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In many ways, self care has been oversold and poorly understood over the past decade. What if real self care was different? What if taking care of yourself was so much simpler than we are led to believe by social media?

We believe it is and this season is all about showing you what real self care is all about. We start it off in this episode with the N.A.P. meditation. More specifically, the “N” part of the N.A.P. mediation.

And no, we don’t mean sleeping while meditating. Although, let’s be honest, I’ve fallen asleep plenty of times when meditating!  In this case, “N” stands for neutral larynx.  It’s actually a focus on the position of your voice box.

In voice to pelvic floor therapy, this is the top of the 3 diaphragms within your body. So this is where we start today. If you want to learn the foundation of voice to pelvic floor therapy AND real self care in order to have a stronger voice, less pain, less stress, and a stronger core, then start here!

Watch the video below on YouTube, or listen wherever you subscribe to podcasts!

Real Self Care on YouTube

Resources

1. Brene Brown’s Living into our Values: https://brenebrown.com/resources/living-into-our-values/
2. Values Cards
3. N.A.P. Meditation Video
4. Dr. Richard Schwartz’s book: No Bad Parts

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Real Self Care Transcript

Hi everyone and welcome to the first episode of season one. I am really excited to be discussing with you a series of topics. We’re kicking off this first episode on self care because I’m pretty sure most of the world isn’t aware of this little connection called the voice to pelvic floor connection. So I wanted to start out this season by asking a simple question. How do you know if you’re pushing your voice or your core or your pelvic floor too hard? Here is how you tell. 

For those of you who don’t know me, my name is Ginger Garner. I am a doctor of physical therapy. I have been a PT for a very long time. And this is the third season of the Living Well podcast. I have been discussing ending medical gaslighting in pelvic health and women’s health. And I have over, gosh, we have over 40 some episodes right now under our belt. The team that is, since it’s a very, very team oriented. I couldn’t do it without the team. 

And I’m just really excited to be able to focus on talking directly to you this season about things you can do. Like immediate change, because isn’t that what we want? Immediate change in the way we manage stress, in the way that we view the world. Because we can’t control it. We can’t change the daily stressors that are going to be introduced to us on a regular basis, but we can change how we respond. 

And…one of the ways that we can do that, I think one of the most important ways, is to check in with our voice.

2:05 The Voice to Pelvic Floor Connection and the Significance of the Voice

If you don’t feel seen, if you don’t feel heard, often your voice is the first thing that tends to get smaller, quieter. Maybe you even physically lose your voice. And if you lose your voice on a regular basis, this is even more important. Or if you also have core health issues or pelvic health issues. 

But you don’t have to have all three in order to benefit from this understanding. So, first of all, I want to talk about what this season is about, and then I want to leave you with a little, I call it, we call them clinical pearls in the field, in the industry of physical therapy, particularly pelvic PT, we call them little clinical pearls. So I want to leave you with some practical pearls, okay, that you can use to improve your voice, reclaim that power, and at the same time, you may find that your core and pelvic strength improve at the same time. But also your stress response, which I think is the most important, and that all comes down to the vagus nerve. 

3:13 Defining Self-Care and the Role of Core Values

So first, let’s define self -care. Like, what is self -care? First of all, I think self -care, and I think lots of other people agree too, in and outside the healthcare field. (That means including the wellness field as well, and the mental health field.) We feel like wellness is something you do for yourself, it’s individual, and self -care as a result comes from, well, really, it should come from the inside. 

But how often are we told to buy this product or, you know, buy these yoga pants, buy this makeup? Buy this bubble bath, buy this $30 candle, whatever. How many times are we influenced in our culture and social media to do that? And that’s not really where wellness and self care comes from, right? So in my experience in therapy, in being a psychologically informed PT in my clinical practice, I define self care as something that comes that grows from the inside out and is driven by your core values. 

