Kim (00:01.878)
Welcome to this week's episode. I am joined today by Vicky, Dr. Vicky Hemet and she's known as the Cairo Queen and I'm excited about this conversation because she has blended her background with chiropractic and pelvic health and so that's not something you see all that often, although it's absolutely completely relevant and so I'm interested to hear what brought you into the world of pelvic health. So maybe if you can
introduce yourself and tell us a little bit about, first of all, how you got into chiropractic and then what led you down the path of specializing and focusing in pelvic health for women.
Vicki Hemmett (00:38.513)
Yeah, sure. Thank you so much for having me, Kim. I've been following you and big fan for many years as a kind of a newbie into this public floor world several decades ago. So it's just been wonderful to see how it's kind of coming more into mainstream in the last five years, I would say. So it's just, it's awesome to get that information out there. But yeah, so I always wanted to work in healthcare and didn't really know where I wanted to fit in.
when I was in my third year of university at Queens, the university in Kingston, Ontario, and I thought that was what I wanted to do. So pursued that, went to National University of Health Sciences in Chicago, and just fell in love with anatomy, the biomechanics, and understanding how the body works.
And I met my husband there and he was from Vermont and we ended up buying a very busy orthopedic practice in 2002, which was really great for hands-on a lot of patients. But I knew really quickly that I wanted to specialize in women's healthcare. I hadn't had any kids, but the biomechanics of becoming pregnant really was something that I was interested in and kind of understanding and knowing that we could help so much because
of relief of just traditional low back pain for pregnant ladies. And I knew that I could, you know, kind of help relieve some of those symptoms. So literally went and knocked on all the OB-GYN doors back in 2002. And there was one practice that was in particular very interested in, you know, kind of working collaboratively. And I did an in-service for them and realized that they really didn't have a great understanding of the musculoskeletal component.
of women's healthcare. And so just teaching them about the anatomy, the piriformis muscle, the SI joints really kind of blew their minds. So we worked really well together for about five years. And then we moved into an integrated health building, which is where our practice is located now. So we have a primary care naturopathic provider there. We have acupuncturists and then their OBGYN practice. And of course we're there too. And that's really, that was in 2008.
Vicki Hemmett (02:59.455)
And that's really when I was introduced to the concept of pelvic floor. And I thought, gosh, that's great to have an in-house pelvic floor provider for this office setting. And I was looking to hire a physical therapist, just thinking in my own space that was kind of traditionally what would happen. And I didn't really get much feedback. So I thought, man, I'll do a little bit of research and found out it was very musculoskeletal. I thought this is in my wheelhouse. So I went to a seminar. I think I was the first chiropractor to do that.
And they're grateful to, yeah, I'm very grateful that they kind of let me in. And I did my first internal evaluation and it was literally like my aha like moment where I said, this is amazing because I knew immediately what to do. You know, I just, I knew with my palpation skills, I could tease out all of these different musculatures. And it was just so incredible to have access to these muscles that I never really knew from, you know, a standpoint before.
So I did a major deep dive to learn about the biomechanics portion of this and Its application with chiropractic work from a joint perspective all of them pelvic floor muscles attached to the bony outlet, right? so you can't discount the The hips the pubic symphysis the SI joint and then the lumbar spine of course and all the fascial connections So, you know, I really did a lot of research into You know kind of
care and really saw that there is a huge neurological loop with adjusting the chiropractic joint manipulation and how it kind of feeds into the pelvic floor and also just that the resolution of these musculoskeletal complaints is incomplete, you know, in my space anyway without kind of addressing some of the bony components of the joints.
Kim (04:53.474)
Very cool, very cool. So when you do, I guess in your practice then, so you kind of said, okay, I'll do, get a pelvic floor physical therapy, but then you said, hey, wait a minute, I can do this. So you went and became trained. So is your, because typically chiropractic is, at least from my perspective, whenever I've gone to see a chiropractor, we have, you know.
Vicki Hemmett (05:00.721)
Mm-hmm.
Kim (05:16.134)
anywhere from like five to 20 minute sessions, sometimes in an open room even, sometimes a lot of practitioners will have open room, tables for everybody there. So I'm assuming you have now a private space and you're combining the sort of the work, the hands-on work of a chiropractor with internal evaluation. Is that a fair assessment?
