Hailee: Welcome to Grey Matters, the podcast for women who are done with the one size fits all health advice and ready for real, honest conversations about health, fitness, and feeling like themselves again. I'm your host, Hailey Pendle, not here with my co-host. She is away. I don't even know where she is, but I do have a very special guest on today. my guest is Dr. Kara Charette, a doctor of physical therapy, registered doctor. Yoga teacher and founder of Bodyful Physical Therapy and Wellness in Oakland, California. I love that name, by the way. Kara isn't your
Dr. Karah Charette, PT, DPT: Thank you.
Hailee: typical pelvic floor PT. She takes some somatic trauma-sensitive approach, which means she works with your nervous system, not against it, helping women with pelvic pain, pregnancy, postpartum, and pelvic changes that come with perimenopause. So welcome, Kara.
Dr. Karah Charette, PT, DPT: Thank you so much. Thanks for having me on.
Hailee: I am super, super stoked. I adore pelvic stuff and it's a little bit of a weird thing for me. Like I never thought I'd be so interested in this. so we can start out with like, where did your love for pelvic floor health come from? And just kind of your story of how you founded your physical therapy clinic and everything like that.
Dr. Karah Charette, PT, DPT: Sure. I'll try to do the short version because this could be like an eight to ten year story, you know, in terms of length. But to make it more concise, what I'll say is that, you know, when I went to PT school, I didn't even know pelvic health was a thing. It's actually still relatively new as a specialty, at least in the field of Western physical therapy. and I was just lucky that I went to a more progressive school in New York City where at the time we at least had an elective. the time called women's health. And you know, for me, I really appreciate that we do distinguish that there are things unique to people with vulvas and uteruses. and I do call it now more pelvic health because I treat all genders and all genitalia across the spectrum. but at the time it was called women's health and that definitely interested me because I've always kind of identified as an activist and someone who was interested in like Even going into the medical field, how do I get into more of an advocacy role? Or I don't know, something about women's health felt very grassroots, like, whoa, this is stigmatized. People aren't talking about it. And so when I got to school, it was a combo of having that elective as well as becoming friends with someone who actually knew that's what she wanted to do. And she definitely inspired me. And then also realizing that the pelvic floor wasn't as mysterious to me because I'm also a dancer, a Pilates instructor. This part of the body was talked about at least a little bit in some of my training. And I was very comfortable with it. So there was definitely like an interest starting there. And then I did a clinical rotation in Women's Health Pelvic Health. And to be honest, I could sit here and say, it's all about the client. And that's definitely true to an extent that like it really was the feeling of how rewarding it was to hold space for this part of the body that can be stigmatized. There can be shame, charge with it. And to be completely honest, I didn't have the language at the time. Now I realize I am a very highly sensitive person. And the context in which pelvic health is often done is behind closed doors in a treatment room where you're one-on-one. Whereas all my ortho training and PT prior was in a loud, chaotic gym, double booked, like just the type of energy where I was like, whoa, I don't think I can do this for the rest of my life. And when I got into my pelvic rotation and realized that the environment had to actually be more private and calm, I realized my nervous system could actually ground a little bit more. And so that even just starts off the journey of why I also value somatics and nervous system work. It's both clinical and personal. But I'd say that's really how I ended up being curious about pelvic health. And then my love and interest just grew from there.
Hailee: I love it. I love it. It's so interesting how we all kind of end up in the path that we end up maybe not anticipating that it was going to end up that way. just curious
Dr. Karah Charette, PT, DPT: Yes.
Hailee: and maybe some questions that the audience might have. What does like somatic mean? And also how do you apply it to your work?
Dr. Karah Charette, PT, DPT: Sure. Somatics is an interesting word because I feel like actually recently it's been, you know, blowing up. And of course, with that, there can be good, bad, neutral feelings about it. and I think my definition changes all the time. I mean inherently somatic soma of the body, but not just of the body. Like when you think of PT, yeah, all my training was in the body, but I would not claim my training was somatic because my experience of somatics is that it's the felt sense of. what's going on in that sensation of the body, of for me, like, yeah, the maybe the deeper sensations and also the beliefs, the stories, the images. so there's so much about, yeah, the personal experience of what movement can mean, what it can represent, how it can feel beyond just do your two sets of 10, which like works for some people. and so yeah, there's, you know, there's so much in the in the beautiful world of somatics, so many different modalities. I'm lucky enough to be training in a somatic movement modality called body-mind centering. And that work really informs how I show up in the treatment room. I would say for me, somatics is also like you gotta do your own personal work to be able to show up with it, right? I think with it blowing up, there's like weekend courses, like, get trained to be a somatic coach. And, you know, it's fine. But I think for me, it's like, how much have I actually met and worked with my own material when it comes to feeling my body, holding space for my emotions, holding space too, to name that I'm not a psychotherapist and I have so much respect for especially somatic psychotherapists. And I do stay within my scope. I always am referring to somatic therapists as well. But there's just a degree to which you cannot separate the mind-body connection when it comes to our experience in the body and definitely pain. And so I think how it shows up for me is first that I've had to do my work and continue to do my work. To be curious in my own experience of my body. And then it really shows up, I think, in how I hold space with my clients. And so I always kind of call this like the attunement game of, you know, really trying to feel into what is the container this person needs? And I'm not trying to read their mind. I'm very collaborative. I ask lots of questions. but I think it shows up in, you know, trying to create a container that feels relatively safe. I can't guarantee 100% safety. But trying to create a container with more safety, more curiosity, and frankly more agency. Because the other thing I love about somatics is I think one of the core principles is the value and the wisdom is in that person's body. And so even
Hailee: Mm-hmm.
Dr. Karah Charette, PT, DPT: though I have knowledge and I can be a guidepost, and I think there's value in that, traditional Western medicine will often say, I'm the provider, I tell you what you need. And for me, my somatics has totally flipped that, I think, for the positive, where You know, yes, I can help guide, but I really think that the answers are within the person. And frankly, the answers are within the process. So like people getting there in their own way. so yeah, there's probably a hundred other ways I could answer that question, but that's the way I feel called to right now.
Hailee: my gosh, that is so so true. And like I see that in my clientele as well of like everyone kind of wants a magic pill or they want you to give you them give them the answer and it's not it does never works like that, right? You can give them a
Dr. Karah Charette, PT, DPT: No.
Hailee: process, you can give them tools, but it's up to them to use them and have that self-discovery, which I think it's super important to then do the nervous system work with it. bringing it back to the first part of your answer, you were talking about like certain beliefs and stories that people tell themselves. What are some really common ones? Like, say someone is coming to you with pelvic plane pain, or they're during pregnancy and they're having some pain in terms of like their pelvic floor. What are some beliefs that they hold that are maybe keeping them stuck inside that pain? And
Dr. Karah Charette, PT, DPT: Mm.
Hailee: how would you work them through that?
Dr. Karah Charette, PT, DPT: I love that question. And there's such a diversity in what people can believe, but there are common themes. Certainly with pain and yeah, during pregnancy or pelvic pain, with or without pregnancy. What I see is a lot of fear. Beliefs that something, I mean, the most common one, because our culture teaches people this is if I have pain, something must be structurally wrong, or I must have tissue damage. And that can unlock a lot of fears depending on that person's relationship to their health, their relationship to their body. People will often have a fear of permanency, that there's like no going back. and also there can be underneath that a lot of undercurrents of shame, isolation, people thinking that they've done something wrong or that there's something uniquely wrong to their body, and especially because the pelvis is. Such a stigmatized part of the body, people aren't talking about it, which then feeds the isolation, which can feed shame. so I would say, yeah, fear, fear of permanency, fear of something being really wrong either structurally or with them as an individual is what I see come up a lot. And most of that isn't true. Right. So yeah. Yeah.
Hailee: Absolutely. Absolutely. And how would you go about like working someone through like obviously, like you mentioned, it's often shame, dismissed, or like
Dr. Karah Charette, PT, DPT: Yeah.
Hailee: people just kind of ignore it because of that stigma. So one, why do you think that is? And how do you work someone through that belief breaking in your own practice?
Dr. Karah Charette, PT, DPT: Yeah. Yeah. I mean, why why it's stigmatized? Like, how much time do you have? Our culture, Like, there's so much of why I believe our culture and the history of it has, you know, kind of shut down this part of the body, be it from the people who are who are traditionally have been learning and researching and teaching the body, I frankly have a belief that the pelvis is a is a major source of power and empowerment. So we can tie it into like, you know, trying to kind of shut down feminist ways of being, things like that, right? But to make it really simple as well, I mean, not so simple, but that this part of the body can really be shut down because of its connotations with sexuality. I mean, even bowel bladder health, right? It's either that it's associated with shame or Things our culture might label as like gross. We don't talk about that. so I think first and foremost, one of the things I've witnessed in the treatment room I do is just normalize, especially with like humor and love and acceptance of like, hey, like these are major things for survival. We've got to be able to not only regulate them, but talk about them. And I think my frankly embodied presence and comfort to be like, You know, so many clients are like TMI. And I'm like, there's no TMI in this room. We talk about everything, right?
Hailee: I say that too.
