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Mommy & Me Yoga Got Me Out the Door. It Is Not a Return-to-Run Program

Mommy & Me Yoga Got Me Out the Door. It Is Not a Return-to-Run Program

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Here’s what your running-informed pelvic floor PT wants you to know before you hit the road.

Let Me Be Clear: This Is Not a Hit Piece on Yoga

I love mommy and me yoga. I really do. Back in 2011, with my first son, there was a Wednesday 11:30am class at a local studio that felt like the holy grail of early postpartum life. Getting there required military-level logistics: timing vaccinations, navigating unreliable naps, figuring out nursing in public, clearing a C-section recovery timeline that told us nothing was allowed until 6–12 weeks postpartum.

But I showed up. And it was less downward dog and more baby-wrangling, nursing on the mat, and the awkward first phases of what I now call “mom dating” — feeling out whether you could really be friends with these women after you got past the breastfeeding, cloth diaper, and sleep training conversations.

One of those moms moved away. One friendship faded when the boys stopped getting along as they got older. And one of those families? They’re still our family friends. Our boys, now 15, are still friendly. So are the little sisters. And the dads. I credit that class with keeping me sane in early motherhood and my longest mom friendship. I wouldn’t trade any of it for the world.

What I cannot credit it with is preparing my body to run again.

What Mommy & Me Yoga Actually Gives You

Let’s be honest about what that class was — and wasn’t — doing:

  • Community and socialization at a moment when isolation is real.
  • Mental health support — getting out of the house is genuinely therapeutic.
  • Some gentle movement — a starting point, not a destination.
  • Mom dating opportunities (which are underrated and essential).

What it was not giving me: progressive loading, single-leg strength work, impact preparation, intra-abdominal pressure management, or anything resembling the components of a return-to-run readiness screen.

Did I run anyway? You betcha. Lots of walking first, then stroller runs, and eventually a postpartum 10K at 7 months. Did I do it with any kind of systematic prep? Absolutely not. Because back then, we didn’t know better. We just handed women kegels and told them to wait.

Here’s What Running Actually Demands

Running is not just “moving your legs faster than a walk.” It’s a high-impact, high-pressure, single-leg sport. Every stride asks your body for:

  • Single-leg loading and stability
  • Significant intra-abdominal pressure management
  • Hip and glute strength to absorb ground reaction forces
  • Core coordination — not just strength, but timing
  • Pelvic floor load tolerance — repeat, progressive, dynamic

A gentle yoga class — even a great one — doesn’t build those capacities. It can lay groundwork, but it cannot be the only step if running is your goal.

What I’d Do Differently — And What I Tell My Patients To Do

If I were doing it over again with the knowledge I have now, here’s what I’d change:

  1. Don’t skip the Mommy and Me Yoga. They’re in there for a reason. Go. Even if the baby is fussy.
  2. Add targeted exercises at home. Tummy time is a perfect opportunity — your baby is on the floor, you’re on the floor. Drop into a plank. Add some glute bridges. It just needs to be the intention of building consistency.
  3. Complete a return-to-run readiness screen. Find your gaps. Pick three exercises that target those gaps. (Worth noting: this concept didn’t even exist until circa 2019). Build consistency, coordination, and strength.
  4. Use a walk-run program intentionally. Not “run or nothing.” The gradual approach isn’t weakness; it’s strategy.
  5. Don’t rush to reclaim your former self. I know you’re scared of losing your identity. But who you’re becoming is so much more than who you were.
  6. Date around a little. If you’re in the DC area, try local resources like SLAM, Fit4Moms, and Mind the Mat. The community piece of postpartum recovery is not a luxury — it’s part of the prescription.

The Bottom Line

Something is better than nothing. But know what you’re getting from each “something.”

Mommy and me yoga is beautiful for community and mental health. It is not a substitute for run-specific preparation. Make sure your actions match the goals you’re setting for yourself. If running is what you’re working toward, build a plan that actually accounts for what running demands.

Were you ever told a single class or activity was “enough” to return to running postpartum? Drop it in the comments — I’d love to hear your story.

Nike “Walkers Tolerated” Controversy

Nike “Walkers Tolerated” Controversy: Why Walking, Running, and Postpartum Exercise All Count

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You can’t promote movement for pregnant and postpartum athletes—and then suggest some forms matter less.

I was a Nike kid. Like… obnoxiously Nike. Black running tights, peak 80s energy—with a thick white stripe up the side and HUGE obnoxious hot pink NIKE letters stamped right down my thigh (IYKYK). I thought I was freaking FloJo.

My first real running shoes were Nike Air Pegasus. Circa 1988. One pair a year—for cross country and track. Because they weren’t my back-to-school shoes? They felt different. Special. Earned. Mine.

Fast forward. Now I’ve got a tween daughter who would love to roll into school in Air Force Ones like her friends. And she knows better than to ask. Because in our house? We have a no Nike rule.