Vicki Hemmett (05:20.816)
Mm-hmm.
Vicki Hemmett (05:37.989)
For sure, yes. And so that's absolutely true. And the interesting thing about chiropractic care, I mean, there's probably with every profession, there's just a spectrum of care. And so there's some people who, some chiropractors who treat like in those open air, kind of rooms and they have very quicker appointments. We're on the other side of the spectrum where we spend a little more time with patients and incorporate rehab exercises. And, but yes, to your point, definitely do the external orthopedic evaluation.
because there is a huge amount of women who have low back pain that's chronic, that never really resolves. And there's actually a study done in McMaster University in Hamilton, Ontario, actually it was about from an orthopedic clinic and 95% of women who have low back pain also have a pelvic floor component. So I'm kind of preaching to the choir with you, but it is undeniable that they're linked. And so if there is something that I can do,
to address the orthopedic component. And that's just, that opens Pandora's box in terms of looking at, for instance, the psoas muscle, the hip flexor that has fascial connections to both the diaphragm and the pelvic floor. And it attaches to the lumbar discs and components of the lumbar spine. I mean, it makes sense that you have to kind of open the lens a little bit and look everywhere.
And so yes, I do a traditional kind of orthopedic evaluation, even in the absence of symptoms, patients come in with a true pelvic floor complaint, we absolutely kind of put them through that orthopedic testing because you're more than likely going to find, just from a palpation standpoint, maybe a restriction in one or more joints for sure, but also in the obturator, the piriformis, that you can palpate quadratus lumborum, so it's as I mentioned.
And I certainly do the manual manipulation, you know, the traditional kind of what you would think about as a pop and click type of back fake adjustment. But really that's like 10% of my appointment time, 90% of the time I'm doing soft tissue release techniques. I'm kind of understanding the lifestyle, you know, are you newly postpartum and holding your baby for seven hours because they're colicky or are you a teacher and standing up and not.
Kim (07:37.051)
Mm-hmm.
Vicki Hemmett (07:54.821)
having the opportunity to go to the bathroom or you know just kind of understanding the components of what's driving them in. So we kind of make that kind of diagnosis and then coupled with of course the history we then transition into an internal palpation exam and this is where I really kind of look at the muscular tension, adhesions, spart tissue.
anything like that, I'm looking for tone, symmetry, all of those things. So, and what's, again, what's interesting is when I did my first exam and still today, I'm just like, wow, it is so cool to be able to palpate those features of the pelvic floor. And also, it's so validating, as you can probably imagine, when I'm able to reproduce pain, let's say if I'm having pain with intercourse, and I can reproduce it, and they think, gosh, that's exactly the pain that's not in my head.
It's so validating for the patients to be able to have this conversation and if you can reproduce it from a musculoskeletal standpoint, you can typically take it away. I'll kind of back up the bus a little bit too because in working with this OB-GYN practice, for me it is just critical to have this collaborative care because I get most of my referrals from
Kim (09:03.032)
Mm-hmm.
Vicki Hemmett (09:15.361)
either urogynecologists, OBGYNs, midwives, who've done that evaluation from that gynecological standpoint, right? So we've already ruled out some of the things that may be either primary or secondary, you know, kind of thing that's contributing. So I know that they've maybe had an evaluation with an ultrasound to rule out like a cyst or something like that, or if there's a history of endo, or I kind of know those things going into it. So.
It's all about patient-centered care in terms of everyone being kind of on the same page for the patient in terms of looking at what their goals are. So I think that's really a valuable part and also kind of a distinction within my profession anyway. There's not a lot of co-management between the traditional medical model and the chiropractic profession, which is kind of a shame. And it's changing for sure. But I mean, there's overlap. And I can just, I have my specialty in musculoskeletal and...
You know, sometimes I need help and this collaboration of maybe getting a referral for like a vaginal valium supplement, you know, or something that a prescription of care that I, that's limited by my sense. So it's really great to be able to work collaboratively.
