Poppy Physical Therapy

10/12/2026

Weak vs. Tight. Which one are you?

Leaking when you sneeze, jump, or laugh? Most people assume the pelvic floor is weak and start doing Kegels.

But a tight (overactive) pelvic floor can cause many of the same symptoms.

A muscle that’s always “on” gets tired and can’t respond quickly when it needs to. It’s like making a fist all day: when you finally need to grip something, there’s not much left.

Signs your pelvic floor may be WEAK:

Leaking with coughing, sneezing, or exercise
Heaviness or pressure in the pelvis
Difficulty holding gas
Urge incontinence

Signs your pelvic floor may be TIGHT:

Leaking or urgency, even with “strong” muscles
Pain with s*x, tampons, or exams
Constipation or straining
Hip, low back, or tailbone pain
Trouble starting your urine stream or fully emptying
Pelvic Pain

Many people have a mix of both, which is why guessing doesn’t work. A tight pelvic floor often needs to relax and lengthen before strengthening helps. Sometimes you might have weakness elsewhere contributing to a pelvic floor that is too "tight."

Everyone's body is different and everyone needs something unique that will work for them, not a one size fits all treatment.

10/08/2026

Free 20-minute assessments at Poppy Physical Therapy Friday, November 6! 🌺

Book a one-on-one with a pelvic floor PT and choose your focus:
• Movement: how you move, lift and bend in everyday life and workouts
• Diastasis: a check for abdominal separation
• Core: how your breath, deep abs and pelvic floor work together
• C-Section: scar mobility and core recovery after a cesarean, at any stage

Spots are limited. Call 518-714-0574 to reserve yours.

10/06/2026

So what actually tells us your risk of prolapse worsening? Your measurements. 📏

In a pelvic floor exam, we take two quick external measurements:

🔹 GH (ge***al hiatus): the opening from the urethra to the back of the vaginal opening
🔹 PB (perineal body): from the back of the vaginal opening to the middle of the a**s

Added together, GH + PB gives us a picture of how much your pelvic floor opening stretches under pressure. We measure it while you bear down, because that's when it best predicts prolapse symptoms.

What the numbers tell us:
✅ Under 7 cm: typical range
⚠️ Over 7 cm: the muscles are stretching more than usual (called "ballooning")
⚠️ 8.5 cm or more: can point to a muscle injury from birth and a higher risk of prolapse coming back after surgery

A larger GH has been linked to prolapse getting worse over time. That's the number worth watching, not whether you did a crunch.

The best part: it's a number we can retest as you go through PT, so we can see whether your pelvic floor is responding to training.

10/04/2026

More prolapse talk today. This is something I feel VERY strongly about and something that comes up more than you’d think: patients who’ve been to multiple pelvic floor therapists — and never once been assessed standing up.

I recently worked with a patient managing prolapse symptoms who had seen several pelvic floor PTs previously. Every assessment was done lying down on the table. Not one of them had ever checked her standing.

Here’s the problem with that:

Gravity changes everything. Prolapse symptoms and leaking often show up — or get significantly worse — when you’re upright, moving, and loaded. Assessing only in a gravity-eliminated position (lying down) can miss what’s actually happening in real life: at the grocery store, picking up your kid, during a workout, standing at the end of a long day. We also know that prolapse symptoms and severity often don’t match up. Therefore, just because someone says they have symptoms during an activity or exercise doesn’t mean that their prolapse is worse. The only way to determine that is by actually assessing. Here are other reasons we assess standing:
✔️ Prolapse can look completely different (or “disappear”) lying down vs. standing
✔️ Leaking with coughing, jumping, or lifting often only shows up loaded and upright
✔️ It tells us how the pelvic floor, breath, and core are actually coordinating under real-world conditions
✔️ It helps us build a treatment plan based on your real symptoms — not just what we see on the table

A thorough pelvic floor assessment should meet your body where your symptoms actually happen. If you’ve been treated before and never assessed standing, it might be worth a second look.

10/01/2026

09/28/2026

INTERNAL EXAMS
Always your choice. Never a requirement.

Let's talk about internal pelvic floor exams.

First, the most important part: an internal exam is always optional. It is never required to start pelvic floor PT, and you can say no, pause, or stop at any point, before or during an exam. Saying "not today" or "not ever" will never change the care you receive.

A lot of what we learn comes from external assessment alone: how you breathe, your posture, how your hips, core, and back move, and how your body manages pressure during everyday movements. Many people make great progress without an internal exam.

For some people, an internal exam can add useful information, and it's a tool we offer only when you're comfortable. It can help us assess:

🌿 Strength: how well the muscles contract and lift
🌿 Endurance: whether they can hold and repeat
🌿 Relaxation: whether they can fully let go (this matters as much as strength)
🌿 Coordination: whether they respond well to your breath and effort
🌿 Tone and tension: whether muscles are tight or overactive
🌿 Tender spots that may be contributing to pain
🌿 Scar tissue, such as from a tear, episiotomy
🌿 Support: how the pelvic organs are supported

That information helps us build a plan that fits your body, instead of guessing.