Why the “No Nike” Rule?

Once you’ve read Kara Goucher’s The Longest Race… once you’ve heard Allyson Felix, Alysia Montaño, Mary Cain… you don’t get to unknow that.

So when I saw the ad—“RUNNERS WELCOME. WALKERS TOLERATED.”—my first thought was: Of course you did.

Boston weekend. Lean into the elitism. Stir the pot. Maybe they assumed those of us who aren’t chasing a BQ (Boston Qualifier) weren’t paying attention. But we are. The ones who run, walk, volunteer, and spectate without needing a cutoff time to justify our presence.

The Marketing Disconnect

Here’s where it gets messy. At the exact same time Nike is running that ad, they’re also running a global campaign—launched in 2022—centered around: “Moms are athletes too.”

They’ve built out prenatal and postpartum training inside Nike Training Club, featuring legit names like Brianna Battles and researcher Laurel Proulx, PhD. That visibility matters. But you can’t say you’re meeting women where they are—especially in pregnancy and postpartum, where movement often starts with walking—and then turn around and say: “Walkers tolerated.”

The Renaissance of Postpartum Care

We are in a full-on renaissance right now. The research is exploding (shoutout to @drmargiedavenport and @mfm_lab). We’re finally challenging the “rest and don’t do too much” narrative.

We’re seeing icons like Tia-Clair Toomey—Fittest on Earth eight times—featured at 24 weeks pregnant, talking about slowing down and listening to her body. That shift is a game changer.

But you can’t build an ecosystem around supporting modified movement and then put out messaging that ranks movement at any pace.

Ranking Movement Loses the Point

Some brands see women—and movement—as moments. Right now, it’s marketable to support pregnant athletes. But this isn’t just about women; it’s about movement at any pace. The second you start ranking who belongs more, you lose the whole point.

For some of us, this isn’t a campaign. This is the work. The patients. The conversations. This is me—as a clinician and as a mom—figuring out my own body through pregnancies, postpartum, and now perimenopause.

We Fought for This Space

Women weren’t even allowed in races not that long ago. We were told lifting would make us “too masculine.” If you want that history, listen to my conversations on the Active Mom Podcast with authors like Danielle Friedman (Let’s Get Physical), Christine Yu (Up to Speed), and Maggie Mertens (Better Faster Farther).

When I see messaging that starts ranking movement again, I’m paying attention. Because if walkers are “tolerated” today, who’s next?

  • Postpartum bodies on a flare day?
  • Slower paces?
  • Modified workouts?

If you only know how to support movement when it’s convenient or profitable, you never really got it in the first place.

When “It Sounds Right” Isn’t the Same as Being Right

When “It Sounds Right” Isn’t the Same as Being Right

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Why this kind of pelvic floor advice pulls you in—and why it doesn’t hold up

I saw a video today that made me stop scrolling. And if you know me, you know I usually don’t stop. I keep it moving—because the second I pause, I can feel myself getting irritated.

Not just because of the misinformation, but because it was packaged just well enough to take off. It wasn’t wildly wrong or dangerous in an obvious way. It was just… convincing enough to make you think: “Wait—should I be doing that?”

The kind of post that blows up for a reason

Here was the gist: A postpartum mom with multiple kids and zero symptoms gave a full breakdown of how she “supported” her pelvic floor:

  • Right-sided pelvic floor overactivity
  • Targeted inner thigh stretching
  • Internal release work with a wand
  • Side-specific strength and “pelvic balance” strategies

She has a Grade 2 prolapse, no symptoms, runs marathons, and lifts heavy. The post had hundreds of likes and shares. And somewhere, a mom is watching this thinking, “Okay… so what am I doing wrong?”

Throwing around words that sound smart but say nothing

I actually understand why this lands. When you’re dealing with leakage or pressure, you want a plan and a reason. This content uses just enough medical language to sound legit.

But let’s look at the phrasing: “Right anterior pelvic floor overactivity” or “Pelvic balance.” I’ve been hearing and using words like this for over 30 years. It’s basic directional terminology from PT 101. When you string them together, they sound like a breakthrough, but they don’t actually provide clear, measurable, or useful guidance. If I asked 10 clinicians to define “pelvic balance,” you’d get 15 different answers.

The right-side vs. left-side trap

This is where we go off the rails. We do not have evidence that:

  1. Most people have a dominant “overactive” side of the pelvic floor.
  2. Organ asymmetry drives predictable pelvic floor patterns.

We all have asymmetrical organs (unless you have two hearts—if so, call me). We are still debating what “tone” even is and whether we can reliably assess it with a finger on a muscle. Building an entire “fix” strategy off of that is a major stretch.