Kim (10:31.438)
That's very cool. It's absolutely the model I think all healthcare should be, really is a collaborative, multidisciplinary approach like that. So I love that. So let's, if we can focus kind of on some of the more common pelvic floor dysfunctions, incontinence, organ prolapse, we talked about back pain, which is usually present when you have incontinence and you have prolapse. So let's say we have somebody coming in to see you and they have a complaint of...
Vicki Hemmett (10:36.153)
100%.
Kim (10:59.654)
stress urinary incontinence, so they're leaking when they're laughing, coughing, sneezing, jumping. What would your, so you're doing your health history, you're looking kind of externally, but then internally. So what would your treatment be and what are the more common findings you see in that population? It's kind of being very general here, but what do you typically see is common in that group?
Vicki Hemmett (11:21.573)
Sure, well I mean the evaluation externally can range from a lot depending on where the patient is, but from an internal perspective what I find is very interesting and which also a lot of people don't realize is that you can have this high tone in the pelvic floor that can contribute to some of the stress urinary incontinence. And to teach patients that your pelvic floor musculature isn't just like one muscle, it's not just like the levator and I, right? There's so many different components.
to posterior, superficial to deep, and there may be some regions of the pelvic floor that are actually hypertonic or spasmed or have a trigger point in them. And that may be actually contributing to the stress urinary incontinence because if you're already at this baseline of high tone and you go to use a Kegel exercise, you're already failing because you're already at the ceiling.
Vicki Hemmett (12:21.647)
And this is where I found a little bit of a gap in care when I was doing my training because I was used to finding hypertonic muscles externally and releasing them through active motion and That was something that I felt was really limited in terms of how I was to understand the pelvic floor
in terms of a treatment perspective, because I didn't invest in the biofeedback machine. I'm all about the palpating. When I'm asking a woman to do a Kegel, I'm saying, what is actually activating? Is it the posterior compartment? Is it the anterior? Are you holding your breath? Are you bearing down? Is the one side failing, or is the other side really flared up? And what I typically find is, what I tell patients is that they just kind of squeeze for their life and hope for the best. And there's really no
you know, kind of confidence or like a relaxed and confident Kegel exercise. And as you know, you know, there's not just one Kegel exercise either. You know, there's fast twitch and slow twitch fibers of that skeletal muscle, muscular portion of the pelvic floor. So I really speak to teaching, you know, this posterior section of the pelvic floor is really responsible for this endurance hold. So it's a different activation. And then the middle portion is kind of in.
is more in control of these combined fibers. And then there's the fast twitch fibers too. So teaching women to really.
utilize the pelvic floor for them, you know, kind of efficiently for the portion of the pelvic floor where it's designed for us to activate for certain things, you know, and then the progression from there, we have two licensed athletic trainers on staff. And so, you know, that rehab component with diaphragmatic breathing, bringing in the transverse abdominis activation is really going to be important with that in addition to, you know, getting more into functional exercises.
Vicki Hemmett (14:21.759)
It's a progression along the chain, but before we even get to those Kegel exercises, we definitely down-regulate with this pelvic power release as I was telling you about, because to reduce the tension and increase the normal baseline tone is really our goal, and then we start to move from there. And there's great research that actually shows the manipulation actually feeds forward into the pelvic floor to down-regulate, which is super cool, you know? It's just one of those wonderful
Kim (14:25.303)
Mm-hmm.
Kim (14:50.807)
Mm-hmm.
Vicki Hemmett (14:52.079)
findings that I came across and anecdotally, absolutely works.
Kim (14:58.242)
When you say manipulation, do you mean sort of the standard chiropractic manipulations? Is that what you're talking about? Yeah, yeah. Cool.
Vicki Hemmett (15:01.437)
Correct. Yes, yeah. So that's the external, you know, the external component. And just, you know, when you think about it again, from a biomechanical standpoint, just that if there's no restrictions in the pelvis from a bony standpoint, and from a facial standpoint, and from a tendinous standpoint, and muscular standpoint, you know, it just allows this freedom of movement and...
you know confidence that the woman is able to kind of utilize her pelvis in a really efficient way.