Dr. Karah Charette, PT, DPT: And it's like it really, it's amazing. So to just kind of have a container that shows like we can talk about this. It's it's normal, it's common. I've seen that be really helpful in healing. and then I think to answer your question a little further, I mean, something I also really identify with is Not trying to put myself in a binary, but I feel like there's a spectrum of like cerebral to somatic. And I feel like I span the whole binary of the whole spectrum in that I love meeting people with like really cerebral information. I think there's safety in that. So evidence, data, like this is common, not normal, right? So showing people you're not alone, giving them actual, you know, pain science and real research-backed ways that. It's probably not just pure structural or tissue damage and that the nervous system can be a part of it. It's not in your head, but there's a dynamic process here and we can work through that all the way to then like the somatic way in which I can hold space for when the emotions come up and also not needing to explain that or quicken it away, but just, you know, find safety maybe in the cerebral if people need that, but also be able to just ground and be a witness to when people maybe need to unload. the charge they've been holding in their body. So I hope that answers that question.
Hailee: Absolutely. I do have a further question on it because you used a term I haven't seen or heard before, pain science. Can
Dr. Karah Charette, PT, DPT: Mm-hmm.
Hailee: you outline kind of what that means? And I suppose how you use science with the somatics. I can imagine some people are like, somatics are like woo-woo. I want the real facts. And I think there's a a marrying of those two things. So if you can describe that
Dr. Karah Charette, PT, DPT: Totally,
Hailee: for us.
Dr. Karah Charette, PT, DPT: totally. yeah. And I want to hold space like I love the woo-woo and I have like so
Hailee: Yeah.
Dr. Karah Charette, PT, DPT: many research articles to be like, it can be both woo-woo and there's so much research. Honestly, also we know evidence is biased, what gets funded, what gets studied. Actually, not that we always need evidence to also validate things, but there's more and more research to support somatics. So anyone who wants that research, I can give it to them. But taking it back to your question around pain science. this is also kind of a developing field where there are probably now multiple definitions and approaches. I always like to take it back to frankly my first experience because it really stuck in PT school, which again, this course was in elective, blows my mind because I'm like, this is the foundation, I believe, of what I'm doing as a PT. we had a guest lecturer come in and he was quoting some work by Butler and Mosley, who are researchers in Australia. And they're not the only ones, but they were just the first ones that I learned of. And basically what they talk about with pain science is that our body has what are called nociceptors, no cception. And that is like our actual ability to pick up on thermal, mechanical, and chemical sensation to scan if something is past a threshold where it could be a quote unquote threat. But no cception is not pain. No cception in and of itself is just taking in that information. The way that pain actually gets decided is in our brain. And so I'm definitely jumping through some of the science here, but essentially that dance that it does in our brain is intermingling with our beliefs, our stories, our images. It's not just mechanical stimulus and that's what pain is. And so they have this really lovely story that I think sums it up pretty nicely when we talk about pain science and why our pain doesn't always equate to tissue damage. And the story they get give, of course, because they're Australians. So they talk about, and it may even be like a true story from one of the researchers, is that this dude is out in the outback and he's walking and he feels like a little prickle on his ankle, but he's in tall grass. So he doesn't really flinch. He's just like, that's kind of strange. I felt this little prickle. But then he looks down and he sees and hears a snake. So his brain registers the context of the sensation with a real threat. So then he drops to the ground in agonizing pain because his brain has now recognized, there's a threat here. So he he heals, he doesn't die, right? Luck, thank God. And then he's able to recover from that. Now he goes back into the outback and however many months later, and this time he feels that same brush from the grass, or you know, the the first associate kind of the pain that he thought he felt was the grass the first time. This time it genuinely is just the grass. There's no snake, but because his brain, our brains are prediction machines, has a memory and a story, that when I feel this sensation, and especially in this context, this is what happened last time, he drops to the ground in agonizing pain. But in that situation, the actual mechanical stimuli does not equate the same threat to his body. So I think that's a really nice anecdote of what I see all the time in the clinic, which is that someone may have had very real pain. From an injury or a one-time, like they bent over and it was just wrong time, wrong place, got that spasm in their back. Unlikely that it's actual damage to their spine, but had this real spasm, recover from it, but now their brain associates that movement with the spasm. And chances are the next time they go to do it, they feel that spasm again. Yes, there can be mechanical components, but a lot of times I see almost like a self-fulfilling prophecy.
Hailee: Mm-hmm.
Dr. Karah Charette, PT, DPT: Where people are anticipating, well, this is what usually hurts. I see this with pelvic pain, people with pain with sex. It's like, yes, there can be real tissue reasons. And if you have a story, every time I experience penetration, it hurts. There's a degree to which that neural pathway is now getting sensitized, and you're going to be either tensing in anticipation, creating the pain, or you actually can get real chemical changes with more pain receptors because your body's getting hyper-vigilant. So Again, it's like two things can be true. I'm not saying it's all in your head. I'm not saying it's all mechanical, but that's that's essentially what pain science means to me and how it started in my training.
Hailee: That's so interesting. And I completely resonate and agree with that too. in terms of like, cause as you know, a lot of my clientele are like hypothalamic ammonrhea. There's no period, so low estrogen levels, and they can complain a lot about pain during like intercourse or like the hormonal shifts throughout their cycles. so what is the correlation between like the mechanics, I suppose, like the actual factual of like. dryness, but then also maybe what might be that learned
Dr. Karah Charette, PT, DPT: Mm.
Hailee: part of it.
Dr. Karah Charette, PT, DPT: Mm-hmm. Yeah. I mean, this is where I think I'm going to speak up for my profession and in a lot of pride, which is I think PTs are really good at holding all the factors and learning with really good history taking, maybe when they're more able to attune to that person in front of them. And again, not reading minds, but hearing language, hearing beliefs, understanding how they might be thinking about their body. and then with a physical assessment, I think we're really good at taking in all the data. And a lot of times I have found it's not just one thing but multiple. But there are situations where one might be more the loud factor. So for someone with very real hormonal changes, that simply can't be ignored, right? We know that estrogen is vital to the pelvic floor for elasticity and decreased sensitization. And so if I see that in the history or that comes out in conversation. I would say that I assume that until proven otherwise is a component of it. Now, at the same time, I have the clients that use an estrogen cream or do the Dutch test, do blood test, their hormones are back on track, and then there's they plateau. Like they might get 50% better. And that's when it's like, okay, what other factors are going on here? I'm usually not treating just one factor unless it's overwhelming. Usually there's a little bit of education on like estrogen and hormones in addition to. beliefs, thoughts, nervous system regulation, and then real mechanical stuff too, of like why is the pelvic floor over recruiting not just with the nervous system, but maybe how you use your core or how you do or do not use your glutes. but I would say more often than not, hormones I would say can definitely be involved. But if I had to pick one, I'd say the nervous system, it doesn't matter what the driver is, that's always going to get involved because the real cause could definitely be a real infection, a hormonal deficit, a real injury, but the nervous system will always respond to that. So to me, that's a non-negotiable. I'm not gonna force ideas and beliefs onto people, but it's always in the room as a conversation point and as a a curiosity point.
Hailee: Absolutely. Absolutely.
Dr. Karah Charette, PT, DPT: Yeah.
Hailee: And for women who also like lift and are quite active, like what are your recommendations when someone 'cause I think this is very nuanced too of like people like engage your pelvic floor. Like what what does that mean? So for that,
Dr. Karah Charette, PT, DPT: Totally.
Hailee: yeah, how do you go about teaching people like how do you actually tangibly engage your pelvic floor?
Dr. Karah Charette, PT, DPT: Sure. So this is another one that I feel like could be kind of nuanced. And to be honest, I think there's a lot of rhetoric online that's saying one thing. But as I go deeper into my studies as a pelvic PT and stay up to date with the evidence, essentially what I feel like most people might traditionally say is engaging your pelvic floor means a key goal. And We can have a whole podcast on Kegels. Kegels, you know, they're fine. They're not great. They're usually not the answer for people. Kegel usually mean the feeling of stopping a stream of urine, or in fancy exercise science terms, a concentric contraction where muscles are shortening. I would say that most people actually, when they're having pelvic floor dysfunction, really need to learn how to relax and lengthen before even attempting the contraction. I'm not saying you can't ever do a kegel. But the reason I bring this up is because when people are going into exercise classes or weightlifting, you'll hear cued a lot engage your pelvic floor. And sometimes they won't, the instructor won't even explain beyond that. And that could mean so many things, right? Or they'll say lift up and draw the belly
Hailee: Thank you.
Dr. Karah Charette, PT, DPT: in. And what I want to plug is some work I've been studying. It's called dynamic neuromuscular stability, DNS. And this work actually came from studying babies. I think it's fascinating. It's all about core and intra-abdominal pressure management. And babies, unless they have like a motor deficit, actually do a very good job at managing their intra abdominal pressure. And
Hailee: Interesting.