The hook: “She doesn’t have symptoms”

The natural leap is: “If I do what she did, I’ll get her result.” Except we have no idea what her baseline was, her genetics, her connective tissue profile, or her medical history. The definition of prolapse has shifted—it’s not just anatomy; it’s anatomy plus symptoms. Grade 1–2 prolapse can exist in people who have never had kids and have zero symptoms.

We don’t know if anything she did actually “prevented” symptoms or if that is just how her body presents.

Pelvic floor symptoms are a unique recipe

Pelvic floor symptoms don’t come from one variable. They come from a recipe of:

  • Load and capacity
  • Hormones
  • Sleep and stress
  • Medical and birth history
  • Genetics (and yes, your poop matters, too)

It’s not one stretch or “fixing” your right side.

What’s actually worth taking from this?

  • A multimodal approach makes sense.
  • Staying active matters.
  • You can have anatomical prolapse and feel completely fine.

If you followed my personal story step-by-step, there is zero guarantee it would work for you because bodies aren’t templates. Don’t expect to find the answers to your problems in mine. You’ll just end up throwing darts at a board hoping they stick.

You didn’t do anything wrong

If you have symptoms, it isn’t because you picked the wrong exercise or failed to “balance” your pelvis. Sometimes it’s just the roll of the dice—genetics and birth history.

You aren’t stuck or broken, but you do need a different question. Instead of asking “What did she do?” try asking “What is my body telling me—and how do I work with that?”

Just because someone sounds smart doesn’t mean they are. And just because they don’t have symptoms doesn’t mean they hold the answer to yours.

Postpartum Return to Running Is Not a Checklist (And We Need to Stop Pretending It Is)

Postpartum Return to Running Is Not a Checklist (And We Need to Stop Pretending It Is)

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Readiness to run postpartum has come a long way. And honestly? That part is really exciting.

Because not that long ago… there was no guidance. No conversation. No real support for women who wanted to get back to running after having a baby.

But now? We’ve swung hard in the other direction. Now there’s guidance everywhere. And not all of it is good. Because at this point? EVERYBODY and their mother—(or just-became-a-mother with a Canva account and an uncomplicated postpartum)—has a marketing lead magnet disguised as a postpartum return-to-run guide.

I have zero issue with marketing. I use it, too. But the problem starts when a 1–2 page PDF is supposed to tell a postpartum mom: “Yep. You’re ready to run.”

The Problem Isn’t the Marketing. It’s the Message.

I downloaded one recently: “5 signs your postpartum core is ready to run.” I was curious because we don’t actually have an evidence-based, standardized way to determine if your “core is ready to run” postpartum.

Even the 2019 UK guidelines—which are a helpful starting point—aren’t fully validated for postpartum yet. Before that, we used basic screens that included:

  • Double-leg hopping
  • Planks
  • Step-ups
  • Single-leg squats
  • Wall sits

It was a start, and it included impact, but it wasn’t the whole picture.

Breaking Down the Flawed “Signs”

Let’s look at what some of these guides actually suggest:

1. “You can breathe through movement without bracing” Running is not a squat. It’s reflexive and anticipatory. You don’t get to “prepare your breath” the same way when your feet are hitting the pavement. This “sign” simplifies physiology to a point where it no longer makes sense for running.

2. “10 single-leg calf raises with zero leaking” Calf raises tell me about your calf endurance (and usually you need 25-35 reps, not 10). They tell me almost nothing about how your pelvic floor handles the high-velocity impact of running.

3. “Your core connects before your limbs move” This is often tested by standing on one leg for 10 seconds. In reality, a wobble could be ankle instability or vestibular changes from pregnancy—not a lack of “core connection.”

4. “You can walk 30+ minutes symptom-free” This is a great baseline prerequisite. It shows you can tolerate low-level load. But walking is not running. Stroller walking and baby carrier walking are also completely different loads.

5. “You feel strong and confident” While nice, most early postpartum moms are sleep-deprived and in a hormone fog. I’d rather see a foundation of strength and core work 2–3x/week. Running alone isn’t enough; we need to stop treating moms like they are fragile and instead help them build durability.

When the Running Program Falls Apart

This is where things usually say, “Tell me you’re not a runner without telling me you’re not a runner.” I see 4-week progressions that increase running volume by 50% or 60% in a single week.

Standard training usually suggests a 10% increase. These guides stack more running, less recovery, and changing total times all at once. That’s a stress spike, not a progression.

A Smarter Way to Progress

Instead of changing every variable, I manipulate one variable at a time. Total time stays the same while we shift the ratios:

  • 1:4 (Run:Walk)
  • 2:3
  • 3:2
  • 4:1
  • 5:0 (Continuous)

Repeat each stage 2–3 times. If symptoms show up, they aren’t a failure—they are information. We adjust, find an in-between ratio, and keep going with a plan rather than just “pushing through” or “starting over.”