Kim (15:33.714)
Would the manipulations be anywhere because chiropractic manipulations again at least in my experience have been sort of from head to sort of pelvis unless there's a specific indication to go down below but it's typically in that top part of the body. I haven't had a lot of experience with pelvis a little bit of it but mainly it's been back and neck again that's maybe just my body but I don't I don't
I see more of a soft tissue person as opposed to the, as you say, pop and crack style. But is it, so in a person with incontinence, is it, and when you say the manipulations can help down regulate, is it more pelvis centric? Is it more spine, neck, or where, or the whole length of the chain?
Vicki Hemmett (16:03.013)
Yes. Yeah.
Vicki Hemmett (16:07.377)
Mm-hmm.
Vicki Hemmett (16:15.899)
love.
So more, I would say, lumbosacral to look at the lumbar plexus and the sacral plexus, kind of stimulating those nerve chains because they are the ones that feed forward into the pelvic floor. So of course, we treat what we find from a palpation standpoint, but yes, in the absence of any like, oh, I have low back pain or specific hip pain, we kind of go in to treat what we find and typically that's a restriction in that lumbosacral region.
That's a lumbar manipulation, SI manipulation, long axis traction for the hips is wonderful to really kind of open up that space where that obturator comes in, and alcox canal, and the pubendal nerve, all of that stuff is really nice to allow some motion to happen through there because there's a lot of tension that can get stagnant in those hips.
Kim (17:09.882)
Can you talk a little bit, before we move on from that, can you talk a little bit about obturator? It's such an interesting muscle in terms of how, because it's, depending on who you talk to, if you look it's not in that immediate bucket of pelvic floor muscles, it sort of interweaves, if you want, but can you describe a little bit about where it is, what its function is, and why it is so intimately involved with the pelvic floor?
Vicki Hemmett (17:24.493)
I know.
Yes.
Vicki Hemmett (17:34.749)
Well for sure. I mean the obturator is a very deep muscle and I always was frustrating to treat from an external perspective because it was such a deep muscle to get external to internal. But when I'm palpating from an internal perspective, you can 100% kind of get into that acetabulum region and where the femoral head comes in and you can feel the different fiber orientation and you can really
kind of appreciate how much abduction, abduction that happens, hip flexion, hip extension, as you're palpating the muscle in real time. And so you can really see where the restriction is and at the same time, palpate where that muscular restriction is. So, you know, it's a, in turn, it's a primarily hip stabilizer, I would say, from a muscular standpoint, but it is a very intimate,
pelvic floor muscle because it attaches. I have to remember my anatomy. I didn't realize it worked. You know? Yeah.
Kim (18:41.559)
Sorry, we don't need to go that deep, but it's a deep rotator and it wraps around and does that sort of 90 degree turn.
Vicki Hemmett (18:48.337)
Yes.
And a lot of what you suspect as a laboral issue or what you suspect as an impingement issue that's challenging to treat externally, from a rehab and a chiropractic standpoint, sometimes this internal work can really be fabulous to reduce that tension just directly onto the muscular belly. And that will also give you a sense of how much true range of motion that joint really has.
And whether you can kind of use a differential list of like, oh, if it's a restriction in the muscle and you can reproduce that again, it kind of like takes some of those, you know, helps with diagnostics without imaging, I guess I would say in the moment. Kind of treat it conservatively first.
Kim (19:35.99)
Right. And I was, I'm gonna ask this question here just because I don't wanna lose sight of it in case I forget. But when we're talking about manipulations and the pelvis in particular, there's a technique that I've heard of which I didn't know during my pregnancy but is called the Webster's Technique. Is that something that you're trained in and something that you utilize? And if so, what is it?
Vicki Hemmett (19:53.809)
Mm-hmm.
Vicki Hemmett (19:58.557)
Absolutely. So the Webster technique is designed for women who have breech presentations with their pregnancies and again working alongside with their OBs to make sure that there's no contraindications of care. Typically how I usually describe it is that there's normal fetal motion, you know, when the baby kind of moves around in utero and sometimes, you know, the baby might twist where their head is up instead of head down.
And typically that is a restriction on a round ligament in the front and then the opposite SI joint posteriorly. So if you think about a dishrag kind of being, you know, kind of run out, you can kind of think about that in a 45 degree angle. And so the objective with this.