Dr. Karah Charette, PT, DPT: essentially, this work, I'm really, you know, kind of boiling it down, but this work has really emphasized for me and taught me that, you know, treating the pelvic floor, we're thinking about the core. We can't really just think of it in isolation. It's a 3D container, respiratory diaphragm, pelvic floor, and transverse abdominis. Its job is to manage pressure. And so when we want to engage our pelvic floor, the way I teach the core work, especially for bracing, is through an eccentric model that a healthy canister that's going to resist pressure from the outside actually needs to push out, not suck in. you know, obviously there's nuance to that. And again, probably not going to be taught in detail on this podcast, but I just really want to emphasize that if someone out there listening is like, I do engage my pelvic floor, I do keegles and I still have leaking. Pain, discomfort. Part of the issue might be that that's not the best primary stabilization pattern for the pelvic floor in the context of bracing the core. We can do Kegels for other reasons, but the eccentric model I've seen much more effective because now we're engaging the pelvic floor but in a more lengthened position. It's a better shock absorber, it's less likely to get more irritated from the shortened fibers. So hopefully that makes sense. That's that's
Hailee: Interesting.
Dr. Karah Charette, PT, DPT: what I teach.
Hailee: Interesting. What how would you explain the lengthened version? So as like
Dr. Karah Charette, PT, DPT: Mm.
Hailee: the concentr or obviously it's like, okay, suck in or hold in a P,
Dr. Karah Charette, PT, DPT: Yeah.
Hailee: but how would you explain the feeling of of the lengthened version?
Dr. Karah Charette, PT, DPT: Yeah, I mean, this one is for me, I'm sure there are people out there that are like, we can boil it down and make it really easy. My experience with it is, and the way I feel like I was taught is that, you know, to get the lengthening, but with good intra-abdominal pressure management is that you really have to manage like three to four factors. And this is where it is helpful to like work with a PT who's trained in this and get the individualized cues for you because someone might hear, lengthen push out. And then what they'll often do is hold their breath. stick their belly down out and like bear down. And that's not what I'm teaching. So the factors that need to be considered when we think about lengthening is breath is number one. So unless you're doing like hardcore Olympic weightlifting where there might be a moment that you, you know, stop the glottis pressure from going down, there's time and place for that. But breath is really essential because we do want that container to have a little bit of like shock attenuation, like a suppleness. So it's not so rigid. so breath is number one. number two is directionality of pressure. So, this is what I screen in the clinic. If I'm telling someone to spread their pressure, first I actually look at their abdomen to see when they engage their core. Where are their dents and where are their hills? If you are doming somewhere, that means you're over pressurizing. And if you have a valley or a dent, that means you're under pressurizing. And so we try to figure out where are those points and can we spread the pressure to those dents. The reason I'm telling you all this is because it's not just lengthen your pelvic floor, you know, it's the whole system. It's like an air mattress. You have to work with it holistically. And so if I get them to spread their pressure in the right direction, then usually the pelvic floor kind of lengthens with it. So that's what's cool about this work too, is I don't, even though as a pelvic PT, internal work which I'm trained in can be very helpful to kind of see what's going on at the pelvic floor. If someone doesn't want to do internal work for any reason or they're even just learning online, teaching this core work we can just do through an external model and it will help the pelvic floor go into that eccentric place. But those are the components and the last one I'll say is spinal elongation because a major point of having good intraabdomal pressure management is to not compress the spine. And so It's another thing to screen for with this work is not flexing or compressing down when you're generating this pressure. So I don't know if I answered that question, maybe a little too complicated, but point being, there's a couple factors, and it's not so simple as draw your belly in or push your belly out, right? Which is probably why it's not being taught
Hailee: Mm-hmm, that's super interesting.
Dr. Karah Charette, PT, DPT: in a class because it is to me an individualized process. Once you get your cueing, it can be fast. But you kind of have to go through the journey to bring it back to the process to find out for yourself what are the cues your body needs to make sure you're doing this correctly.
Hailee: Absolutely. I totally agree with that too. interestingly enough, I was doing that in the gym this morning. I was noticing my like the middle part of my stomach domes, right? And so in that instance,
Dr. Karah Charette, PT, DPT: Yes, yes, said
Hailee: like I'm trying to bring that dome in rather than like push
Dr. Karah Charette, PT, DPT: Mm.
Hailee: it out or let it go out. And then so I think
Dr. Karah Charette, PT, DPT: Mm-hmm.
Hailee: like that was just a good exercise of what exactly you're explaining because in that instance it's
Dr. Karah Charette, PT, DPT: Yes.
Hailee: not just like me doing a Kegel, it's still gonna dome, right? It's it's more of a whole thing. so I
Dr. Karah Charette, PT, DPT: No. Yep. Yep. Yes.
Hailee: think that's very that's very interesting.
Dr. Karah Charette, PT, DPT: Yeah.
Hailee: and then two are I'm just gonna kind of go into the baby aspect. So someone who is maybe pre pregnancy wanting to do some pelvic floor work to strengthen, lengthen how do you usually go about that for
Dr. Karah Charette, PT, DPT: Hm.
Hailee: like the pregnancy aspect. Say they like leaking 'cause they like can't hold in their pee, so on and so forth.
Dr. Karah Charette, PT, DPT: Totally.
Hailee: how do you usually go about that?
Dr. Karah Charette, PT, DPT: Yeah, so the first thing I'll screen, really with anyone with leakage, but certainly during pregnancy, we know that as the baby's growing, as the core is lengthening, right? There's a degree to which muscles can be too long. And pregnancy
Hailee: Mm-hmm.
Dr. Karah Charette, PT, DPT: is an example of that when they're and it's not too long in a bad way. The belly is doing exactly what it should. It needs to expand for the baby to grow. But what that does is it makes engaging the core a little bit harder, right? It's harder to feel, and it's genuinely harder to get that full contraction. So, what I see very commonly during pregnancy is the pelvic floor works harder. And what we know is tight muscles are weak muscles. People want to put themselves in one category or another, but it's often both. And so leakage, where people will go and do a million kegels to try to fight that, a lot of times it's the relaxation I've seen make a big difference. I will, of course, teach this DNS approach to Core and pressure management. I always tell my pregnant folks if it's the first time learning it while they're pregnant, they're learning it on hard mode. It doesn't mean it's impossible, but proprioception is a little bit skewed during that time. But I will still teach them core bracing, glute engagement, right? These are things that help offload the pelvic floor, especially when done correctly with good coordination, good breath management. But in addition, if it's a person that's seeing me in person, they don't have any contraindications to internal work. typically I won't do internal work in the first trimester, but afterwards, as long as they're cleared. then we can actually also do like trigger point release and honestly pelvic mapping, like getting their brain through the internal work to feel their pelvic floor more clearly for both coordination and relaxation. And I've seen that really help with common pip complaints during pregnancy. So incontinence, pain, that could be internal pain or like pelvic girdle pain at the pubic symphysis, the SI joint. and then also, frankly, to me, it's birth prep. So even if someone doesn't have those complaints, it's still worth doing. So many people walking into my office when pregnant, it's the first time they've even heard of their pelvic floor muscles, let alone have them palpated. It's different than intercourse because we're we're tapping individual muscles in a therapeutic
Hailee: Mm-hmm.
Dr. Karah Charette, PT, DPT: container. And that has been so helpful for people because. I don't really want the first time you feel your pelvic floor to be when you're giving birth and there's all kinds of other stuff going on and now you're trying to figure out how to relax. Like we want to do almost exposure therapy and try to do that before all the chaos ensues. And so I've got a lot of clients where just that breathwork and going slow and mapping their pelvic floor alone really helped them be able to relax, because that's also the majority of what you need to do during birth. It's The uterus is doing all the pushing. The pelvic floor needs to relax and get out of the way. So we don't want you contracting because you've never learned how to relax and then potentially being more at risk for tears. that's a lot of what I do with my pregnancy folks. Yeah.
Hailee: That's so interesting. I freaking love the woman's body. I think it's so cool and so interesting. And
Dr. Karah Charette, PT, DPT: It's so cool.
Hailee: yeah, and I think there's like there's not a lot of information about it and people, you know, go especially pregnancy, they go into pregnancy thinking like, my my body is just made for this when it can be a lot less painful or a little bit more functional when you do get help like yourself with pelvic floor work and and things like that
Dr. Karah Charette, PT, DPT: Mm-hmm.
Hailee: as well. Cause I think like that lack of release. is something that a lot, a lot of people struggle with, especially if they're under
Dr. Karah Charette, PT, DPT: Yes.
Hailee: a lot of stress or chronic stress and things like that. And they're like, How do I do this? Right. Yeah, absolutely. I do have
Dr. Karah Charette, PT, DPT: Yes. Hmm Yes.
Hailee: one weird question for you. Not weird, but I was requested to ask you this, because it's very admirable of you and your thoughts on Botox and why
Dr. Karah Charette, PT, DPT: Mm.
Hailee: we don't why you don't do that and why you would
Dr. Karah Charette, PT, DPT: Mm.
Hailee: You just kind of let yourself be you, essentially. Yeah.
Dr. Karah Charette, PT, DPT: And are you talking about Botox like anywhere in the body? Because as a pelvic
Hailee: Yeah.
Dr. Karah Charette, PT, DPT: PT, I'm like Botox for the pelvic floor actually can be helpful if people can't relax their muscles. So it depends on the context, but you're talking more sure. Yeah. Hmm.
Hailee: Yeah, like yeah, just aesthetics, things like that. Yeah.