For example, one of my core values is curiosity. I heard a podcast recently that was, I believe it was We Can Do Hard Things, so it was Glennon Doyle and Abby Wambach and Sisters podcast. And they were talking about being able to say no, right? Being able to say no, that’s a part of healthcare, self-care healthcare. 

But the other thing that they were talking about is defining values. And someone said, well, a lot of people say, well, my family is important. I value my family, I value my children. And the next question would be, well, doesn’t everyone? So it’s not necessarily a value. A value is a verb. A value is something that your words and actions come together and align and do. 

And in the yoga realm, which is what we’re about to embark upon this season, is medical therapeutic yoga and integrative lifestyle medicine. What my two textbooks are based on. A lot of what we end up focusing on is the external. And then our values become external. I value my children. Okay, you’ll always value your children and everyone does, but what do you truly, what is your value associated with being a parent? Because as a parent of three and watching my oldest go off to college this year, I have lots of feelings, lots of big feelings that I’m working through.

Because my identity changes. I’m not, he won’t need me as much anymore and that is hard. But it doesn’t change my values, right? It doesn’t change my values. I value connection, right? So that makes more sense than saying I value my role as a parent, but then when your role as a primary caregiver is over, you never stop parenting, but you stop primary caregiving, right?

I will have seen if I step back, I feel and see that my primary value there was really, it was not the parenting, although I love, love it. It was the connection. It was being curious about my children and what they love, right? And being curious and learning together. So I want you to, as you go through this season with me, think about, there are so many values exercises online. Brene Brown has a good one.

There are so many. I have a box of cards called values cards and that is so much fun to go through with just yourself first and then maybe your family, your children, your partner, whomever that is afterwards. Figure out what your values are. Some people kind of push away from that but I encourage you that if you really want to embrace this season of self -care for you then you’ll determine what’s important to you. Because that’s how you work this into your everyday life. 

And that’s where your self care comes blossoming from the inside and not, you don’t feel that push and the pull from the outside. Of society telling you what you should value or what you should do, right? So keep exploring. You don’t have to determine what your values are today in order to listen to the rest of this podcast. But I think that, or I feel that we’re gonna start, try and stop saying, “think” so much.

I feel that.

If you are feeling burnout from your voice to your core to your pelvic floor in that mind -body connection, this will be the season for you to tune in and listen to what you can do to turn that around. Knowing that those stressors won’t stop, but how you handle them will change.

8:34 Eight Optional and Amazing Values from Dr. Richard Schwartz

One more thing on values and self compassion and self care before we go into the actual task at hand, which is how to know if you’re pushing your voice too hard, is one of the systems of mental health therapy that I value. It’s called internal family systems. If you haven’t heard of it, there’s a book. 

I think I can turn around and pull it right off my bookshelf behind me. This was entirely unplanned and unscripted, so if you’re watching, YouTube. I actually got this ring bound. It’s Dr. Richard Schwartz’s book, No Bad Parts. And that’s an incredibly powerful book. Sorry while I turn this around.

and put that book back on the shelf. If you’re listening to the podcast, take that moment to just take a deep breath and exhale and listen to the eight Cs of IFS. The eight Cs of IFS, which is one of the ways that you kickstart looking at the fact that we have all these feelings inside of us that are identified with different parts of us, but no, none of those parts are bad. So listen to these eight Cs.

Compassion, calmness, clarity, curiosity, confidence, connectedness. I say a big yes to that one, connectedness, creativity, and courage. Did those sound like values that you want to embody? Compassion, calmness, clarity, curiosity, confidence, connectedness, creativity, and courage. I would say if I could pick eight values, they would definitely be it. Right?

So maybe that resonates with you, because we’re going to talk a lot about resonation and frequency this season in order to change our vagal tone, improve our stress response, and dive deep into a more robust way of living.

10:46 How do you know if you’re straining your voice?