Breach technique is that you're releasing tension within that round ligament. It's a you know a direct palpation to that structure You're not touching the baby or not doing any external versions or anything. It's very comfortable and then you're also Reducing the restriction within the opposite side of the SI joint With the mindset that you're reducing that tension and they're reducing, you know kind of that wrung out kind of idea
and allowing the baby to kind of fall head first, which is where they want to be from a gravity standpoint, but there's so much restriction through there. So that's a powerful, powerful technique. And again, it's risk free. The only side effect is typically the low back pain that's accompanied goes away with that technique. But it's a fabulous technique that speaks volumes to the...
importance of addressing the musculoskeletal structure during pregnancy and how it really impacts not only like pain syndromes but also functional syndromes with pregnancy.
Kim (21:49.207)
Mm-hmm.
Kim (21:56.462)
Could you use that technique on somebody who is not even pregnant or somebody who didn't have a breach presentation but was pregnant and had back pain? And then, like I said, somebody who's not pregnant at all and has low back pain or pelvic issues, can similar techniques be used?
Vicki Hemmett (22:12.377)
Interesting question. So the technique really is truly designed to help with the breach presentation. However, again, I would always assess round ligament in any pregnancy. I would assess side to side. And if there is tension in that, I would proactively work that to make sure that the baby's in optimal position. I usually always adjust pregnant ladies in the SI region.
because the piriformis muscle kind of crosses both the SI joint and the hips, and that's kind of the most, that's, I believe the statistic is 70% of low back pain is sacroiliitis, so it's such an important structure, which I can get into, you know, kind of the relaxing component and why that is, but yes, so I mean, in isolation, all of those treatments are really applicable to pregnant ladies in general, just to optimize pelvic motion.
And then, you know, in a non-pregnant state, the round ligament is less stressed because it's obviously not being pulled so much by the uterus. But what I find is another kind of a silent muscle with pelvic floor dysfunction is that psoas muscle. So it's regionally about the same. And so I always look at psoas because a lot of people think that they have.
ovarian cysts that's kind of causing some of this pain, and when A, that's rolled out by an ultrasound, or B, if I could reproduce the pain by palpation and then kind of have the patient engage it, it's really, it's a fun diagnosis to make because it's easy to take away, right? Like cytomodifications with active release techniques, with kind of the rehab engaging TA.
Kim (23:50.115)
Mm-hmm.
Vicki Hemmett (23:56.657)
to help protect that lower back so the muscle doesn't have to engage so much. So that's a great diagnosis and typically will really help with pelvic floor work also because I said it has facial connections not only to the diaphragm which is so important and the pelvic floor itself.
Kim (24:14.082)
So before we move on from incontinence, just to kind of close that loop, your premise, and this may be the premise for everything you treat, but essentially it's kind of down regulating the system, some external manipulations, some internal work to kind of get a status and release some of that tension that's in the way and then start to work with some of, say, the kinesiologists or whoever in your clinic to do the active rehab component, would that be fair?
Vicki Hemmett (24:39.101)
Absolutely, yes. And I would just say normalizing baseline tone. Whether that's through the manipulation, if there's tension in the joints, through the active release techniques, just kind of getting to a baseline tone where you feel like you're kind of starting at a really healthy blank canvas, if you will, and then building from there. And again, it's all specific to whatever the patient's goals are, what their needs are. Everybody has this different...
Kim (24:44.661)
Mm.
Kim (25:04.892)
Mm-hmm.
Vicki Hemmett (25:09.237)
lifestyle, they have different amount of kids and what they're doing for work and what they're doing for play and what they're doing for fun and everybody has different goals. So we really do work together with that. So yes, my job is to really assess, make a good diagnosis and get the patient to a really healthy non-painful baseline of care and then move up from there and yes, work collaboratively with our rehab trainers.
I am the only one in the office that does the internal pelvic floor work. And I do condition-based practice. So when we're at medical end and everyone's feeling great, then we dismiss you from care with a toolbox of care. And they can come back if necessary or tune up every six months like the dentist. Or sometimes you just say, I'll see you maybe after you have your next baby or something like that.
Kim (25:58.562)
Mm-hmm.
Kim (26:05.066)
Right, right.
Vicki Hemmett (26:05.65)
to work to optimize function and to optimize pain relief and to really meet those goals for the patient.
