. So it’s like, let’s go for it.

So I went into the course very open minded and having no idea what this was about. I heard it would be helpful for people who had prolapse or, or people who had incontinence potentially. And going through that course weekend physically made such tremendous changes in my body.

Now, prior to that weekend, I was recovering from a hysterectomy. It was one that happened after a surgery I had previously. So I had a myomectomy, which means I had a fibroid removed from my uterus. One of the big reasons why was fertility issues, wanted a second child, and was having a hard time conceiving. And the doctors were like, this is your problem, go ahead and have the surgery to remove it. But it ended up being much more complicated than we thought. Thank God it wasn’t cancer. But there were some suspicions that things weren’t well, with the fibroid looked bad, looked very necrotic, had a hard time getting it out. And I ended up with adenomyosis.

And so that adenomyosis then progressed over the year to the point where I was now having a very hard time with lots of bleeding, bleeding for very long periods of time, becoming anemic at that point. And so I had to make a decision quickly about what was going to happen with the fate of my uterus. So I ended up having to have a full hysterectomy.

And I think it tied into the fact that it meant that I could no longer conceive, no longer have another child. It had a lot of psychological, emotional connections and ramifications with it. And so I think for many ways, I was carrying a lot of that around. And so I tried my best to recover just as anyone does. I fortunately knew a little bit, I knew because I was a PT, a pelvic PT, right? I was doing some breath work, I was doing scar work, I was trying to do the best I could with moving, but a lot of my nervous system was just revolting with me.

And I ended up having a significant amount of pain. I ended up having pain not in areas where I thought I would have pain. I had pain in my neck. I had pain just in parts of my spine and back because what my body was doing and what my brain was doing was trying to protect itself from what had happened, trying to kind of understand what had happened. And so my nervous system was on fight/flight. I was like tensing all the time. I was gripping tremendously.

And that created then a whole bunch of symptoms like pelvic pressure, a feeling like I had a prolapse, that heaviness, that dullness, that feeling of swelling.

My neck, as I said, my upper traps were up in my ears practically. I went to a chiropractor thinking, oh, something’s wrong with my alignment. I can’t stretch this out. I can’t relax it out. And there must be something driving this going on. And sure, what was driving it was honestly my nervous system, my faulty mechanics and breathing, the gripping that my body was doing, especially in the core and the abdominal area, trying to just compensate for what had happened with those two back-to-back surgeries.

So going into that first weekend of the low pressure where we broke it down to the fundamentals, we were breathing, we were posturing, we were elongating through the spinal column. We were putting our body and activating our whole body. But a lot of it was that abdominal vacuum technique of, this is the signature look that people see when the hypopressives, it’s also known as Uddiyata Bandha in yoga, but that vacuuming technique to stretch and mobilize all the fascia, the diaphragm. And I walked out of that course going like, oh my gosh, I’m breathing for the first time and God knows how long. I’m expanding my rib cage. I don’t feel that tension. My shoulders literally just felt like they dropped down and my neck grew an inch or two. And I was like, I feel amazing.

I remember emailing the people who taught the course and I’m like, this is phenomenal. I need to know more. I need to learn more. And I think that then catapulted me into this whole life change for me in the sense of how I’ve become so passionate about wanting to teach this, wanting to share this, wanting to give my experience, you know, to and let somebody else know that there can be so many ways that they can get help and they don’t have to feel this way, especially after having a significant surgery or major surgery like a hysterectomy.

And so then I got to meet Dr. Tamara Rael, who just again happened to, it was all fate kind of intervenes here, happened to move to the United States back in around 2017. I think I met her in 2018, happens to live about 20 minutes from where I currently live. So when I found out she was here, I was like, please, I need to learn more. I want to learn more. And so I was able to mentor, learn, become certified. And then I think naturally with the progression of where I was with my career and professionals, like I want to teach this. Again, I want to share this with everyone. And so I started back in the pandemic here. So 2020, right?