So, back to the question at hand. How do you know if you’re straining your voice? Well, this is what vocal fatigue looks like. And I’ll be honest, I’ve been experiencing it lately. There was a time in my life where it was worse, however, and that was when I was just beginning to appreciate the voice to pelvic floor connection. Now, the voice to pelvic floor connection in a nutshell. In a tiny, nerdy anatomy and physiology based nutshell. The voice is connected to the pelvic floor via the nerves, the vagus nerve, and also through neural structures. The nerve structure that I mentioned, and the vagus nerve, and fascial structures. 

So we have neural and fascial structures. What is fascia? In an overly simplistic explanation, it is kind of like a plastic wrap that is a continuous sheath in your body that kind of holds everything together. So, with your voice to pelvic floor being an important connection to your stress response and to your voice to pelvic floor health, which includes your core, vocal fatigue looks like this. 

• Frequent laryngitis
• Hoarseness
• A smaller range than usual if you’re a singer
• Inadequate breath support
• Breath holding
• Raising your volume to be heard.

These are all the things that I was doing when I said I had a problem with my voice a long time ago. Yep, I’ve had some vocal fatigue lately, but I’ve been doing all the good stuff that you’re supposed to do to handle that. And so that’s the thing I want to teach you and share with you is what I’ve lived and learned and studied and practiced and taught. And I teach now.

So way back when, those are the things that I was having. Laryngitis, hoarseness, it just felt like my voice was strained all the time. I was a jazz singer for about two decades and I just was struggling getting through gigs. I’d have several a week and it got so bad where I actually visited my ENT and they scoped me. 

And when they looked at my vocal cords, they looked great, which was wonderful. But it left me realizing that although I had no vocal nodules and any other things that could be going on in my voice, which is great to rule out, it still left me with the same problem, right? Which is oftentimes what happens when you get diagnostic testing, whether it’s for pelvic pain, gastrointestinal issues, back pain, vocal pain. Structurally, things look fine, and that’s what you want.

You don’t want any big catastrophic things happening. That would be surgical in nature. But then it’s a little scary because then you’re like, now what am I supposed to do? And that’s what I was feeling at that time. And that’s why I dove deep. And out of that, I created this little acronym and approach to practicing orthopedics and pelvic health. And that is called the Voice to Pelvic Floor Approach, or the V2PF approach.

14:12 Introducing the N.A.P. Meditation

And out of that was born a little acronym called the NAP. N-A-P. Like you’re sleeping. Like, nap. Literally. What the NAP means is it’s an approach, I call it the NAP meditation, and when I use the phrase with patients, I say, if you can’t nap while you’re doing your ab work, if you can’t nap while you’re driving, if you can’t nap while you’re, you know, eating, then you’re doing it wrong.

So what does that mean? It means that you need to have the N first, letter N as in Nancy. N as in Nancy, neutral larynx. And I’ll go ahead and tell you, I can’t say the word larynx. Half the time I want to say NYX and the other, it doesn’t matter. The problem is everybody has pronunciation issues from time to time. And I’ll just tell you that that is one of my nemesis words is larynx. 

So, if you’re listening and you say it a different way, bless you. You’re probably saying it right and I’m probably saying it wrong. But tomato, tomato, here we go. If your larynx is not in a neutral position, then you need to check some things. Now I’m going to show you how to do it. I will put the link in the show notes to the YouTube, okay, video of this if you’re not… if you’re just listening to the podcast. If you’re watching it on YouTube, hi!

15:43 Starting with a Neutral Larynx

Okay? What you want to do is, and I’m going to lift my chin, but I do not want you to do that when you’re actually practicing this. All right, I’m going to move my mic for a second. Lift my chin. Do you see where the chin creases?

Okay? So the chin crease, that point where the skin of the neck and the skin of the underside of the chin meet, that’s your chin crease, right? That’s where you want your hands to go, and you’re going to do a thumb and index finger like a C, right? Just make a little C with your thumb and your index finger. The rest of your fingers are all curled up. You make a little C shape, and you’re going to come into that spot at the crease of the chin.