Kim (26:17.487)
Yep. And I could, I imagine, so urgent consonance can often be tension in the muscles as well. So I think a similar approach if somebody was to come in with urgency would be, it would be similar. Is there anything different that would happen?
Vicki Hemmett (26:23.307)
Mm-hmm.
Vicki Hemmett (26:32.913)
Absolutely not. I mean, I think you can get the different presentation for the same physical findings. And that's very true with low back pain is that two people can present with exactly the same symptoms but have totally different etiologies and vice versa. So, you know, it really is the while the history is important and understanding what the main problem is in diagnosis.
Kim (26:43.126)
Mm-hmm.
Vicki Hemmett (27:01.277)
That's almost secondary to what I'm finding physically what's happening and then just kind of going from there. But yes, that urgency is annoying and people think that it's a small bladder or overactive bladder and there's a component of that for sure but most often it's just a high tone on this pelvic floor that really needs to be down-regulated and freed up and manual manipulation of the tissues.
Kim (27:26.786)
Yep, yep.
Vicki Hemmett (27:30.021)
really is a fabulous way to address that. Permanently too.
Kim (27:35.606)
Yeah. Okay, yeah. So moving on to prolapse. Sometimes tension comes into play with prolapse. Sometimes it can be laxity. Sometimes it can be the integrity of the actual suspension structures. So what, walk us through what that looks like. Somebody coming in doesn't, like let's just say they have a bladder prolapse. What sort of...
Vicki Hemmett (27:38.225)
Mm-hmm.
Kim (27:58.634)
treatments and manipulations do you find can be helpful for that and does anything change compared to what you're doing with incontinence?
Vicki Hemmett (28:06.117)
Yes, I would say that there's not a lot of big variability in terms of the exam and the treatment. Again, just kind of going with what I'm palpating. I think the big difference for that would be really the lifestyle in terms of...
and the demands of maybe lifting the baby. And that's when I would rely a little more heavily on my rehab team to really kind of work with me and helping the patients really understand how to do a really efficient and effective Hegel exercise. And then when you are doing that, how to then functionally brace the pelvic floor with the breasts. And so I kind of more rely on my rehab team
the TA activation, the dynamic motion, by holding the pelvic floor, but not by stressing it out too much. And also, you know, collaboratively working with my OBs, sometimes at Pessary, you know, if they wanted to return back to running or training is necessary temporarily or during times of, you know, intense exercise and how to co-manage that condition with the patient and with their other providers.
Kim (29:12.034)
Mm-hmm.
Vicki Hemmett (29:22.747)
is definitely something that can be healed and you know can really be reversed and it just takes a little bit more time I would say and a little bit more effort on the patient's home care stuff but you know it's totally reversible if you're depending on the level of course but it just takes a little bit more of the rehab effort I would say versus the straight out manual work that I would do. Yeah.
Kim (29:36.727)
Yep.
Kim (29:43.094)
Right.
Kim (29:51.158)
Right, right. And incontinence and prolapse are not exclusive to women who've been pregnant, but we know that pregnancy and childbirth are known contributors and risk factors to these conditions. So kind of, you know, from back when I started, my work was really with pregnant women initially trying to get the information to people to prevent, learning about things like the Webster technique and...
other pelvic floor physical therapy and other things we can do from a prevention perspective. And I know that that's part of your practice as well with you have a prenatal program or programming around that as well. So can you talk a little bit about what do you advise, what do you teach that population and what would you recommend for people who are pregnant?
Vicki Hemmett (30:39.933)
Yeah.