That’s when I started actually teaching for low pressure fitness and now teach it with a co-instructor in English, basically. So we’ll teach internationally. We’ll teach here. I’m teaching here in the U.S. I’m starting to, you know, get out and travel around the U.S. hosting courses for it. So yeah, that’s a little bit about how, you know, I think I feel from that standpoint of like, wow, this is what drives me to want to share this and do this with people.

11:45 Dr. Ginger Garner Yeah. Thank you for sharing your story. Becky, because first it’s hard to, you know, share a personal story that will be heard by, you know, untold number of people. And oftentimes, because when we get to share our personal stories, it’s in a one-on-one or a small group. So first of all, thank you for sharing your story. So many women share this kind of initial outcome that you describe, which I think is one of the reasons that I wanted to bring you on the podcast.

So again, thank you for being here and talk to you about your experience because there are no standards of care after abdominal surgery, after major abdominal surgery. So myomectomy, C-section, it could just be a scope.

I’ve had multiple abdominal scopes done and I needed significant care that I couldn’t physically deliver with my own hands. It’s an awkward reach. You can’t get down there to do the myofascial release or the pelvic floor work that you need to do. And I often tell people that, especially when I’m talking to colleagues, because we tend to beat ourselves up like we can fix it all on our own, you know?

But then I remind, you know, I tell this to my patients, I go, well, if I cut your hair for a living, could I cut the back of my hair? No. I have to have somebody go in and, you know, and cut my hair for me because I couldn’t do it, even if I am “an expert at it”. So I think there’s a couple of layers of this. It’s one, it’s us as practitioners who specialize in this area and have specialized for decades in this area going, oh no, we need help too. We’ve got to get help too.

And then B is we are patients as women in a healthcare system that will slice open your abdomen and then send you home because medically your blood pressure is fine, et cetera, but you have no quality of life. You’ve not been able to recover or rehab at all. And there are no protocols for it. So I think that if you’re out there and you’ve had an abdominal surgery, or even if it’s a small thing, like a scope, know that, you know, some of the treatment types, things that we’re going to talk about are very relevant to your recovery and that there is help out there. Even if you can’t access a pelvic PT, maybe you can access, maybe hypopressives are right for you. I know that I, you know, I do free consults. Lots of PTs do free consults. Becky, do you guys do a free phone call or answer emails like for people? [Yeah.]

So ask the question, just reach out, ask the question if you’re not sure if what we’re about to talk about is right for you. Because if you’ve had abdominal surgery, just like Becky’s experience, I’ve had some similar experiences that I just couldn’t have gotten better without that help. So don’t beat yourself up. There’s help out there. And, you know, with that in mind, let’s talk about what that help looks like.

14:45 Becky Keller: Yes, exactly.

14:48 Dr. Ginger Garner: I get fired up about this. So, and I know that, you know, based on your experience, too, Becky, you’re fired up about it. So you got certified and you’re teaching, you’re teaching, you know, therapists now. I’ve actually referred some patients to Becky up in Jersey because I have people travel all over to come and see me. I’m like, oh, you’re near Becky, go see her.

So what does it look like for someone to get started? Like, what would be an indication? Or in the medical world, we call them contra-indications, or what wouldn’t work, you know, with hypopressives? But what would be a good indication, too? So can we talk about that for a little bit?

15:23 Becky Keller Yeah. And I, it’s interesting, because I’ll often say, I think I could probably spin anybody can do hypopressives, anybody could do low pressure fitness, let’s put it that way. And why? Because low pressure fitness is a movement system. And so we’re always encouraging movement. It’s a postural breathing, fascial approach, in many ways to core strengthening. And so what we mean by fascia is all that connective tissue.

And sometimes that connective tissue can get scarred down from surgeries, it could get restricted, it has abilities to contract and relax, it has the ability where that brain could also get it to contract and become very stuck, tight, restricted, dehydrated in many ways. So there’s so many aspects. So I think, you know, when we look at low pressure fitness, like I say, hey, you know, anybody could do this.