Dr. Karah Charette, PT, DPT: that's an interesting question. I mean, hmm. For me, I feel like there's probably a connection on a somatic layer as like. I think as I continue to do my own somatic work, really feel my body. I mean, for me, it's incredibly spiritual. Like I don't really have like a strong religious background, but to me, anatomy is spiritual. And so I guess the reason I'm saying this in response is that when I really feel my body, like I I will be honest, I don't really I've never thought about Botox that deeply. And so I hold space for like all the ways we can get influence in this culture. It's just not something that's come up for me a lot. But what I imagine is that when we're getting that messaging, it's coming again from a very certain lens that I will call the white supremacy patriarchy capitalism lens. And it's very much like a, it's very much a, I'm not trying to shame if someone wants Botox, by the way, too. So it's just like for me, my felt experience
Hailee: Yeah. This is a controversial.
Dr. Karah Charette, PT, DPT: is why is that messaging being taught to us and through what lens? That's the lens I feel like if it's brought up, it's because of this more purely. not felt place is what I'm trying to say, right? When I think about somatics, it's not about how something looks at all. It's about how something feels. And so this is gonna sound really corny, but when I really get deeply into my somatic practices and I feel my body, I can just feel how everything is exactly how it's supposed to be. I feel the divine wisdom of my cells. Like I just, to me, there isn't this strong urge This is years of doing this work. I'm not saying this happens to me in one meditation, right? but my experience in my body is that when I'm really pausing and really with it, there's nothing to pathologize or fix. so I think it's helped me really land in a deep acceptance while holding space that it's complicated. Relationships with bodies are complicated. So if you're listening and you're like, I don't resonate with that, I hold space for that. Our culture does not make it easy to feel that. So it just
Hailee: Yeah, absolutely. Absolutely. I agree. And
Dr. Karah Charette, PT, DPT: That's my experience. Yeah. Yeah.
Hailee: I think it's true for like body image and all of this. We always have that like little low hum not enoughness or trying to specifically
Dr. Karah Charette, PT, DPT: Yes.
Hailee: for women, like try and stay youthful. And the kind of
Dr. Karah Charette, PT, DPT: Mm.
Hailee: reframe I've had throughout the years is like what a blessing it is to grow old and have these expressive marks on your face because you've smiled so much and like
Dr. Karah Charette, PT, DPT: Hmm, beautiful.
Hailee: Why try and hide that or try and avoid what's inevitable? Right. Because just grow like
Dr. Karah Charette, PT, DPT: Mm.
Hailee: imagine I've had many people who unfortunately like pass away at like 19 and like
Dr. Karah Charette, PT, DPT: Mm.
Hailee: what what a tragedy that you did not get
Dr. Karah Charette, PT, DPT: Mm.
Hailee: the luxury of growing old and having wrinkles and having experiences and things
Dr. Karah Charette, PT, DPT: Yes.
Hailee: like that. So that's kind of the reframe I've had. throughout the years 'cause I'm
Dr. Karah Charette, PT, DPT: Hmm.
Hailee: exactly like you where I I have never had the urge to change it or try and avoid it in some capacity. 'Cause like what what's what'll be will be if I have to like squint my my eyebrows or whatever.
Dr. Karah Charette, PT, DPT: Right.
Hailee: I don't know. It's just gonna happen. I can't control it.
Dr. Karah Charette, PT, DPT: Totally. I love that. The privilege. Yes, the privilege
Hailee: Yeah.
Dr. Karah Charette, PT, DPT: of aging and the stories our bodies tell that comes with it. Yeah. Beautiful.
Hailee: Absolutely. Absolutely. And I obviously I haven't done this yet or gone through it, but I imagine this will be harder for me in the moment. But going through like pregnancy and having those stretch marks and how your body changed with that,
Dr. Karah Charette, PT, DPT: Mm.
Hailee: I try to reframe that with my clients as well of like how how much of a blessing it it is to have those marks on your body because now you have something to show for it. and it was It's not, it's just a body. That's all it is. And we're just gonna grow old
Dr. Karah Charette, PT, DPT: Yes.
Hailee: and like get wrinkly and no one cares about that. Like I think of my
Dr. Karah Charette, PT, DPT: Yes.
Hailee: grandma and like how different she looks from with the pictures I see of past version. I'm I've looked at it a lot because I'm actually wearing her wedding dress at my own wedding. So I've gone through a bunch
Dr. Karah Charette, PT, DPT: Mm.
Hailee: of her pictures and like how different she seems, and it's like I love her just as much. Like it's it
Dr. Karah Charette, PT, DPT: Yes.
Hailee: has nothing to do with looks.
Dr. Karah Charette, PT, DPT: huh.
Hailee: So yeah, I think it's it's a really beautiful thing to just kind of come to terms and accept that this is life and that is a beautiful thing and it's gonna go the way it goes and we don't have to try and avoid or shame or anything like that.
Dr. Karah Charette, PT, DPT: Yes. Hmm. That's beautiful. Thank you for sharing that. Hmm.
Hailee: Thank you. Yeah, of course. this is gonna conclude. did you have any other closing thoughts? firstly.
Dr. Karah Charette, PT, DPT: Hmm. any closing thoughts?
Hailee: Mm-hmm.
Dr. Karah Charette, PT, DPT: you know, I would just say, because I when I was looking over like questions you might ask me, I really appreciated your final question. Like if there was one thing someone could take away today. And to me, this is feels very much derivative of my studies with Body Mind Centering. Something I feel like I've learned in that work, and I think a lot of somatics explores this, is capacity to be in questions. So rather than end with like a fact of like, here's what you should know, I feel called to say, you know, invite a question in of what would it be like for people who are listening to just pause with your pelvic floor now or at some point in the next couple days with just a lens of pure curiosity, because it is so common to qu it's amazing. I feel this in my own body that I feel a part of my body and it immediately goes to a story, a judgment. or pathologizing.
Hailee: Mm-hmm.
Dr. Karah Charette, PT, DPT: And so I just would invite people to not trying to be too prescriptive, but just to like really, what is it like to land in pure curiosity of just being with the tissue if it feels safe? Because this may not be a part of the body that even feels safe to go there right now. But this could be any part of the body and to just witness it without this like immediate jump to labels and stories, that's just like a question I'd like to plop in.
Hailee: I love that question.
Dr. Karah Charette, PT, DPT: as an inquiry.
Hailee: And I think it's really important to just kind of because I think we look for ways to avoid being with ourselves a lot. And that can show up in
Dr. Karah Charette, PT, DPT: Yes.
Hailee: like for myself. It was like showed up in my eating disorder, binge eating, like obsession with like food and macros, and things like that. Right.
Dr. Karah Charette, PT, DPT: Mm-hmm.
Hailee: And we just don't give ourselves space or time to actually just like sit with ourselves and learn ourselves. Right. So I think that's a really important question to ask throughout
Dr. Karah Charette, PT, DPT: Yes.
Hailee: the Next few days. Fabulous. Thank you so much, Kara, for being on. I appreciate
Dr. Karah Charette, PT, DPT: Mm yes.
Hailee: you. I appreciate your time. Let us know where we can find you. If someone watching this maybe wanted to work with you, or anything like that. Social media, where can we where can we find you?
Dr. Karah Charette, PT, DPT: Yeah, thank you. Thank you for having me. And I would quickly say that if you're located in Oakland, East Bay Bay area and you want to work with me in person, probably going to my website, which is www.bodyful
Hailee: Shop.
Dr. Karah Charette, PT, DPT: physical therapy.com. It is a mouthful, or you can just Google my name and the word bodyful and it should come up. if you're in the state of California, I can do telehealth and still under a PT license. If you are out of California or out of the country, I could still work with you, but it would have to be clearly through like a somatic and coaching lens, which I think can still be very powerful, but just wouldn't be as like medically diagnostic as PT services and and not so much hands-on work. all of these modalities I think can be really good with the right person. and then I will just say too, if someone listening felt like really interested or called to like more somatic pieces, I think that shows up in my PT work all the time. but I also do offer more like This other work I trained in called Authentic Movement, and I'm hosting a yoga retreat next year in Portugal that's very somatic. And so I guess I could send you info for that because if
Hailee: Who send me information on that? Yeah.
Dr. Karah Charette, PT, DPT: people are interested in that, they're maybe not hearing like, I need PT, even though I think everyone can benefit from PT, even preventatively. a lot of that information, if you were to type my name into Google, I have a separate website that's just my name, and that's more like my somatic artistic offerings, like dance, poetry, workshops. I have this whole like other, I feel artist side to me that intersects and comes out in different ways. And then it's on Instagram as well, Bodyful Physical Therapy would be the PT account. But then this like more somatic artist side of me is a brand I've called Wise Movement. And so it's W-I-S-E dot movement, and it stands for Wiggily Integrative Somatic Embodiment, because that is just how I
Hailee: I love that.
Dr. Karah Charette, PT, DPT: Feel like I approach everything. I have Wiggly tattooed on my body. It just it's an important
Hailee: Wiggly.
Dr. Karah Charette, PT, DPT: word. Yeah. so if people feel interested, then that's how you could find me with those offerings and I can send you some of that info.
Hailee: my gosh, I absolutely love that acronym. So thank you so much for sharing that. obviously, I will also
Dr. Karah Charette, PT, DPT: Yes. Thanks for thanks for being curious.
Hailee: be putting all of your information in the description box. So if you guys need links, just go down there and click them. again, thank you so much, Kara, for coming on the podcast. I appreciate you. Thank
Dr. Karah Charette, PT, DPT: Yes.