for sure. So I love treating pregnant ladies because it's such an exciting time especially for a first-time mom it's a really exciting time in their in their lives but it also can be really scary if you know it would just have the unknowns so the education piece is really important and again in drawing on my specialty is musculoskeletal so that's where I you know that's where my scope of practice is so I just that's where I am very
Vicki Hemmett (31:10.591)
I have a lot of experience in. So I just tell patients that you know, it's totally common to have pain early on even if you are not, you know, a big belly because at 16 weeks the relaxin hormone actually peaks most in pregnancy, which is interesting. You would think that it would be later on in the pregnancy. But even at 16 weeks your bodies are really preparing for this big transition and you know relaxin only has an effect on ligaments. So it doesn't affect the actual
striated muscles. And so your body's just really kind of feeling unstable and loosey goosey, but the muscular system is completely blind to relax in, and they're sensing that everything is just unstable. So the muscles actually engage around those muscles to stabilize. And so that's where patients will get plantar fasciitis, and they'll get knee pain and hip pain, and absolutely this localized sacroiliac pain,
and low back pain, sciatic symptoms also, and you know really understanding again looking and palpating all of the musculature and for me from a chiropractic standpoint, I'm not putting a bone into place. I'm assessing for joints that aren't really moving all that well and typically it's because there's a muscle that's crossing the joint that's spasmed or tight. So really kind of looking at
Vicki Hemmett (32:40.351)
anatomy books and I show them what the muscles look like and teach them exercises to stretch the muscles. But just as important is that stabilization piece, that rehab piece. So really giving them permission and empowering them to actually use transverse abdominus when they are pregnant in a healthy way. I think that that's really important. A lot of women tend to shy away from exercise when they are pregnant because they want to protect the baby, which is understandable.
ways to activate core and to activate pelvic floor and to activate diaphragmatic breathing in a healthy way that will really kind of set you up for success postnatally because the more fit you are as you know going into a pregnancy and a delivery, the better recovery processes in that fourth trimester which is challenging for sure. So yeah definitely do some manipulation. We do this the muscle manual muscle technique but really looking at stabilization making sure their footwear is great.
Kim (33:30.307)
Mm-hmm.
Vicki Hemmett (33:40.071)
sure that they're sleeping properly with proper pillow placement and using ice instead of heat and teaching really great specific exercises for patients through the pregnancy.
Kim (33:55.886)
Can you talk a little bit to ice and the heat? I'm curious on that, because there's been so many backs and forth that used to always be ice initially, then heat, and then it was like, no ice, just heat. And now you're saying ice, not heat. So what's your rationale there?
Vicki Hemmett (34:05.585)
Thank you.
Yeah, so my personal take is that ice is typically best. For me, I kind of think about it as flames in the fire. So if you're already at an inflammatory process and you're already kind of hot, if you will, then just putting heat on it will kind of increase the flames. But it's also a vasodilator. So the good thing about heat is that, yes, it does bring in blood to the region. And all of the kind of anti-inflammatory cascade
happen and you'll get good work there for the white blood cells to help with that process. But typically people just lie on their heating pad all night long or their heated pillow and so there's never this push back into the lymphatic system to actually all of those byproducts of that process like the lactic acid. That's never pushed back into your lymphatic system with ice or movement.
Vicki Hemmett (35:08.647)
lingers in that region and too much of that I think is not a great thing. So for me, ice is an analgesic, it's a natural anti-inflammatory, it's a vasoconstrictor. I actually say after you do all of your rehab or stretching or exercise, then that's when you put the ice on, not before or if you're in acute pain to put it on a region, either your, you know, maybe neck pain for a headache or low back pain, but really optimally to move the muscles,
and then throw a nice pack on for 10-15 minutes to really get that fluid exchange, what we call a vascular whip, right? Like you get that opening and then the shutting down and then drinking lots of water to push through the lymphatic system so your body can naturally do what it really wants to do.
Kim (35:56.758)
And with the placement of the ice, would it be anywhere on the body? Or would you ever apply it externally to the vulva, to the buttocks, to anywhere?
Vicki Hemmett (36:07.361)
A region of pain for sure. So it's very, very effective for sacred iliacs, joint dysfunction and pain, certainly piriformis syndrome. But I'd say away from the vulvar region, I mean those tissues are pretty sensitive, but you know what, the best thing for ice for pregnant ladies is this pubic symphysis, right? So pubic symphysis is so exposed to this relaxin because of its cartilaginous structure and the baby is right there, right? That's kind of like that pelvic ring
opens up mostly in that region. And so these little tiny muscles that kind of fan around it in a nice little rainbow tend to engage and get really, really tight and painful to the touch. So we do like this really nice kind of sweeping technique to really kind of help reduce the inflammation and the tension in those pyramidalis muscles and pectineus. And just...
throwing an ice pack in on that pubic symphysis region just inferior to where that belly is immensely relieving for these pregnant women. And then of course it's like we want to get out of the car with both feet on the ground instead of one foot on the ground and teaching them how to walk up the stairs and that kind of thing to stay stable. But icing the pubic symphysis is gold.