So whether you choose that, like, you’re like, hey, I want to improve breath capacity, I want to improve my breathing mechanics, I want to improve my posture, I want to cross train a little bit, because I have a lot of people who are wanting to do heavy lifting, but they also are mechanically having a difficult time managing pressure, or they’re bearing down. And there’s ways that, you know, I can teach with the hypopressives that we can do before and after other exercises, running other other types of sport or physical activity with that pelvic health in that sense.

So I love using hypopressives or low pressure fitness for people who are recovering after surgery, who need to be able to increase circulation in their body, because we’re really targeting a big portion of the diaphragm in the sense of being able to stretch and mobilize the diaphragm, getting the diaphragm to efficiently move and contract and relax with our breathing, and that will pump and circulate so much out of the abdomen and/or pelvic region.

So when we get a lot of after surgeries, we often will have that sense of congestion, that sense of swelling that can happen. So it could be a great way to help with utilizing movement of the diaphragm to utilize the movement of the fluids within our body. For people who have pelvic issues too, as well.

17:56 Dr. Ginger Garner Oh, well, one of the things I was going to add to that is, you know, so if we’re working on basic, you know, breathing, when I’m doing imaging in the clinic and I’m actually imaging a hypopressive, I see all kinds of magnificent things happening. And so all, you know, if you’ve had abdominal surgery before, or really any surgery, think about the pain meds you’ll receive in surgery and the kind of the positioning that they’re putting you in, how many people actually just suffer from straight up constipation after surgery?

Oh, yeah. Like pretty much 100%, right? Everybody at home listening is going, oh, yeah, yeah, no about that. Nobody has time for that. And that is one of the ways in which I think hypopressives then can be safe, make health care safer. Imagine if everyone was doing some level of this work just to manage something like the sump pump of, you know, assisting with the congestion that you’re mentioning and addressing constipation and that kind of thing, getting things moving. Anyway, I just had to throw it in there because it’s a universal application for everybody.

18:56 Becky Keller Yeah. Yeah. And again, you know, constipation is the number one GI complaint in the US, right? I even have a course that I do or six week series that I do called hypopressives for constipation, you know, and so I love it for, again, there’s a number of different reasons why I think physiologically, it helps so much. I also tie in education to that because there’s a huge behavioral component with that. And then how can we understand, you know, a little bit more with fluid/fiber management, all that good stuff.

19:32 Dr. Ginger Garner. But, but yeah, so lifestyle medicine, you know, yes, she’s, Becky’s talking about lifestyle medicine because she just threw in like a bunch of pearls at one time. Talking about hydration and nutrition, your level of fiber, you know, how you’re carrying yourself through the day, all that is a broad spectrum description of essentially lifestyle medicine. Sorry to interrupt. I just got excited about that.

19:54 Becky Keller That’s awesome. Yeah. Yeah. And then when it comes to pelvic health, again, I use it for people who have everything from pelvic organ prolapse. So that’s the sensation that, you know, we kind of define it as that dropping down or descent of our pelvic organs. Sometimes one, sometimes three or four prolapses, everything from constipation to coordinating pelvic floor, coordinating with breath, the respiratory diaphragm, coordinating with the deep abdominal wall, the transverse abdominis.

Again, I have an ultrasound too, where I’ll look at it. And it’s amazing. It’s kind of magical how that happens. Sometimes it’s like it’s hard to explain to people until you see it. But being able to really use in many ways, the fascial connections of the organs to the diaphragm and being able to lift and pull up from that very almost inside out or that very internal standpoint, people who have urinary symptoms.

So a lot of times, it could be from a stress urinary incontinence where people are leaking urine with a cough, a sneeze, a laugh, an exertion of some point, a lift, basically that rise of intra abdominal pressure. I’ve also, it’s also worked really well with people who have urgent continence too, because I think there’s so many factors that can cause that urgency, that overactive bladder or that urge incontinence for people.

So I again, having had a bit of longevity, I mean, not nearly as much as the people who’ve developed the low pressure fitness, Tarama and Piti, but being able to have several years of practicing and just experimenting a bit, let’s try this, let’s see how it works. I’m really using it a lot for my male population too, as well. So some of my men coming to see me and younger men in their 20s and 30s and having a lot of chronic prostatitis type symptoms, having pelvic pain.