Run Readiness Is Not a Checklist

I’ve been a PT for 27+ years and a runner for 43. This isn’t theoretical; it’s lived. After hundreds of conversations with researchers and elite athletes on the Active Mom Podcast, I’ve landed here:

It depends. It depends on your genetics, your delivery, your sleep, your support, and your strength.

What I Actually Recommend

  1. Foundations First: Sleep, fueling, and mental health.
  2. Walk Tolerance: 30–40 minutes with minimal symptoms.
  3. Real Screening: Testing balance, strength, and impact tolerance.
  4. Phased Approach: Moving from return to activity → exercise → participation → sport.

A 5-question checklist isn’t enough. Learning to pay attention to your body and following an adaptive plan is a much better place to start.

Rock and Roll Half 2026

No PR. Just This.

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There was no plan for a PR yesterday.
(Spoiler alert: there wasn’t.)

The plan was to get to the start line healthy, take it all in, and finish. That’s it. No big expectations. No chasing a number. Just… be there and see what the day gives me.

The start line (and the very real pre-race pee nerves)

Race morning was actually smooth. Suspiciously smooth. I even randomly ran into a colleague on the way to the corral, which was perfect timing—just enough distraction to take the edge off those pre-start nerves.

And then, about five minutes before we were supposed to go…

I had to pee.

And not in a “maybe I should go just in case” way. In a this is going to be a problem if you ignore it way. Because yes, pre-race pee nerves are real, but this was also very real.

So I did the quick mental math and slipped out to hit one of the porta potties right outside the corral. Figured that was way better than trying to ignore it for the first mile.

Felt efficient. Felt like a good decision.

Until about a mile in when I realized… my soft flask with three gels was gone.

Gone gone.

Somewhere between urgency and trying to get back into the corral, I left it behind.

But—this is where being an over-preparer pays off—I had backup gels in my holster. Not ideal, but also not a disaster. Just one of those early “okay, this is how today’s going to go” moments.

And then we were off.

Settling in (and choosing logic over pride)

The first few miles felt oddly… easy. Not fast, just steady. Like things were clicking without me forcing it. I knew people had to be out there on the course, but I didn’t see a single familiar face. (Post-race Instagram told a very different story—apparently a lot of you were there.)

Then Calvert Hill showed up.

If you’ve run it, you know.

That 6–10% grade that always feels personal.

There’s always someone yelling at you to run it. Yesterday it was the drill sergeant. And I’m sure he meant well, but I power walked it anyway and very quietly flipped him off in my head.

Because it wasn’t worth it.

Not worth the energy. Not worth blowing things up that early. That was one of those moments where experience wins over ego. Old me probably would’ve tried to prove something. Current me? I’ll take the smarter move every time.

Got to the top, picked it back up, and not long after I started to feel a little hamstring cramping. Nothing dramatic, just enough to get my attention.

So I walked a bit.

Not because I had to. Because I wanted to keep going later.

The heat (and adjusting on the fly)

Then the sun started to make itself known.

It was one of those perfect blue sky mornings, mid-50s, which sounds amazing unless you’ve spent the entire training cycle in freezing temps, wind, and layers. I’ve had more than a few long runs in -12 windchill this winter, bundled up and just trying to get through it.

This? This was a different kind of stress.

And historically, heat and I are not friends. It’s not just “oh I slow down a bit.” It’s the lightheaded, slightly nauseous, everything-feels-off kind of situation.

So I adjusted early. Grabbed water, took a few sips, dumped the rest over my head. Over and over again. It was clear pretty quickly this wasn’t going to be a fast day, and honestly, that was fine.

The middle miles (where you just keep going)

Somewhere near Howard I missed a friend I thought I’d see, and then suddenly we were rolling down North Capitol—those little downhills under the overpasses and the climbs back up.

At some point I noticed my Garmin was consistently ahead of the mile markers, which just confirmed what I already suspected… no one was running tangents. Everyone was just following the person in front of them.

And then somehow we were getting close to the end.

The last mile (when everything hits at once)

That last mile and a half… I remembered it from 2023. Long. Kind of sneaky in how it drags out. I kept ducking into whatever shade I could find and doing the mental math.

Ten minutes. Maybe fifteen.

That’s it.

And then my playlist shifted.

Heart’s version of Stairway to Heaven from the Kennedy Center Honors.

If you know it, you know. It starts slow, almost too slow for that moment, but then it builds and builds until it just… hits. There are a few songs that do that—no matter how many times you’ve heard them, they just cut straight through everything.

I’ve had training runs where that song comes on and my stride opens up, I look up, and suddenly I’m crying for no logical reason.

And there I was again.

Closing in on the last 400 meters, that same feeling creeping in. The straightaway felt like it went on forever, but I knew I was there.

The finish (and what it actually meant)

After my second labral tear in 2024, I really didn’t know if I’d get back to this. Not in a dramatic way, just in a very honest, realistic “I don’t know how this is going to play out” kind of way.