Hailee: you all for listening. That will be the end of this, and I will see you guys in the next episode.
Dr. Karah Charette, PT, DPT: Thank you.
Dr. Karah Charette, PT, DPT: Thank you.
Hailee: typical pelvic floor PT. She takes some somatic trauma-sensitive approach, which means she works with your nervous system, not against it, helping women with pelvic pain, pregnancy, postpartum, and pelvic changes that come with perimenopause. So welcome, Kara.
Dr. Karah Charette, PT, DPT: Thank you so much. Thanks for having me on.
Hailee: I am super, super stoked. I adore pelvic stuff and it's a little bit of a weird thing for me. Like I never thought I'd be so interested in this. so we can start out with like, where did your love for pelvic floor health come from? And just kind of your story of how you founded your physical therapy clinic and everything like that.
Dr. Karah Charette, PT, DPT: Sure. I'll try to do the short version because this could be like an eight to ten year story, you know, in terms of length. But to make it more concise, what I'll say is that, you know, when I went to PT school, I didn't even know pelvic health was a thing. It's actually still relatively new as a specialty, at least in the field of Western physical therapy. and I was just lucky that I went to a more progressive school in New York City where at the time we at least had an elective. the time called women's health. And you know, for me, I really appreciate that we do distinguish that there are things unique to people with vulvas and uteruses. and I do call it now more pelvic health because I treat all genders and all genitalia across the spectrum. but at the time it was called women's health and that definitely interested me because I've always kind of identified as an activist and someone who was interested in like Even going into the medical field, how do I get into more of an advocacy role? Or I don't know, something about women's health felt very grassroots, like, whoa, this is stigmatized. People aren't talking about it. And so when I got to school, it was a combo of having that elective as well as becoming friends with someone who actually knew that's what she wanted to do. And she definitely inspired me. And then also realizing that the pelvic floor wasn't as mysterious to me because I'm also a dancer, a Pilates instructor. This part of the body was talked about at least a little bit in some of my training. And I was very comfortable with it. So there was definitely like an interest starting there. And then I did a clinical rotation in Women's Health Pelvic Health. And to be honest, I could sit here and say, it's all about the client. And that's definitely true to an extent that like it really was the feeling of how rewarding it was to hold space for this part of the body that can be stigmatized. There can be shame, charge with it. And to be completely honest, I didn't have the language at the time. Now I realize I am a very highly sensitive person. And the context in which pelvic health is often done is behind closed doors in a treatment room where you're one-on-one. Whereas all my ortho training and PT prior was in a loud, chaotic gym, double booked, like just the type of energy where I was like, whoa, I don't think I can do this for the rest of my life. And when I got into my pelvic rotation and realized that the environment had to actually be more private and calm, I realized my nervous system could actually ground a little bit more. And so that even just starts off the journey of why I also value somatics and nervous system work. It's both clinical and personal. But I'd say that's really how I ended up being curious about pelvic health. And then my love and interest just grew from there.
Hailee: I love it. I love it. It's so interesting how we all kind of end up in the path that we end up maybe not anticipating that it was going to end up that way. just curious
Dr. Karah Charette, PT, DPT: Yes.
Hailee: and maybe some questions that the audience might have. What does like somatic mean? And also how do you apply it to your work?
Dr. Karah Charette, PT, DPT: Sure. Somatics is an interesting word because I feel like actually recently it's been, you know, blowing up. And of course, with that, there can be good, bad, neutral feelings about it. and I think my definition changes all the time. I mean inherently somatic soma of the body, but not just of the body. Like when you think of PT, yeah, all my training was in the body, but I would not claim my training was somatic because my experience of somatics is that it's the felt sense of. what's going on in that sensation of the body, of for me, like, yeah, the maybe the deeper sensations and also the beliefs, the stories, the images. so there's so much about, yeah, the personal experience of what movement can mean, what it can represent, how it can feel beyond just do your two sets of 10, which like works for some people. and so yeah, there's, you know, there's so much in the in the beautiful world of somatics, so many different modalities. I'm lucky enough to be training in a somatic movement modality called body-mind centering. And that work really informs how I show up in the treatment room. I would say for me, somatics is also like you gotta do your own personal work to be able to show up with it, right? I think with it blowing up, there's like weekend courses, like, get trained to be a somatic coach. And, you know, it's fine. But I think for me, it's like, how much have I actually met and worked with my own material when it comes to feeling my body, holding space for my emotions, holding space too, to name that I'm not a psychotherapist and I have so much respect for especially somatic psychotherapists. And I do stay within my scope. I always am referring to somatic therapists as well. But there's just a degree to which you cannot separate the mind-body connection when it comes to our experience in the body and definitely pain. And so I think how it shows up for me is first that I've had to do my work and continue to do my work. To be curious in my own experience of my body. And then it really shows up, I think, in how I hold space with my clients. And so I always kind of call this like the attunement game of, you know, really trying to feel into what is the container this person needs? And I'm not trying to read their mind. I'm very collaborative. I ask lots of questions. but I think it shows up in, you know, trying to create a container that feels relatively safe. I can't guarantee 100% safety. But trying to create a container with more safety, more curiosity, and frankly more agency. Because the other thing I love about somatics is I think one of the core principles is the value and the wisdom is in that person's body. And so even
Hailee: Mm-hmm.
Dr. Karah Charette, PT, DPT: though I have knowledge and I can be a guidepost, and I think there's value in that, traditional Western medicine will often say, I'm the provider, I tell you what you need. And for me, my somatics has totally flipped that, I think, for the positive, where You know, yes, I can help guide, but I really think that the answers are within the person. And frankly, the answers are within the process. So like people getting there in their own way. so yeah, there's probably a hundred other ways I could answer that question, but that's the way I feel called to right now.
Hailee: my gosh, that is so so true. And like I see that in my clientele as well of like everyone kind of wants a magic pill or they want you to give you them give them the answer and it's not it does never works like that, right? You can give them a
Dr. Karah Charette, PT, DPT: No.
Hailee: process, you can give them tools, but it's up to them to use them and have that self-discovery, which I think it's super important to then do the nervous system work with it. bringing it back to the first part of your answer, you were talking about like certain beliefs and stories that people tell themselves. What are some really common ones? Like, say someone is coming to you with pelvic plane pain, or they're during pregnancy and they're having some pain in terms of like their pelvic floor. What are some beliefs that they hold that are maybe keeping them stuck inside that pain? And
Dr. Karah Charette, PT, DPT: Mm.
Hailee: how would you work them through that?
Dr. Karah Charette, PT, DPT: I love that question. And there's such a diversity in what people can believe, but there are common themes. Certainly with pain and yeah, during pregnancy or pelvic pain, with or without pregnancy. What I see is a lot of fear. Beliefs that something, I mean, the most common one, because our culture teaches people this is if I have pain, something must be structurally wrong, or I must have tissue damage. And that can unlock a lot of fears depending on that person's relationship to their health, their relationship to their body. People will often have a fear of permanency, that there's like no going back. and also there can be underneath that a lot of undercurrents of shame, isolation, people thinking that they've done something wrong or that there's something uniquely wrong to their body, and especially because the pelvis is. Such a stigmatized part of the body, people aren't talking about it, which then feeds the isolation, which can feed shame. so I would say, yeah, fear, fear of permanency, fear of something being really wrong either structurally or with them as an individual is what I see come up a lot. And most of that isn't true. Right. So yeah. Yeah.
Hailee: Absolutely. Absolutely. And how would you go about like working someone through like obviously, like you mentioned, it's often shame, dismissed, or like
Dr. Karah Charette, PT, DPT: Yeah.
Hailee: people just kind of ignore it because of that stigma. So one, why do you think that is? And how do you work someone through that belief breaking in your own practice?
Dr. Karah Charette, PT, DPT: Yeah. Yeah. I mean, why why it's stigmatized? Like, how much time do you have? Our culture, Like, there's so much of why I believe our culture and the history of it has, you know, kind of shut down this part of the body, be it from the people who are who are traditionally have been learning and researching and teaching the body, I frankly have a belief that the pelvis is a is a major source of power and empowerment. So we can tie it into like, you know, trying to kind of shut down feminist ways of being, things like that, right? But to make it really simple as well, I mean, not so simple, but that this part of the body can really be shut down because of its connotations with sexuality. I mean, even bowel bladder health, right? It's either that it's associated with shame or Things our culture might label as like gross. We don't talk about that. so I think first and foremost, one of the things I've witnessed in the treatment room I do is just normalize, especially with like humor and love and acceptance of like, hey, like these are major things for survival. We've got to be able to not only regulate them, but talk about them. And I think my frankly embodied presence and comfort to be like, You know, so many clients are like TMI. And I'm like, there's no TMI in this room. We talk about everything, right?
Hailee: I say that too.