Kim (37:29.174)
Yeah. One final question, just thinking about the pubic symphysis and pelvis and pregnancy. There's a lot of, I've seen them now more on social media. So once one person does something on social media, usually then somebody catches on, it becomes a trend and you see a lot of pregnant women who are walking on a curb. So they have one foot on the top of the curb, one curb, sorry, one foot on the road or the lower part, or they may go up and.
Vicki Hemmett (37:41.661)
Mm-hmm.
Kim (37:58.626)
their stairs and down their stairs in that staggered stance. So what is the, what's the reason? Why are they doing that?
Vicki Hemmett (38:05.509)
You know, I have been perplexed when I have seen that, you know, because for me, I feel like it may be provoking some asymmetry if they're not doing it both sides. Like if you're just walking down the road one side, I feel like there's so much stress on the one side. I think the idea is to maybe, you know, open the pelvis a little bit in preparation for childbirth. But I get worried that there's just...
Kim (38:20.951)
Yeah.
Vicki Hemmett (38:34.917)
not enough stabilization in these core muscles. You know, your knees are full of ligaments that can be exposed to this relaxin. Your ankles can be exposed to that. I mean, you have 26 joints in your foot. And so it's really important to, if you are walking up and down on that unstable surface, like you really do need to be engaged and be aware of just core activation to stabilize, especially in a pregnant state.
So I get nervous about that. Something similar that I would suggest is maybe like happy baby type exercises or kind of reaching out to a healthy prenatal yoga studio to really kind of work with opening the pelvis and doing stretches and again, understanding the purpose of what you're doing because your body will naturally do it. I mean, listen, women have been birthing for thousands of years and so we...
We know how to do it. We just need a little bit of help. So having that information, that education, and I know that's a big thing that you do too, is just informing them of their anatomy because I think that's something that is missed and it's really important to have patients understand what's happening, not to be afraid of it, but to work with their bodies and to be patient with their bodies too. A lot of times...
If you're an athlete and you have the pregnancy and you don't want to slow down, it's sometimes it's really important to be patient with your body and to know that this is just a little blip in your life. And it's really important to listen to your body if you need to.
Kim (40:06.39)
Mm-hmm.
Kim (40:15.594)
Yeah, I love that. It's a perfect way to end. Where can people find you to potentially come and work with you or to learn more about the programs that you have?
Vicki Hemmett (40:22.633)
Thank you. So I am chiroqueen.com and on Instagram and Facebook and all of the social outlets at Chiroqueen. So that's a pretty easy way to find me. We still own our clinic up in Vermont. So we are in near Burlington, Vermont that you can have access if you want an inpatient experience. And I just opened my new clinic down here in Naples, Florida. We relocated our family about two years ago. So this practice here is really...
specializing just in women's health care and it's such a pleasure to be able to bring this to Southwest Florida.
Kim (40:59.798)
Amazing. Thank you. And I'll post links to all of those in the show notes below. But I really appreciate your time. And I love the, I love the blend of chiropractic with pelvic health that you are, like I, I've had chiropractors come to my certification course that is non-internal. It's, it's a, it's really designed for kind of fitness and allied health professionals. But I don't know of anybody who's combining.
Vicki Hemmett (41:01.977)
Amazing. Thank you.
Kim (41:26.734)
chiropractic with the internal piece as of yet so you're a bit of a trailblazer.
Vicki Hemmett (41:30.365)
I believe I am probably the only one and it just makes so much sense but it's such a pleasure and I just I really am trying to use this platform you know with the chiro queen to really educate providers and also other potential chiropractors that are interested and also a physical therapist like we all are in the same space there's we're all kind of have that same goal for our patients and it just happens to be that I'm a chiropractor and
what I know how to do also helps. So you know it just kind of makes sense for us all to work together and I'm just I'm grateful for the opportunity to speak to you because like I said you are also your own pioneer in this field and it's lovely to have it be more mainstream now.
Kim (42:19.434)
Yeah, amazing. Thank you so much for your time.
Vicki Hemmett (42:20.433)
Thank you, likewise.