But I just kept taking it piece by piece. Mile by mile. Adjusting when I needed to. Not forcing things when they didn’t feel right.

And in that moment it all kind of landed at once—

My body can still do this.

I’m still here.

There aren’t that many moments where you feel like you’re sitting right on the edge of discomfort and something really meaningful at the same time. Where it’s hard and emotional and kind of messy and really, really good all at once.

This was one of those.

Some people come back for PRs.

Apparently, I come back for that.

The after (because this part matters too)

After I finished, I met up with my husband and daughter. She immediately took about half of my post-race snacks, which—let’s be honest—I fully expected and planned for. Because that’s just what moms do.

Hot shower later, I found the exact spot where my water bottle had been chafing my back (turns out winter layers were hiding that problem pretty well).

A couple slow walks with my dog, and by the next day it already felt like it had shifted into memory.

Why this mattered (and why I’m sharing it)

Because none of that happens without what came before it—

  • The cold, slow miles.
  • The wet runs you almost talk yourself out of.
  • The snow-crete footing.
  • The early mornings before anyone else is up.
  • The honest moments where you look at what’s not working… and keep going anyway.

That’s the part that builds this.

That’s the part that makes that one moment possible.

And I’m really grateful for that.

What’s next?

I’ve got a few things to sort through now—some cramps, a couple niggles, and yes, some pelvic floor questions in there too—so the adventure definitely isn’t over.

Will I do another one?

I honestly don’t know.

And I’m kind of okay with not knowing.

Your turn

We talk a lot about goals and times.

But the moments that stay with you are usually something else entirely.

Have you ever had one of those moments where it wasn’t about the outcome—but it still hit you way harder than you expected?

Eight Years, a Yard Sale, and a Back Room Full of Sombreros

Eight Years, a Yard Sale, and a Back Room Full of Sombreros

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How a Dreary November Day Turned Into a Practice That Changed My Life (and Theirs)

There are some things you can count on me to remember.

My kids’ birthdays.

Our dog’s gotcha day.

And then there are things I should remember… like my own business anniversary.

February 27th marked 8 years in my office for Carrie Pagliano Physical Therapy. Eight. Years.

In so many ways it feels like yesterday. In other ways, it feels like a lifetime ago.

In October 2017, after 11 years at Georgetown University Hospital and 18 years as a practicing PT, I stepped out to do a little home care. I told myself it was just to “see.” To decide if it was finally time to do this on my own.

Thanksgiving weekend, I was out on a walk and passed a yard sale in front of a garden-style apartment building. I almost kept walking. Instead, I stopped.

Tom and Bob—the owners—were clearing out a front office space they’d just decided to rent to the business next door (a builder company that eventually went bankrupt and skipped out on their lease… police eviction and all… but that’s another story).

They mentioned they had a back storage space and offered to show it to me.

Floor to ceiling junk.

Sombreros.

Old chemistry books.

Things I still can’t identify.

Collectors? Hoarders? We’ll never know.

I said, “If you ever want to rent it, let me know.”

Two days later, I called them.

They said yes.

Managing the Momentum of Big Moves

Here’s the part that feels very on-brand for me.

The week before I opened my doors, I was sworn in as President of the Academy of Pelvic Health Physical Therapy.

Clearly… I’ve never had an issue taking on more than one big thing at a time.

New brick-and-mortar business.

National leadership role.

Two young kids.

Sure. Why not?

Looking back, it sounds mildly unhinged. At the time, it just felt like momentum. Like when you know you’re supposed to step forward, even if you don’t yet know how it’s all going to work.

Eight years ago, solo PT practices were rare. Especially in pelvic health. Pre-pandemic, the idea of stepping away from insurance-dictated care and building something independent felt… risky.

I asked a few friends how to do it. I didn’t love the answers.

So I decided to do it my way.

I negotiated a lease. Picked carpet. Chose paint. Shopped at IKEA…A LOT. (And you know what comes after that) Learned more about occupancy permits and Arlington County signage regulations than any human should ever need to know (spoiler: the hoops are MANY). Passed inspection.

Voila. I was a business.

Pivoting Through the Unexpected

Two steady years of patient care came to a grinding halt on March 17, 2020, when I closed in-person sessions because of COVID.

After a few days of complimentary check-ins, I pivoted fully to telehealth. Not totally foreign—I’d done virtual second and third opinions before—but suddenly it was everything.

Meanwhile, my kids were “homeschooling” first and third grade.

I consolidated my schedule. Waited until after they got up. Took my daughter to the office with me. Did telehealth while she played with toys in the corner. Hosted the occasional virtual classroom check-in from my treatment table. Turned my clinic gym into snack central.

That went on for months. A few sporadic in-person sessions in May. Back to 50% in October 2020. In the 5+ years since then, the office has settled into the new normal of a hybrid practice—currently 75% in-person, 25% virtual.