It’s even interesting, I think, again, I look at it from a circulation standpoint and just being able to circulate and get improved blood flow to that area and how the use of the breathing, the vacuum technique can help with that circulation. So I can go on, I feel like for so many patient examples where somebody could benefit from this and really this ends up being as people learn it and they become more proficient with the breathing component, the hypopressives breathing, the abdominal vacuum, learning the poses, it progresses just like yoga progresses, just like Pilates progresses, it progresses. And so this could be in many ways a lifestyle change.

This could be a fitness program that people can do. And I think that’s why I love it so much is you can really adapt it to, well, do I want to use it very clinically and break it down or use these components or am I doing it for the fitness and wellness aspect? And so when we teach and we do it, yes, I teach to a lot of PTs and pelvic PTs, but we also offer this to our fitness professionals too, as well, yoga and Pilates instructors. So I’m hoping one day it’ll be a common household name, hypopressives or low pressure fitness here in the United States. But we’re slowly making grounds and progress with that.

23:37 Dr. Ginger Garner Yeah. I think that the way the different populations that it’s beneficial for is really helpful and hopefully you guys caught on to all the ways that it can benefit you. Even without abdominal surgery or any active issue, it can totally be used for fitness. And coordinating the core and the pelvic floor is one thing that I’ve felt that I’ve seen patients really progress with that on.

And if I may add another population that I work with, which not everybody works with, so it’s not on a lot of pelvic PT radars, is in performing arts, in musical theater, in vocal students and instrumentalists and dance. That’s been very uplifting, no pun intended, to work with that population because music is such medicine. And the fact that either their vocalists are either moving to dance or back and forth in musical theater or just singing or playing their instruments is such a healing experience in itself. To be able to help those healers on their way is pretty incredible.

On the flip side of that, I’ve had people come in because of chronic vocal issues or maybe the way that they’re playing their instrument. And when I’m using imaging with them, I realize that the vocal diaphragm, as much as the respiratory diaphragm, is actually really negatively impacting the pelvic floor so that it could be hard for them to do any of the number of things that we’re asking them to do. Or they end up struggling with one end of the tube, as I call it, or the other. We’re just a pressure tube. So maybe it’s the pelvic floor, could be the respiratory diaphragm. It could actually be the top. It could be the laryngeal or vocal diaphragm. So I’ve just seen a range of benefits in using them, even if it’s something quite small, as in rib cage expansion.

For those of you trying to imagine what a hypopressive might be, one of the very first things would be, and Becky, you should be talking about this, not me, but as a square one for people, I want them to feel back rib expansion. Can they feel any expansion to their back ribs? And pretty much 100% of people that come in can’t move them at all.

Imagine a bucket handle lifting, and not speaking to Becky about this, but speaking to y’all about this, imagine a bucket handle lifting. That’s what you want to feel if you put your hands on your rib cage now and just inhale. But a lot of times it’s expansion through the belly, like over breathing into the belly, or flipping the front ribs out and really flaring those front ribs. So maybe you could take us through what kind of a feel, what that kind of ground level feel should be like for their breathing.

26:22 Becky Keller Yeah. And I’m glad you mentioned that, because I think everybody gravitates towards, well, I want to do this vacuum technique, right? And it’s hard to do the vacuum if you can’t move the rib cage. And so that’s it. So we spend a lot of time, and sometimes I need to spend sessions with people, like, yeah, we got to get some movement into the rib cage.

And I always say to people, think about this, where are your lungs actually in your body? Your lungs aren’t in your belly. You know, for the most part, your lungs are, you know, in that rib cage. So we should feel movement and expansion happening in this area. And so for our listeners, you know, basically, if even if you just take your hands, and sometimes I’ll just put flat palm to either side of the rib cage, sometimes I’ll do a seat position of my hands. And I know some people are just listening and can’t see, but imagine making a seat with your hands and just wrapping that around kind of the lower aspect of that rib cage. And so as we breathe in, we should feel that movement of the rib cage kind of encompassing almost 360 around us.