Dr. Karah Charette, PT, DPT: And it's like it really, it's amazing. So to just kind of have a container that shows like we can talk about this. It's it's normal, it's common. I've seen that be really helpful in healing. and then I think to answer your question a little further, I mean, something I also really identify with is Not trying to put myself in a binary, but I feel like there's a spectrum of like cerebral to somatic. And I feel like I span the whole binary of the whole spectrum in that I love meeting people with like really cerebral information. I think there's safety in that. So evidence, data, like this is common, not normal, right? So showing people you're not alone, giving them actual, you know, pain science and real research-backed ways that. It's probably not just pure structural or tissue damage and that the nervous system can be a part of it. It's not in your head, but there's a dynamic process here and we can work through that all the way to then like the somatic way in which I can hold space for when the emotions come up and also not needing to explain that or quicken it away, but just, you know, find safety maybe in the cerebral if people need that, but also be able to just ground and be a witness to when people maybe need to unload. the charge they've been holding in their body. So I hope that answers that question.
Hailee: Absolutely. I do have a further question on it because you used a term I haven't seen or heard before, pain science. Can
Dr. Karah Charette, PT, DPT: Mm-hmm.
Hailee: you outline kind of what that means? And I suppose how you use science with the somatics. I can imagine some people are like, somatics are like woo-woo. I want the real facts. And I think there's a a marrying of those two things. So if you can describe that
Dr. Karah Charette, PT, DPT: Totally,
Hailee: for us.
Dr. Karah Charette, PT, DPT: totally. yeah. And I want to hold space like I love the woo-woo and I have like so
Hailee: Yeah.
Dr. Karah Charette, PT, DPT: many research articles to be like, it can be both woo-woo and there's so much research. Honestly, also we know evidence is biased, what gets funded, what gets studied. Actually, not that we always need evidence to also validate things, but there's more and more research to support somatics. So anyone who wants that research, I can give it to them. But taking it back to your question around pain science. this is also kind of a developing field where there are probably now multiple definitions and approaches. I always like to take it back to frankly my first experience because it really stuck in PT school, which again, this course was in elective, blows my mind because I'm like, this is the foundation, I believe, of what I'm doing as a PT. we had a guest lecturer come in and he was quoting some work by Butler and Mosley, who are researchers in Australia. And they're not the only ones, but they were just the first ones that I learned of. And basically what they talk about with pain science is that our body has what are called nociceptors, no cception. And that is like our actual ability to pick up on thermal, mechanical, and chemical sensation to scan if something is past a threshold where it could be a quote unquote threat. But no cception is not pain. No cception in and of itself is just taking in that information. The way that pain actually gets decided is in our brain. And so I'm definitely jumping through some of the science here, but essentially that dance that it does in our brain is intermingling with our beliefs, our stories, our images. It's not just mechanical stimulus and that's what pain is. And so they have this really lovely story that I think sums it up pretty nicely when we talk about pain science and why our pain doesn't always equate to tissue damage. And the story they get give, of course, because they're Australians. So they talk about, and it may even be like a true story from one of the researchers, is that this dude is out in the outback and he's walking and he feels like a little prickle on his ankle, but he's in tall grass. So he doesn't really flinch. He's just like, that's kind of strange. I felt this little prickle. But then he looks down and he sees and hears a snake. So his brain registers the context of the sensation with a real threat. So then he drops to the ground in agonizing pain because his brain has now recognized, there's a threat here. So he he heals, he doesn't die, right? Luck, thank God. And then he's able to recover from that. Now he goes back into the outback and however many months later, and this time he feels that same brush from the grass, or you know, the the first associate kind of the pain that he thought he felt was the grass the first time. This time it genuinely is just the grass. There's no snake, but because his brain, our brains are prediction machines, has a memory and a story, that when I feel this sensation, and especially in this context, this is what happened last time, he drops to the ground in agonizing pain. But in that situation, the actual mechanical stimuli does not equate the same threat to his body. So I think that's a really nice anecdote of what I see all the time in the clinic, which is that someone may have had very real pain. From an injury or a one-time, like they bent over and it was just wrong time, wrong place, got that spasm in their back. Unlikely that it's actual damage to their spine, but had this real spasm, recover from it, but now their brain associates that movement with the spasm. And chances are the next time they go to do it, they feel that spasm again. Yes, there can be mechanical components, but a lot of times I see almost like a self-fulfilling prophecy.
Hailee: Mm-hmm.
Dr. Karah Charette, PT, DPT: Where people are anticipating, well, this is what usually hurts. I see this with pelvic pain, people with pain with sex. It's like, yes, there can be real tissue reasons. And if you have a story, every time I experience penetration, it hurts. There's a degree to which that neural pathway is now getting sensitized, and you're going to be either tensing in anticipation, creating the pain, or you actually can get real chemical changes with more pain receptors because your body's getting hyper-vigilant. So Again, it's like two things can be true. I'm not saying it's all in your head. I'm not saying it's all mechanical, but that's that's essentially what pain science means to me and how it started in my training.
Hailee: That's so interesting. And I completely resonate and agree with that too. in terms of like, cause as you know, a lot of my clientele are like hypothalamic ammonrhea. There's no period, so low estrogen levels, and they can complain a lot about pain during like intercourse or like the hormonal shifts throughout their cycles. so what is the correlation between like the mechanics, I suppose, like the actual factual of like. dryness, but then also maybe what might be that learned
Dr. Karah Charette, PT, DPT: Mm.
Hailee: part of it.
Dr. Karah Charette, PT, DPT: Mm-hmm. Yeah. I mean, this is where I think I'm going to speak up for my profession and in a lot of pride, which is I think PTs are really good at holding all the factors and learning with really good history taking, maybe when they're more able to attune to that person in front of them. And again, not reading minds, but hearing language, hearing beliefs, understanding how they might be thinking about their body. and then with a physical assessment, I think we're really good at taking in all the data. And a lot of times I have found it's not just one thing but multiple. But there are situations where one might be more the loud factor. So for someone with very real hormonal changes, that simply can't be ignored, right? We know that estrogen is vital to the pelvic floor for elasticity and decreased sensitization. And so if I see that in the history or that comes out in conversation. I would say that I assume that until proven otherwise is a component of it. Now, at the same time, I have the clients that use an estrogen cream or do the Dutch test, do blood test, their hormones are back on track, and then there's they plateau. Like they might get 50% better. And that's when it's like, okay, what other factors are going on here? I'm usually not treating just one factor unless it's overwhelming. Usually there's a little bit of education on like estrogen and hormones in addition to. beliefs, thoughts, nervous system regulation, and then real mechanical stuff too, of like why is the pelvic floor over recruiting not just with the nervous system, but maybe how you use your core or how you do or do not use your glutes. but I would say more often than not, hormones I would say can definitely be involved. But if I had to pick one, I'd say the nervous system, it doesn't matter what the driver is, that's always going to get involved because the real cause could definitely be a real infection, a hormonal deficit, a real injury, but the nervous system will always respond to that. So to me, that's a non-negotiable. I'm not gonna force ideas and beliefs onto people, but it's always in the room as a conversation point and as a a curiosity point.
Hailee: Absolutely. Absolutely.
Dr. Karah Charette, PT, DPT: Yeah.
Hailee: And for women who also like lift and are quite active, like what are your recommendations when someone 'cause I think this is very nuanced too of like people like engage your pelvic floor. Like what what does that mean? So for that,
Dr. Karah Charette, PT, DPT: Totally.
Hailee: yeah, how do you go about teaching people like how do you actually tangibly engage your pelvic floor?
Dr. Karah Charette, PT, DPT: Sure. So this is another one that I feel like could be kind of nuanced. And to be honest, I think there's a lot of rhetoric online that's saying one thing. But as I go deeper into my studies as a pelvic PT and stay up to date with the evidence, essentially what I feel like most people might traditionally say is engaging your pelvic floor means a key goal. And We can have a whole podcast on Kegels. Kegels, you know, they're fine. They're not great. They're usually not the answer for people. Kegel usually mean the feeling of stopping a stream of urine, or in fancy exercise science terms, a concentric contraction where muscles are shortening. I would say that most people actually, when they're having pelvic floor dysfunction, really need to learn how to relax and lengthen before even attempting the contraction. I'm not saying you can't ever do a kegel. But the reason I bring this up is because when people are going into exercise classes or weightlifting, you'll hear cued a lot engage your pelvic floor. And sometimes they won't, the instructor won't even explain beyond that. And that could mean so many things, right? Or they'll say lift up and draw the belly
Hailee: Thank you.
Dr. Karah Charette, PT, DPT: in. And what I want to plug is some work I've been studying. It's called dynamic neuromuscular stability, DNS. And this work actually came from studying babies. I think it's fascinating. It's all about core and intra-abdominal pressure management. And babies, unless they have like a motor deficit, actually do a very good job at managing their intra abdominal pressure. And
Hailee: Interesting.
Dr. Karah Charette, PT, DPT: essentially, this work, I'm really, you know, kind of boiling it down, but this work has really emphasized for me and taught me that, you know, treating the pelvic floor, we're thinking about the core. We can't really just think of it in isolation. It's a 3D container, respiratory diaphragm, pelvic floor, and transverse abdominis. Its job is to manage pressure. And so when we want to engage our pelvic floor, the way I teach the core work, especially for bracing, is through an eccentric model that a healthy canister that's going to resist pressure from the outside actually needs to push out, not suck in. you know, obviously there's nuance to that. And again, probably not going to be taught in detail on this podcast, but I just really want to emphasize that if someone out there listening is like, I do engage my pelvic floor, I do keegles and I still have leaking. Pain, discomfort. Part of the issue might be that that's not the best primary stabilization pattern for the pelvic floor in the context of bracing the core. We can do Kegels for other reasons, but the eccentric model I've seen much more effective because now we're engaging the pelvic floor but in a more lengthened position. It's a better shock absorber, it's less likely to get more irritated from the shortened fibers. So hopefully that makes sense. That's that's
Hailee: Interesting.