Survival, Seasoning, and the Second Opinion

If I’m honest, it wasn’t until 2023 or 2024 that I felt like I even partially stepped out of fight-or-flight as a parent and a business owner.

By then I’d already passed the five-year mark. I’d watched small businesses around me close. Survival felt like a miracle.

Eight years in, I’m used to my head being down and when I pop up, I realize I’m still here. A little wiser. A little clearer. A little more “seasoned” as a business owner.

Pelvic floor PT isn’t the secret we’re shouting from the rooftops anymore. Around the DC area, it’s much closer to standard of care. That’s progress.

It also means more providers. More practices. More options.

Which has naturally gently nudged me to niche down.

Now, a lot of what I do is second opinions. The cases where someone did “all the right things” and still isn’t where she wants to be. The runner told to stop running. The lifter told to stop lifting. The mom with prolapse navigating return to sport. The woman in perimenopause who is finally done leaking and done pretending it’s fine. That’s super cool to be able to give options when someone was told there were none.

The Power of Saying “Yes”

The beautiful part about living in the Arlington/DC area? There is no shortage of active, driven women who want to feel strong in their bodies at every stage.

And I’m humbled each day to get to help them.

Last Sunday, I was out on a long run when a woman passed me going the opposite direction. A few minutes later, she circled back.

“You changed my life,” she said.

She was a former patient. Four years out. Training for Boston.

She told me I talked to her about “dinosaurs…” the other providers who had told her no, but I had said “yes.”

It’s those moments. The unexpected ones. The ones you can’t plan or manufacture.

All made possible because on a dreary November day I stopped at a yard sale and asked to see a messy back room.

Because eight years ago I decided to hang a shingle.

Because sometimes you leap before you fully know how the landing will feel.

It still feels ridiculous to write this much about it. I don’t naturally shout things from the rooftops. But this is my way of saying thank you.

To the Arlington/DC community.

To the women who trust me in person.

To the virtual clients all over the world.

To my family and friends who let me turn a storage unit full of sombreros into a business.

Eight years later… we’re still here.

And if you’re standing at your own version of that yard sale moment—wondering if you can hold more than one big thing at a time—what would happen if you just said yes?

You’re Not Broken. You’re Just Running on 2019 Information

You’re Not Broken. You’re Just Running on 2011 Information.

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Why pelvic floor physical therapy for leakage, prolapse, and perimenopause looks very different in 2026 (and what that means for active women)

I love seeing repeat patients.

Not because something went wrong.

But because life happened.

Another pregnancy.

Kids are older and suddenly you have 45 minutes to yourself again.

You’re diving headfirst into perimenopause and wondering why your body feels… different.

Or maybe three years ago there was a lot to do and pelvic floor PT slid quietly off the priority wagon.

Recently, I was lucky enough to see a woman I’d treated three years ago. The goal was to get back to herself again, and one of my favorite parts of this job is helping women return to their recreational sport — soccer, ultimate, curling (yes, really), sword fighting (also really), a 5K fun run. That said, life got to life-ing and after a few visits, it wasn’t the right time to keep coming.

Getting back to the thing that makes you feel like yourself again? That’s not small.

That’s identity.

Not being able to be yourself? We shouldn’t have to give up on that, no matter how many grenades life throws at us.

The Pelvic Floor Isn’t a Block of Concrete

Here’s some fun stuff that happened in the meantime since I first saw that patient…

There’s A LOT we’ve misunderstood for a long time about the pelvic floor.

We’ve hyper-focused on the pelvic floor muscles — strength, kegels, squeeze harder, hold longer.

But structurally and functionally, your pelvic floor works with:

  • Fascia
  • Ligaments
  • The vaginal wall
  • Connective tissue support systems

Together, they create dynamic support to maintain continence and organ support.

It’s actually a simple pressure equation:

  1. If pressure below > pressure above → usually no symptoms
  2. If pressure above > pressure below → leakage or pelvic pressure

That’s it.

But here’s where it gets interesting.

In 2024, Marie-Ève Bérubé and colleagues published research showing that after a run:

  • The levator hiatus (the opening) is larger
  • The bladder neck sits lower
  • The levator plate length is longer (aka the pelvic floor)

And this happened in runners with and without running-induced stress urinary incontinence.

Translation?

Your pelvic floor changes shape after running.

That’s normal.

It’s not supposed to function like a brick. It’s meant to be dynamic.

So when someone tells you to “just kegel before you jump,” it tells me they don’t understand how the pelvic floor actually works.

When you run or jump, your brain anticipates the impact and automatically activates your system. Mid-air, it decreases activation. On landing, it increases again.

You cannot consciously time that and you sure as hell can’t think that fast.