So that ability that we’ve got movement expanding into that lower rib cage, and even, you know, through your sternum and the space between the shoulder blades, there should be kind of movement going in that front back direction too, as well as our breathing starts to progress. Because again, you said we spend so much time sometimes just front loading and belly breathing right into just only that abdomen, or sometimes we’re just going right up into the shoulders a lot. And I think that’s what I was doing. And so it created immense neck tension and immense neck pain for me during my recovery after my rehab. So as much as I knew not to do that, my body was still making, I was still doing that. But anyway, so as we’re breathing, I think that 360.

28:15 Dr. Ginger Garner Yeah. Oh, hold that, hold that thought for one second. But you know what I call that? That our trauma posturing, like after surgery, after, because what do we want to do? We kind of fetal position things, which tightens everything down, the hip flexors, the abdominals, everything that we need to be long and move freely. And I feel like that’s what you’re about to go into is like that description of opening things back up. But I often describe that to patients as a trauma posture.

28:47 Becky Keller Yeah. And that’s exactly what was happening with me. It’s exactly. And then combined with, I was back at work very quickly after I had surgery. And so I’m bending over patients on top of it. So I was like completely just curling and flexing forward and missing that whole beautiful just expansion and elongation of my body. But back to our breathing.

So we do that 360 breathing, you know, that idea of sometimes I’ll use again, I like that bucket handle, like we’re again, as we inhale those ribs kind of lifting like buckets. As we inhale, we can think about almost like an accordion kind of a feeling. We’re breathing out into the sides of the rib cage expanding, even an umbrella opening going from a closed position to that 360. So lots of those images can really help when you’re doing it.

The other thing that I bring into most of my breath training work is the exhale to elongate. And I think that’s a huge component because oftentimes we want to take this breath in and then we want to, you know, we want to just dump it out. And so we teach it this idea of we’re going to elongate so that we’re not quickly closing our lower rib cage, but we’re having this sense of coordinating what’s actually helping us to exhale is some of our abdominals, right?

So we’re coordinating that elongation of the tube of the waist, the space between the ribs and the hips all the way around again, like a 360. So I love this, that practice of breathing through the nose for the inhale to the umbrella to the bucket handle, and then the exhale through the mouth to elongate and grow and taking almost that double time to exhale. So that’s a lot of the foundations of what we call the rest breathing.

So once you can master that, then you can go into the vacuum technique. And so for us, the vacuum is done at the end of an exhale. So we’re kind of in that time where the air has come out, we don’t force our air out. So we don’t like say, Oh, try to empty everything you possibly can and collapse down because we still want to maintain that height. We exhale the air and then we need to close the top.

So we think about: we close the nose, the mouth and the throat, which means we’re not letting airflow in. Then the magic happens with how we create that suction plunger or vacuum, we open the rib cage then. So again, if you don’t have that ability to open the rib cage, it can get very difficult to try to do this vacuum. Because people watch somebody do a vacuum and they’re like, oh, yeah, they’re just pulling in their belly. And that’s not how it’s done. Right. And so you’ll miss that excursion and that pull of the diaphragm into its lengthened stretched position. If you’re just trying to do it from your belly, right, Ginger? Yeah, I know you know how you do it. Yes.

31:49 Dr. Ginger Garner And that’s what when you mentioned the not forcing the exhale, I think that, you know, if I’m using imaging, when you’re using imaging, if you can get to someone that uses imaging, and you’re having a hard time with this, you it could be that that’s exactly what you’re doing is you’re forcing the exhale out so much. It’s kind of like, for me, what I see is the obliques or other structures, it can be all the way up here in the neck is kind of beating up on the pelvic floor and pushing everything down on the exhale with too much force. So you learn in hypopressives a really fluid, graceful, you know, effortless exhale that doesn’t beat up on the pelvic floor. And then you get this amazing vacuum that kind of puts things into place.

32:39 Becky Keller It does. It does.