When you bring your fingers around that area, now trauma, you know, trauma trigger here. If you’ve had trauma from physical abuse, this might feel invasive, right? Because your hand is on your throat. But it’s probably better if you do it than someone else. Which is why we’re very sensitive to the trauma that people and specifically women have experienced because of the high rates of domestic violence that women are victims of. 

And so if you’re feeling that, be easy, be gentle with yourself. You don’t have to jump into this straight away. And by the way, you know, this is not, we’re not doing physical therapy prescription or I’m, you know, I’m not your PT. These are just suggestions. This is what I do with patients. It’s totally up to you, you know, and at your own risk if you want to try it.

But this is all educational in nature so that you can learn more about your body. So if this makes you feel a little strange, then just go easy with it. Maybe listen to it the first time. So with that C grip, you’re going to see if anything feels tight or painful. Certainly nothing should be clicking, popping or point tender, but if you’ve had these issues, you’re probably gonna find something.

So when you do that, if you’re watching the YouTube video, I’m gonna move away from my mic for just a minute, watch what I’m doing. And for those of you listening, I am barely gliding my hyoid and thoracic cartilages, which is right where your fingers land when you’re in the chin crease, okay, or that neck crease, however you wanna identify it. And so that’s what you’re doing. You’re just barely gliding side to side.

And I’m showing everybody.

See how little of a movement that is? Very, very small. If that is painful clicking, that’s a great time to see a voice to pelvic floor literate or informed therapist. And I’ll tell you this, if the voice is strained or if this is tight, usually the voice is strained. And that means so is the pelvic floor. So in other words,

If the voice is strained because you felt this area, the hyoid and thyroid cartilages, which is where we are, chances are something’s happening in the pelvic floor. So if your vocal diaphragm then, which is where you were, is tight and rigid, again, so is your pelvic floor. If your voice is impaired, your stress and pain response are going to be altered.

That’s also known as the hypothalamic pituitary adrenal axis or HPA axis. We can also identify it loosely as the gut brain body connection or axis. So in other words, what all that fancy speak means is if your voice ain’t happy, ain’t nothing happy. You have to be able to claim the power of your voice to be truly healthy. So what I just taught you is part one of the NAP.

Notice we didn’t make a sound. We did not test the voice. All we did was see if A, and I’m going to teach you the rest of it now, swallow and you should feel that laryngeal area rise. It should be a silent swallow, right? So when you go side to side, silent swallow, pain -free, no clicking, no crunchy, or what we call crepitus sounds. So if you found any of that, that’s a really good time to reach out to us on YouTube, reach out at the website, reach out and leave us a comment.

We would certainly appreciate that and like to know how you’re doing. I do train therapists all over the world in the voice to pelvic floor connection or the V to P, V to PF approach. So if you feel like you need that, that’s what we’re here for is to help.

20:51 What’s Coming Next

So that’s part one. Part one of the nap is a neutral larynx. If it’s held too low or too high, you’re not going to be able to glide the cartilages side to side and the little hyoid bone without feeling some kind of strain. I hope this has been helpful for you. Now notice we didn’t make a noise at all. That will really come later. That’s what P stands for, is pitching. 

If you want to get ahead, and you like to be, you’re that kind of person that likes to jump ahead in the book and in the instructional, then you would try the same thing by going, “mmmm,” and just making a nice hum sound. It doesn’t have to be an intense sound. It can be light, breathy, airy. It doesn’t have to be a pretty sound. But if you’re actually adding some sound on top of that neutral larynx check and the voice quality changes, then you definitely are pushing your voice and likely your core and your pelvic floor too hard. 

So, nothing to be afraid of. It’s actually pretty simple to address and it really increases the longevity and the strength and the connection of your voice, core, and pelvic floor. Alright, listen up for episode two, which is going to be explaining the A, which is called apposition. And in the next episode, I’ll explain exactly what that is.