Dr. Karah Charette, PT, DPT: what I teach.
Hailee: Interesting. What how would you explain the lengthened version? So as like
Dr. Karah Charette, PT, DPT: Mm.
Hailee: the concentr or obviously it's like, okay, suck in or hold in a P,
Dr. Karah Charette, PT, DPT: Yeah.
Hailee: but how would you explain the feeling of of the lengthened version?
Dr. Karah Charette, PT, DPT: Yeah, I mean, this one is for me, I'm sure there are people out there that are like, we can boil it down and make it really easy. My experience with it is, and the way I feel like I was taught is that, you know, to get the lengthening, but with good intra-abdominal pressure management is that you really have to manage like three to four factors. And this is where it is helpful to like work with a PT who's trained in this and get the individualized cues for you because someone might hear, lengthen push out. And then what they'll often do is hold their breath. stick their belly down out and like bear down. And that's not what I'm teaching. So the factors that need to be considered when we think about lengthening is breath is number one. So unless you're doing like hardcore Olympic weightlifting where there might be a moment that you, you know, stop the glottis pressure from going down, there's time and place for that. But breath is really essential because we do want that container to have a little bit of like shock attenuation, like a suppleness. So it's not so rigid. so breath is number one. number two is directionality of pressure. So, this is what I screen in the clinic. If I'm telling someone to spread their pressure, first I actually look at their abdomen to see when they engage their core. Where are their dents and where are their hills? If you are doming somewhere, that means you're over pressurizing. And if you have a valley or a dent, that means you're under pressurizing. And so we try to figure out where are those points and can we spread the pressure to those dents. The reason I'm telling you all this is because it's not just lengthen your pelvic floor, you know, it's the whole system. It's like an air mattress. You have to work with it holistically. And so if I get them to spread their pressure in the right direction, then usually the pelvic floor kind of lengthens with it. So that's what's cool about this work too, is I don't, even though as a pelvic PT, internal work which I'm trained in can be very helpful to kind of see what's going on at the pelvic floor. If someone doesn't want to do internal work for any reason or they're even just learning online, teaching this core work we can just do through an external model and it will help the pelvic floor go into that eccentric place. But those are the components and the last one I'll say is spinal elongation because a major point of having good intraabdomal pressure management is to not compress the spine. And so It's another thing to screen for with this work is not flexing or compressing down when you're generating this pressure. So I don't know if I answered that question, maybe a little too complicated, but point being, there's a couple factors, and it's not so simple as draw your belly in or push your belly out, right? Which is probably why it's not being taught
Hailee: Mm-hmm, that's super interesting.
Dr. Karah Charette, PT, DPT: in a class because it is to me an individualized process. Once you get your cueing, it can be fast. But you kind of have to go through the journey to bring it back to the process to find out for yourself what are the cues your body needs to make sure you're doing this correctly.
Hailee: Absolutely. I totally agree with that too. interestingly enough, I was doing that in the gym this morning. I was noticing my like the middle part of my stomach domes, right? And so in that instance,
Dr. Karah Charette, PT, DPT: Yes, yes, said
Hailee: like I'm trying to bring that dome in rather than like push
Dr. Karah Charette, PT, DPT: Mm.
Hailee: it out or let it go out. And then so I think
Dr. Karah Charette, PT, DPT: Mm-hmm.
Hailee: like that was just a good exercise of what exactly you're explaining because in that instance it's
Dr. Karah Charette, PT, DPT: Yes.
Hailee: not just like me doing a Kegel, it's still gonna dome, right? It's it's more of a whole thing. so I
Dr. Karah Charette, PT, DPT: No. Yep. Yep. Yes.
Hailee: think that's very that's very interesting.
Dr. Karah Charette, PT, DPT: Yeah.
Hailee: and then two are I'm just gonna kind of go into the baby aspect. So someone who is maybe pre pregnancy wanting to do some pelvic floor work to strengthen, lengthen how do you usually go about that for
Dr. Karah Charette, PT, DPT: Hm.
Hailee: like the pregnancy aspect. Say they like leaking 'cause they like can't hold in their pee, so on and so forth.
Dr. Karah Charette, PT, DPT: Totally.
Hailee: how do you usually go about that?
Dr. Karah Charette, PT, DPT: Yeah, so the first thing I'll screen, really with anyone with leakage, but certainly during pregnancy, we know that as the baby's growing, as the core is lengthening, right? There's a degree to which muscles can be too long. And pregnancy
Hailee: Mm-hmm.
Dr. Karah Charette, PT, DPT: is an example of that when they're and it's not too long in a bad way. The belly is doing exactly what it should. It needs to expand for the baby to grow. But what that does is it makes engaging the core a little bit harder, right? It's harder to feel, and it's genuinely harder to get that full contraction. So, what I see very commonly during pregnancy is the pelvic floor works harder. And what we know is tight muscles are weak muscles. People want to put themselves in one category or another, but it's often both. And so leakage, where people will go and do a million kegels to try to fight that, a lot of times it's the relaxation I've seen make a big difference. I will, of course, teach this DNS approach to Core and pressure management. I always tell my pregnant folks if it's the first time learning it while they're pregnant, they're learning it on hard mode. It doesn't mean it's impossible, but proprioception is a little bit skewed during that time. But I will still teach them core bracing, glute engagement, right? These are things that help offload the pelvic floor, especially when done correctly with good coordination, good breath management. But in addition, if it's a person that's seeing me in person, they don't have any contraindications to internal work. typically I won't do internal work in the first trimester, but afterwards, as long as they're cleared. then we can actually also do like trigger point release and honestly pelvic mapping, like getting their brain through the internal work to feel their pelvic floor more clearly for both coordination and relaxation. And I've seen that really help with common pip complaints during pregnancy. So incontinence, pain, that could be internal pain or like pelvic girdle pain at the pubic symphysis, the SI joint. and then also, frankly, to me, it's birth prep. So even if someone doesn't have those complaints, it's still worth doing. So many people walking into my office when pregnant, it's the first time they've even heard of their pelvic floor muscles, let alone have them palpated. It's different than intercourse because we're we're tapping individual muscles in a therapeutic
Hailee: Mm-hmm.
Dr. Karah Charette, PT, DPT: container. And that has been so helpful for people because. I don't really want the first time you feel your pelvic floor to be when you're giving birth and there's all kinds of other stuff going on and now you're trying to figure out how to relax. Like we want to do almost exposure therapy and try to do that before all the chaos ensues. And so I've got a lot of clients where just that breathwork and going slow and mapping their pelvic floor alone really helped them be able to relax, because that's also the majority of what you need to do during birth. It's The uterus is doing all the pushing. The pelvic floor needs to relax and get out of the way. So we don't want you contracting because you've never learned how to relax and then potentially being more at risk for tears. that's a lot of what I do with my pregnancy folks. Yeah.
Hailee: That's so interesting. I freaking love the woman's body. I think it's so cool and so interesting. And
Dr. Karah Charette, PT, DPT: It's so cool.
Hailee: yeah, and I think there's like there's not a lot of information about it and people, you know, go especially pregnancy, they go into pregnancy thinking like, my my body is just made for this when it can be a lot less painful or a little bit more functional when you do get help like yourself with pelvic floor work and and things like that
Dr. Karah Charette, PT, DPT: Mm-hmm.
Hailee: as well. Cause I think like that lack of release. is something that a lot, a lot of people struggle with, especially if they're under
Dr. Karah Charette, PT, DPT: Yes.
Hailee: a lot of stress or chronic stress and things like that. And they're like, How do I do this? Right. Yeah, absolutely. I do have
Dr. Karah Charette, PT, DPT: Yes. Hmm Yes.
Hailee: one weird question for you. Not weird, but I was requested to ask you this, because it's very admirable of you and your thoughts on Botox and why
Dr. Karah Charette, PT, DPT: Mm.
Hailee: we don't why you don't do that and why you would
Dr. Karah Charette, PT, DPT: Mm.
Hailee: You just kind of let yourself be you, essentially. Yeah.
Dr. Karah Charette, PT, DPT: And are you talking about Botox like anywhere in the body? Because as a pelvic
Hailee: Yeah.
Dr. Karah Charette, PT, DPT: PT, I'm like Botox for the pelvic floor actually can be helpful if people can't relax their muscles. So it depends on the context, but you're talking more sure. Yeah. Hmm.
Hailee: Yeah, like yeah, just aesthetics, things like that. Yeah.
Dr. Karah Charette, PT, DPT: that's an interesting question. I mean, hmm. For me, I feel like there's probably a connection on a somatic layer as like. I think as I continue to do my own somatic work, really feel my body. I mean, for me, it's incredibly spiritual. Like I don't really have like a strong religious background, but to me, anatomy is spiritual. And so I guess the reason I'm saying this in response is that when I really feel my body, like I I will be honest, I don't really I've never thought about Botox that deeply. And so I hold space for like all the ways we can get influence in this culture. It's just not something that's come up for me a lot. But what I imagine is that when we're getting that messaging, it's coming again from a very certain lens that I will call the white supremacy patriarchy capitalism lens. And it's very much like a, it's very much a, I'm not trying to shame if someone wants Botox, by the way, too. So it's just like for me, my felt experience
Hailee: Yeah. This is a controversial.