Anyone suggesting you can is asking your brain to override a anticipatory activation and reflex loop that fires faster than you can think.

Sometimes It’s Not About Strength. It’s About Support.

With this returning patient, we knew there were coordination and timing issues. Impact activities like hopping reliably caused leakage. We KNEW strength wasn’t the issue so kegels weren’t on the menu.

So we tried something that wasn’t even part of my skillset three years ago.

A pessary.

Think of it as an orthotic for your pelvis.

Before fitting, I had her hop in place.

Five or six hops in? Leak.

I assessed her pelvic floor, measured for a simple ring pessary, checked the fit, and had her try again.

She stopped at 30 hops…because she was tired…NO LEAKS!

We removed it to confirm.

Five hops.

Leak.

Sometimes clinical reasoning really is that clear. She didn’t have enough support or coordination. We added support, it was enough to address the symptoms.

Now the plan is straightforward:

  • Order her personal pessary
  • Ensure she can insert and remove it independently
  • Add vaginal estrogen for tissue health support
  • Shift focus to lingering hip/back discomfort
  • Progress cardiovascular capacity and recreational sports to get back to feeling like herself again.

Because once your pelvic floor symptoms are no longer the barrier, everything else becomes possible.

What This Means for Perimenopause and “Vintage” Moms

I’m seeing more and more women my vintage (aka we have kids in middle school, high school or even college).

When we had babies, pelvic floor PT barely existed. If you went, it was often:

“You had a baby. You’re weak. Let’s get you stronger. Here are your kegels. Good luck.”

Maybe they worked.

Maybe they didn’t.

Maybe they partially helped and you quietly blamed yourself for not doing enough.

Now you’re in perimenopause and symptoms are back — or they never fully left.

Here’s the truth:

We’ve learned a lot.

Not just in 10 years.

In the last 3.

In the last 6 months.

Pelvic floor physical therapy for stress urinary incontinence, pelvic pressure, and return to running in perimenopause looks very different today than it did in 2019, even 2023.

Understanding normal pelvic floor morphology changes with impact allows us to choose better solutions because we understand the WHY more than ever.

Sometimes it’s strength (it’s usually not).

Sometimes it’s coordination.

Sometimes it’s tissue support.

Sometimes it’s external support like a pessary.

Often, it’s a combination.

But it’s almost never just “only do more kegels.”

If You Tried Pelvic Floor PT Before…

And it didn’t work…

Or it kind of worked…

Or you stopped going because life got loud…

Or you blamed yourself for not being consistent enough…

Enough of the guilt trips.

You’re not broken.

You might just be operating on outdated information.

I love when past clients come back because I get to look at them with new eyes and new tools. The science evolves. My skillset evolves. The options expand.

And sometimes it really is that simple.

Does this sound like you?

If you’re in the DC/Arlington area, I focus on complex and second-opinion pelvic floor cases for active women and perimenopausal athletes.

Not local? I offer virtual consults and collaborate with colleagues nationwide.

It might be worth another look.

Because returning to your sport — your run, your league, your fun — isn’t just about exercise.

It’s about getting yourself back.

Email me directly: carrie@carriepagliano.com

Keep the Village. Add the Expertise

Keep the Village. Add the Expertise

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A hopeful, evidence-based approach to postpartum pelvic floor rehab beyond kegels and internet advice

Sometimes at 2am, when you’re sore, leaking, Googling, and wondering if your body will ever feel like yours again… the internet feels like the only place awake with you.

And I get it. I really do.

Because I’m a huge fan of the village.

I love that more women than ever are accessing pelvic floor physical therapy.

I love that we’re talking about leakage and prolapse out loud instead of whispering in locker rooms.

I love that postpartum moms aren’t just quietly accepting “this is your new normal.”

That part? That’s progress.

But here’s where I need you to gently tap the brakes.

Support is one thing.

Medical advice is another.

And somewhere along the way… we started treating them like the same thing.

When community quietly turns into crowdsourced healthcare

We’re crowdsourcing our healthcare now.

Facebook groups.

Reddit threads.

“Hey moms — what worked for you?”

And honestly? With the barriers to care — insurance, cost, geography, childcare, time — I don’t blame anyone.

If you’re not getting answers from the system, of course you’re going to go where you feel understood.

That makes total sense.

But when the question shifts from:

👉 “Has anyone else felt this?”

to

👉 “What should I do medically?”

That’s when I need you to hit pause.

The kegel thread that made me sigh

I’m in a few everyday-women-driven groups. Some diagnosis specific. Some running groups. Mostly kind, well-intentioned spaces.

Then I see a post like:

“Is it okay to do kegels laying down at 8 weeks postpartum or should I be standing?”

Totally fair question. Great place to start.

And then the answers roll in.

Not curiosity.

Not “it depends.”

Not follow-up questions.

Just certainty.

“Definitely…”

“You should…”

“So much better…”

“My PT said…”

Over and over.