32:41 Dr. Ginger Garner And you really see that on imaging when you’re doing it correctly. And that’s what my patients love to see. I’m sure yours do too, when they do one correctly and they see, oh, wow, that’s amazing, you know, excursion. And the other thing that’s lovely about hypopressives too is, you know, if you’re a person out there and exercise isn’t your favorite, that’s okay, because you don’t have to do endless repetitions and lots of tedious, boring things.

Hypopressives are, they’re named after Greek goddesses, right? Yes. And so they have these lovely positions and names. And I really dare anyone to get bored with the process, because you really don’t have to do tons of reps. And this is me speaking personally, too. I didn’t find that I needed to do endless numbers of repetitions for weeks and weeks and weeks. It tended to have a high payoff in a relatively short amount of time.

33:31 Becky Keller Yes. I love that you say that. Yes. Because that’s the thing, and even when we look at studies too. Because they’re just looking at the duration of where we start to see improvements in whatever they’re measuring for that particular study. It can be as short as eight to 10 weeks. As quick as anywhere from 20 minutes twice a week, believe it or not, they were showing in just some of the recent studies. It was just a study that was published at the end of last year. And it was like eight weeks of twice a week for 20-25 minute sessions, and made improvements in contractility of the pelvic floor outcome scores. So it was pretty, pretty amazing with that.

And so sometimes with me even, I will just do sometimes eight to 10 minutes, and that’s all I need. And it’s interesting because I have so many clients that say, wow, this is hard. This is harder than it looks. And they’re like, because you’re working your entire body with this, and it’s a very controlled, conscious breath work. And that can be very challenging for people.

And I love that you say it’s a very high payoff for a short period of time. And people ask me, what do I do a lot for exercise? Well, I mean, I left a little bit, but I’m not like in the gym all the time. But I’m committed to doing my low pressure fitness, pretty much at least four to five times a week. And sometimes as quick as 8 to 12 minutes, 8 to 15 minutes, because that’s all I got in the morning. So it can be nice. And that’s what’s really great about it.

But that the idea of that resisted breath work, the idea of the use of the vacuum, and then adding in the postures, and the postures become challenging too, because they become more dynamic as we learn more and can control our body position and space.

And yes, they’re named after goddesses. And so there is an empowerment with that. And that’s where I love when Dr. Tamara Rial had the creation with this is that idea of the psychology of the myth. And we’re a very, you know, we’re very biopsychosocial creatures, even as pelvic physical therapists, right? We’re always thinking about this mind-body connection.

And so I think there’s lots more research and understanding coming out about how emotions drive posture, posture drives emotions, how emotions can drive breathing, breathing can drive emotions. So how that interplay back and forth between the mind, the psychosocial emotional aspect of things, and how then the actual physical changes can be in the body or the somatic changes in the body. So it’s quite interesting.

So we have all these poses, and they’re named after goddesses, archetypes and personalities, to some degree, where your body position is in space, like think about Venus, right goddess of love, she’s an extrovert, she’s social butterfly. So we stand, she’s a standing pose with an expansive arm, right? So it’s in many ways that power posing that we know and just doing a couple cycles of breathing and posturing that way can just totally flip the light switch on your brain and be like, I got it, you know, I can I’m ready to conquer the world kind of thing.

37:05 Dr. Ginger Garner So I love that because you know, there are therapists, there are talk therapists, mental health, health therapists who focus on somatic experiencing. And that’s kind of what you’re describing is another form of somatic experiencing where we’re trying to interoceptively, it would be the the technical jargony word, but really, what we’re trying to do is just understand what we’re feeling in our body and see if we can shift the internal dialogue from a fixed mindset of, I can’t or I feel broken, or I’ve been medically gaslit, or I didn’t get the care that I needed, or I don’t have the support I need to, I am strong enough, you know, I can recover, I can do this.

And, you know, it’s challenging all of us to think about all of our movement becoming mindful, whether it is hypopressives. We think of typical things like Tai Chi or yoga, maybe less so Pilates, although it could be mind-body too. But I love the system of hypopressives, because it challenges you to be mind body centric. And that’s a wonderful thing for that kind of total mind body healing, that biopsychosocial approach that the evidence overwhelmingly, you know, tells us you must use that in order to get total healing for someone. So it’s a system that you should check out.