If you do choose an exam, you're in control. We explain what we're doing before we do it, go at your pace, check in throughout, and you can stop at any time. If you'd rather wait until you feel ready, that's completely okay.

You deserve to understand your options and feel safe in your care.

09/23/2026

Meet the obturator internus: this hip muscle is really having its moment right now, which is why I haven’t talked about it yet.

However, this small, deep muscle lines the inside wall of your pelvis, wraps out the back, and attaches to the top of your thigh bone. Its main job is rotating your hip outward and keeping the ball of your hip centered in its socket. When your foot is planted, like when you walk, climb stairs, or stand on one leg, it helps rotate and steady your pelvis over your leg.

Here’s the pelvic floor connection 👇

Part of your pelvic floor (the levator ani) anchors onto a band of connective tissue running along the obturator internus, called the arcus tendineus. That means:

🔸 A tight or overworked obturator internus can pull on the pelvic floor and keep it from fully relaxing
🔸 A weak one can leave the pelvic floor working overtime to stabilize you
🔸 The pudendal nerve travels through a tunnel formed by its fascia, so tension here can contribute to pelvic, ge***al, or tailbone pain and even LEAKING. Therefore, how this muscle is functioning is incredibly important. Learning how to use this muscle appropriately can be incredibly helpful to your pelvic floor health. So do you have tight hips? Stretching isn’t helping. Maybe this muscle is part of the problem.

09/21/2026

MYTH MONDAY
MYTH: The pelvic floor is its own separate system, so if something's off, you only need to work on the pelvic floor.

TRUTH: Your pelvic floor is part of a team. It works with your diaphragm, deep abdominals, low back muscles, glutes, and hips, and it's constantly adjusting to your breath and movement.

Think of your core as a canister:
🌿 The diaphragm is the lid
🌿 The abdominals wrap the front and sides
🌿 The back muscles (multifidus) support the spine behind
🌿 The pelvic floor is the base

These parts are designed to move together, and breathing is what keeps them coordinated:

INHALE: Your diaphragm drops down, your ribs expand, and pressure in the canister increases. Your pelvic floor responds by gently lengthening and relaxing downward.

EXHALE: Your diaphragm rises, pressure decreases, and your pelvic floor and deep abs naturally engage and lift.

It also happens without you thinking about it. When you cough, laugh, lift a grocery bag, or stand up from a chair, a healthy pelvic floor and deep core activate just before you move, to manage the pressure. Your glutes and inner thigh muscles connect into the pelvic floor too, so tension or weakness in your hips can change how it functions.

When one part isn't doing its job, another takes over. Holding your breath, clenching your glutes, or gripping your abs can leave the pelvic floor overworking or unable to respond when you need it. That can look like leaking, heaviness, pain with intimacy, constipation, or low back and hip pain.

This is why pelvic floor PT looks at how you breathe, move, and manage pressure, not just the muscles you can't see.

09/14/2026

Welcome to Poppy Physical Therapy 🌸

At Poppy, we believe healing happens best when you feel seen, not just treated. Pelvic floor PT can be a deeply personal journey — so we’ve built a space that feels less like a clinical waiting room and more like a warm exhale.

Here, sessions are unhurried. One-on-one, always. We take the time to actually listen — to your story, your goals, your body — before we ever get to a treatment plan. No rushing, no cookie-cutter protocols.

Our space reflects that same care: soft, calming, and private, so you can show up exactly as you are. Because the environment you heal in matters just as much as the care you receive.

This is a space for every body, every stage, every story.

09/03/2026

Your pelvic floor isn’t weak. It’s exhausted.
If you have EDS, you already know your joints move more than they should — but that same connective tissue issue affects your pelvic floor too. The ligaments and fascia that are supposed to help hold everything in place just aren’t as reliable. So your muscles pick up the slack.
The pelvic floor ends up gripping constantly, trying to do a job that isn’t fully its to do, all day, every day — instead of contracting only when it’s actually needed.
Over time, that looks like:
Pelvic, hip, or low back pain with no obvious cause
Pain with s*x or pe*******on
Urinary urgency or a sense of incomplete emptying
Constipation or straining
Muscles that fatigue fast, because they never really get to rest
This is why “just do more Kegels” so often backfires — you’re asking an already-clenched muscle to clench harder. For a lot of EDS bodies, the real starting point is learning to let the pelvic floor fully release again, before asking it to do more.
If any of this sounds familiar, you’re not broken and you’re not imagining it. Your body has been compensating for a long time. There’s a way to work with that instead of against it.
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