In one thread, “my PT said” showed up six times in nine responses.

Like gospel.

Like universal truth.

Like one person’s rehab automatically equals everyone’s rehab.

And every time I read that, my shoulders creep up to my ears.

Because after 25+ years treating pelvic floors?

If there’s one thing I know for sure…

It’s almost never that simple.

Here’s the part most people don’t see

A “simple” kegel can be:

Exactly what one person needs

…and exactly the wrong thing for someone else.

Same diagnosis.

Same postpartum week.

Completely different treatment.

Why?

Because bodies aren’t templates.

We’ve got:

  • genetics
  • hypermobility
  • nervous system sensitivity
  • birth history
  • sleep and fueling
  • stress and trauma
  • prior injuries
  • strength history
  • beliefs about our bodies
  • and a brain constantly trying to protect us

This is the nuance.

This is the stuff you cannot crowdsource.

This is where clinical reasoning lives.

Pattern recognition.

Asking better questions.

Forming a hypothesis.

Testing. Adjusting. Plan A, B, C.

It’s not sexy.

But it’s how people actually get better.

Why this keeps happening

And listen — I say this with empathy, not judgment.

Don’t forget, I’ve navigated my own pelvic floor issues through pregnancy, postpartum, and now perimenopause too. I’ve been the tired mom on the bathroom floor Googling. I’ve been the one who just wanted someone to hand me a plan and say, “Do this. You’ll be fine.”

So I understand.

I think this happens because we’re human.

We’re tired.

We want answers.

We want clarity.

We want someone to just tell us what to do.

And at 2am, when your nervous system is spiraling, a social media reply feels faster than booking an appointment.

Plus?

There’s this sisterhood in suffering that’s powerful. It reminds us we’re not alone.

“I tried this and it worked for me” feels safer than “it depends.”

But here’s the problem:

Personal experience is not the same as medical guidance.

And lately, I’ve watched women with no medical or professional background take one personal rehab story… turn it into a course… sell it… and suddenly they’re seen as more trustworthy than trained clinicians.

No oath.

No medical responsibility.

No anatomy or physiology background.

No ability to evaluate research.

Just vibes and testimonials.

And somehow… that wins.

And yes — I get it.

To a degree, I’m even a little envious of it.

Because I wear what I jokingly call institutional handcuffs — the ones I signed up for. Paid for. Trained for. Back when people automatically trusted medical providers.

And now those ethics require me to do something that doesn’t always sell well online:

Slow down.

Ask better questions.

Shine a light on the nuance.

Even when nuance is the last thing someone wants to hear.

The irony I can’t ignore

Here’s what’s wild.

The more research we get about pelvic health… the more questions I have.

Because science and working with thousands of women across 2+ decades humbles you.

It shows you complexity.

It shows you gray.

But online?

Everyone sounds more certain than ever.

A quick example of how myths stick around

I read a post recently from researcher Margie Davenport about where the idea came from that exercise causes miscarriage.

For years, women were told to rest. Be careful. Don’t move too much.

Turns out?

That belief came from specifically a 2007 study, that upon analysis, is heavily influenced by recall bias. If you ask someone about their exercise after a miscarriage — instead of when they’re happily pregnant and doing fine — of course their memory is going to skew. (If you’ve been there, you’re probably like, “no, duh.”)

Today…when we analyze the data correctly?

Movement is protective.

Just 10 minutes of walking a day is associated with a 25% reduction in preeclampsia risk. It supports both physical and mental health.

So for decades… women were told to restrict or self restricted movement for no good reason.

Not because anyone meant harm.

But because no one questioned the evidence hard enough.

Because “someone said” became “fact.”

Sound familiar?

So what’s the solution?

Not less community.

We need community.

We need stories.

We need “me too.”

We need the village.

But we also need:

  • More critical thinking.
  • More “this was MY experience, not advice.”
  • More providers explaining the WHY.
  • More nuance.
  • More humility and self reflection.
  • More “it depends.”

Because absolutes are rarely medicine.

They’re usually myths.

One of my favorite quotes

“There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.” — Desmond Tutu

That’s pelvic floor care.

Not random kegels.

Not throwing darts at a dartboard and hoping they stick.

But asking:

Why you?

Why now?

What’s actually driving this?

The hopeful part

And here’s what makes me optimistic.

More women are asking questions.

More women are demanding better care.

More women are finding pelvic floor PT.

More research exists than ever before.

We’re not stuck anymore.

We’re just learning how to pair the village with expertise.

Community for support.

Clinicians for medical decisions.

Both matter.

Both belong.

You don’t have to DIY this.

You don’t have to guess.

And your body isn’t broken — it just needs the right plan.

So next time you’re scrolling at 2am looking for answers… ask yourself:

Am I looking for support, or medical advice?

Because those are not the same thing.