Where can we find you online? What’s the best way to find you online?

38:35 Becky Keller Elevate core health, Instagram, I’m on Instagram a lot. I am always trying to put things up.

38:45 Dr. Ginger Garner Definitely check out Becky on Instagram. Is that elevate core health on IG too?

38:50 Becky Keller Yes, elevate core health. Yep, elevate core health.com. I’m potentially going to be going through rebranding soon though. So and I will be low pressure fitness USA, I think is is where I’m heading to. And again, as I as I told you before, I am the LPF USA distributor here in the United States. So I help to teach and organize a lot of the courses and you know, we’re, we’re adding more courses, you know, each year so that we can start to train more and more professionals with it.

But I work with private clients at this point, too. I’m also at if anybody’s local or in this area of New Jersey, I’m in the Princeton, New Jersey area, I’m at activecore.com, which is where I treat my patients. But we have I have a whole team that works with me there. They’ve all been trained as well with low pressure fitness. So they’re all LPF certified. We actually Active Core has a location in Colorado, I just hosted a course back in June there. And so I taught a number of our providers out there too, as well. So, people can contact me as well. They need to find providers in their area that are LPF trained to be able to learn a little bit more about this awesome system.

40:12 Dr. Ginger Garner Fantastic. I’ll make sure that that goes into the show notes too. So whatever the updated links are, we’ll put those in the show notes. And I just wanted to finish up with a few rapid fire questions. Oh, surprise. They’re easy, though. What book are you reading right now?

40:31 Becky Keller: Body by Breath. Jill Miller. Okay, yeah, it’s not really an enjoyable, I mean, it’s not really a leisure book. I guess it’s a little bit more reading to learn.

Dr. Ginger Garner We are guilty of that all the time, picking up a book to learn instead of reading for just completely indulgent fun. But shout out to Jill Miller for that and her body by breath. Let’s see. What’s your favorite thing to do when you’re not fighting for the hypopressive cause?

40:57 Becky Keller My favorite thing to do is go on a hike.

41:06 Dr. Ginger Garner Oh, yes. Yes. I spent a whole month doing that on my sabbatical. All right, that definitely.

41: 30 Becky Keller I was in Utah. We were in Utah. Well, I was in June, Colorado in June, Utah in March. So I did Moab in arches and Canyonlands National Park there. So loved that. I love that part of the country. I grew up here in the East Coast. So it’s a very different look and feel than out there. And part of me is like, you know, I am a desert girl by heart a little bit. I still love my water, you know, with the ocean and all of that stuff being close, but love to be out in that area too. Maybe someday we’ll relocate there.

41:53 Dr. Ginger Garner It’s a stunning area. We spent our whole month there and I was surprised at how much I actually was enamored by the desert. So this might be the next question, maybe even easier, which is what’s your favorite thing to do? That’s like a failsafe, failsafe chill pill?

42:14 Becky Keller binge watch TV. Netflix or something. I don’t know. honest. Yeah. Just put something ridiculous on and I just chill out and watch it.

42:32 Dr. Ginger Garner Yeah. Yeah. I appreciate that answer. All right. Well, what are you watching now? That’s fun then.

42:40 Becky Keller Oh, I’m watching. I don’t know if it’s fun. I don’t know. I’m trying to get, get through some of it. I’m watching Domina right now, which was on the MGM. It’s, it’s a little bit about why I liked it a little bit about Roman Greek type of, yes, but a strong heroine in the story there who like, you know, behind every male leader is an amazing female driving, driving the decisions that are being made.

43:16 Dr. Ginger Garner Okay, I have to check that one out. I know it’s one more thing to add to the list. We have new books to add to the list. We have new Netflix series to add to the list. Thank you very much, Becky, for joining us today. It was a pleasure. It was a pleasure, Ginger. 42:27 Becky Keller Thank you for having me and huge fan of yours too.