Dr. Karah Charette, PT, DPT: is why is that messaging being taught to us and through what lens? That's the lens I feel like if it's brought up, it's because of this more purely. not felt place is what I'm trying to say, right? When I think about somatics, it's not about how something looks at all. It's about how something feels. And so this is gonna sound really corny, but when I really get deeply into my somatic practices and I feel my body, I can just feel how everything is exactly how it's supposed to be. I feel the divine wisdom of my cells. Like I just, to me, there isn't this strong urge This is years of doing this work. I'm not saying this happens to me in one meditation, right? but my experience in my body is that when I'm really pausing and really with it, there's nothing to pathologize or fix. so I think it's helped me really land in a deep acceptance while holding space that it's complicated. Relationships with bodies are complicated. So if you're listening and you're like, I don't resonate with that, I hold space for that. Our culture does not make it easy to feel that. So it just
Hailee: Yeah, absolutely. Absolutely. I agree. And
Dr. Karah Charette, PT, DPT: That's my experience. Yeah. Yeah.
Hailee: I think it's true for like body image and all of this. We always have that like little low hum not enoughness or trying to specifically
Dr. Karah Charette, PT, DPT: Yes.
Hailee: for women, like try and stay youthful. And the kind of
Dr. Karah Charette, PT, DPT: Mm.
Hailee: reframe I've had throughout the years is like what a blessing it is to grow old and have these expressive marks on your face because you've smiled so much and like
Dr. Karah Charette, PT, DPT: Hmm, beautiful.
Hailee: Why try and hide that or try and avoid what's inevitable? Right. Because just grow like
Dr. Karah Charette, PT, DPT: Mm.
Hailee: imagine I've had many people who unfortunately like pass away at like 19 and like
Dr. Karah Charette, PT, DPT: Mm.
Hailee: what what a tragedy that you did not get
Dr. Karah Charette, PT, DPT: Mm.
Hailee: the luxury of growing old and having wrinkles and having experiences and things
Dr. Karah Charette, PT, DPT: Yes.
Hailee: like that. So that's kind of the reframe I've had. throughout the years 'cause I'm
Dr. Karah Charette, PT, DPT: Hmm.
Hailee: exactly like you where I I have never had the urge to change it or try and avoid it in some capacity. 'Cause like what what's what'll be will be if I have to like squint my my eyebrows or whatever.
Dr. Karah Charette, PT, DPT: Right.
Hailee: I don't know. It's just gonna happen. I can't control it.
Dr. Karah Charette, PT, DPT: Totally. I love that. The privilege. Yes, the privilege
Hailee: Yeah.
Dr. Karah Charette, PT, DPT: of aging and the stories our bodies tell that comes with it. Yeah. Beautiful.
Hailee: Absolutely. Absolutely. And I obviously I haven't done this yet or gone through it, but I imagine this will be harder for me in the moment. But going through like pregnancy and having those stretch marks and how your body changed with that,
Dr. Karah Charette, PT, DPT: Mm.
Hailee: I try to reframe that with my clients as well of like how how much of a blessing it it is to have those marks on your body because now you have something to show for it. and it was It's not, it's just a body. That's all it is. And we're just gonna grow old
Dr. Karah Charette, PT, DPT: Yes.
Hailee: and like get wrinkly and no one cares about that. Like I think of my
Dr. Karah Charette, PT, DPT: Yes.
Hailee: grandma and like how different she looks from with the pictures I see of past version. I'm I've looked at it a lot because I'm actually wearing her wedding dress at my own wedding. So I've gone through a bunch
Dr. Karah Charette, PT, DPT: Mm.
Hailee: of her pictures and like how different she seems, and it's like I love her just as much. Like it's it
Dr. Karah Charette, PT, DPT: Yes.
Hailee: has nothing to do with looks.
Dr. Karah Charette, PT, DPT: huh.
Hailee: So yeah, I think it's it's a really beautiful thing to just kind of come to terms and accept that this is life and that is a beautiful thing and it's gonna go the way it goes and we don't have to try and avoid or shame or anything like that.
Dr. Karah Charette, PT, DPT: Yes. Hmm. That's beautiful. Thank you for sharing that. Hmm.
Hailee: Thank you. Yeah, of course. this is gonna conclude. did you have any other closing thoughts? firstly.
Dr. Karah Charette, PT, DPT: Hmm. any closing thoughts?
Hailee: Mm-hmm.
Dr. Karah Charette, PT, DPT: you know, I would just say, because I when I was looking over like questions you might ask me, I really appreciated your final question. Like if there was one thing someone could take away today. And to me, this is feels very much derivative of my studies with Body Mind Centering. Something I feel like I've learned in that work, and I think a lot of somatics explores this, is capacity to be in questions. So rather than end with like a fact of like, here's what you should know, I feel called to say, you know, invite a question in of what would it be like for people who are listening to just pause with your pelvic floor now or at some point in the next couple days with just a lens of pure curiosity, because it is so common to qu it's amazing. I feel this in my own body that I feel a part of my body and it immediately goes to a story, a judgment. or pathologizing.
Hailee: Mm-hmm.
Dr. Karah Charette, PT, DPT: And so I just would invite people to not trying to be too prescriptive, but just to like really, what is it like to land in pure curiosity of just being with the tissue if it feels safe? Because this may not be a part of the body that even feels safe to go there right now. But this could be any part of the body and to just witness it without this like immediate jump to labels and stories, that's just like a question I'd like to plop in.
Hailee: I love that question.
Dr. Karah Charette, PT, DPT: as an inquiry.
Hailee: And I think it's really important to just kind of because I think we look for ways to avoid being with ourselves a lot. And that can show up in
Dr. Karah Charette, PT, DPT: Yes.
Hailee: like for myself. It was like showed up in my eating disorder, binge eating, like obsession with like food and macros, and things like that. Right.
Dr. Karah Charette, PT, DPT: Mm-hmm.
Hailee: And we just don't give ourselves space or time to actually just like sit with ourselves and learn ourselves. Right. So I think that's a really important question to ask throughout
Dr. Karah Charette, PT, DPT: Yes.
Hailee: the Next few days. Fabulous. Thank you so much, Kara, for being on. I appreciate
Dr. Karah Charette, PT, DPT: Mm yes.
Hailee: you. I appreciate your time. Let us know where we can find you. If someone watching this maybe wanted to work with you, or anything like that. Social media, where can we where can we find you?
Dr. Karah Charette, PT, DPT: Yeah, thank you. Thank you for having me. And I would quickly say that if you're located in Oakland, East Bay Bay area and you want to work with me in person, probably going to my website, which is www.bodyful
Hailee: Shop.
Dr. Karah Charette, PT, DPT: physical therapy.com. It is a mouthful, or you can just Google my name and the word bodyful and it should come up. if you're in the state of California, I can do telehealth and still under a PT license. If you are out of California or out of the country, I could still work with you, but it would have to be clearly through like a somatic and coaching lens, which I think can still be very powerful, but just wouldn't be as like medically diagnostic as PT services and and not so much hands-on work. all of these modalities I think can be really good with the right person. and then I will just say too, if someone listening felt like really interested or called to like more somatic pieces, I think that shows up in my PT work all the time. but I also do offer more like This other work I trained in called Authentic Movement, and I'm hosting a yoga retreat next year in Portugal that's very somatic. And so I guess I could send you info for that because if
Hailee: Who send me information on that? Yeah.
Dr. Karah Charette, PT, DPT: people are interested in that, they're maybe not hearing like, I need PT, even though I think everyone can benefit from PT, even preventatively. a lot of that information, if you were to type my name into Google, I have a separate website that's just my name, and that's more like my somatic artistic offerings, like dance, poetry, workshops. I have this whole like other, I feel artist side to me that intersects and comes out in different ways. And then it's on Instagram as well, Bodyful Physical Therapy would be the PT account. But then this like more somatic artist side of me is a brand I've called Wise Movement. And so it's W-I-S-E dot movement, and it stands for Wiggily Integrative Somatic Embodiment, because that is just how I
Hailee: I love that.
Dr. Karah Charette, PT, DPT: Feel like I approach everything. I have Wiggly tattooed on my body. It just it's an important
Hailee: Wiggly.
Dr. Karah Charette, PT, DPT: word. Yeah. so if people feel interested, then that's how you could find me with those offerings and I can send you some of that info.
Hailee: my gosh, I absolutely love that acronym. So thank you so much for sharing that. obviously, I will also
Dr. Karah Charette, PT, DPT: Yes. Thanks for thanks for being curious.
Hailee: be putting all of your information in the description box. So if you guys need links, just go down there and click them. again, thank you so much, Kara, for coming on the podcast. I appreciate you. Thank
Dr. Karah Charette, PT, DPT: Yes.
Hailee: you all for listening. That will be the end of this, and I will see you guys in the next episode.
Dr. Karah Charette, PT, DPT: Thank you.
