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Charisse Balance Chat - Pelvic Floor, Yoga, and Dogs

Gena Graceful founder, Tracy Steingold, sat down with Charisse Balance – an expert on women’s Pelvic Floor. 

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I have known Charisse for around 6-7 years.  She has always been a ray of sunshine, phenomenal energy, a big heart for others and especially dogs, and the expert of all things physical therapy and yoga.  Most recently, she opened her practice up to an area that all women need to be aware of and unfortunately, most just aren’t.  Her approach to working with women and making them feel comfortable and normal is such a breath of fresh air.  So here is a recap of our session chatting with on what it is she does exactly and why it’s important.  Hope you enjoy!

Tracy:  Charisse, thank you so much for taking the time to chat with me.  I think you are amazing and you do so much for women – so I’m excited to talk more about what you do.  We’ve known each other for about 6-7 years now, however, for everyone else – could you tell us a little bit about yourself, such as where you are from, what you do, etc?

Charisse:  Of course!  I hail from the amazing city of San Francisco, CA.  I am a dog lover (yes, I'm that crazy dog lady!), nature worshiper, yogini (not just asana, but try to live the ongoing, experiential practice of the yoga sutras in my everyday life - Thank you to my teacher Kate Holcomb!) and an anatomy nerd turned physical therapist.  

Tracy:
An anatomy nerd turned physical therapist…hmmm, I have already learned something new about you!  Haha!  Can you tell us a little bit more about your educational background?

Charisse: 
I received my doctorate in Physical Therapy in 2009 and since then I’ve become absolutely obsessed with all things pelvic floor. My obsession started as I treated patients in my chronic pain practice - I felt helpless when patients said they couldn’t sit because “their tail bone hurt”.  I felt the most direct way for me to effectively treat the coccyx (Tail bone) was internally - however I didn't have the tools to do so at the time.  I pursued extra studies in abdominal and pelvic rehabilitation, and it was there that my MIND was BLOWN!  We learned so LITTLE of this stuff in PT school - probably since its unethical to force students to do internal palpations on each other against their will.

Being in my stage of life, I began to gain interest in how pregnancy effects the pelvic floor - to best prepare my body for what was to come.  I’m not tall, I’m 2 inches shy of 5 feet! I wanted to know everything possible to prevent avoidable dysfunction/injury to my body, come time for pregnancy.  In my search for this knowledge, I learned SO MUCH and felt the need to share all of the info to my fellow women preparing and or recovering from pregnancy and birth. 

Tracy:  That is amazing.  I had no idea about pelvic floor therapy before pregnancy and really not until speaking with you a while back.  The only thing I was really told was to be in shape and keep doing those kegels.  For everyone wondering, what is Pelvic Floor Therapy?

Charisse:  Pelvic floor PT focuses on the skeletal muscle function of the pelvic floor. It also focuses on the muscle function of the abdominal wall and diaphragm, as all three (PF, Abdominal wall and diaphragm) work together to stabilize the midsection and provide support to the internal organs.

Tracy: That sounds important, but could you tell us why?

Charisse:  This is SO important because your pelvic floor is responsible for: Peeing, Pooing and Pro-creating (Sex).  All very important activities of daily life! Our society places so much shame on discussing your “private parts”.  I believe that this has led to a cultural disassociation from the pelvic floor and as a result, a significant lack of awareness of these muscles.  Your pelvic floor muscles are skeletal muscles, just like your biceps and quads. You have voluntary control of these muscles! You should be able to voluntary contract, relax and lengthen these muscles for optimal functioning - if not, then it is likely you have pelvic floor dysfunction.

Tracy:  Interesting.  You are so right, no one ever talks about their “private parts” when it comes to this topic. 

Charisse:  The first thing most people think of when they think PFPT is “Kegels”- Yes Kegels are important to maximize the strength of your PF muscles to support your pelvic organs and prevent pelvic organ prolapse (when a pelvic organ intrudes on another pelvic organ’s canal due to weakness of the musculature). However, if you are constantly focusing on tightening your pelvic floor and not getting full excursion of the muscle length, it’s as if you’re holding your bicep in flexion all day - not allowing your elbow to straighten. Functionally, you NEED full relaxation and lengthening of these muscles to produce optimal force / strength to hold gas, pee or poop.

Tracy: Yikes, I’m a little speechless on the bicep metaphor.  Okay, so please tell me there is something I can do on my own.

Charisse:  YES!!  Become familiar with your pelvic floor - how it looks, how it feels, what is normal. Think of a breast exam. If you do routine exams on yourself, you will become familiar with the normal consistency of your breast tissue - you will know what lumps are normal. In that, you will be able to recognize when an abnormal lump arises. Likewise, it is important to become familiar with your vagina – yes, I said it. Look at it, feel the outside (vulva), feel the inside of your vaginal canal - know what YOUR normal is. I tell my patients to do malasana (yogic squat) over a mirror to become familiar with what their perineum and vulva looks like.  You can also do a self-test of your pelvic floor muscle function. When squatting over the mirror, pay attention to the perineum (The tissue between the rectum and the vagina). This is where many of your pelvic floor muscle tissues intersect, creating the perineal body. Look at the perineal body’s position as you contract your pelvic floor (close your holes and pull up and in), relax to resting position and bulge and lengthen your pelvic floor (a helpful cue is “belly big and belly hard” as you lightly bare down while exhaling). You should notice your perineal body move upward with the contraction, come back to rest, and lower towards the mirror with the bulge.  

Tracy: I can see why you didn’t get to practice or learn too much about this in PT school 😉  This makes perfect sense and seems easy enough.  Looks like I need to get a mirror I can stand over.  Any other final thoughts on Pelvic Floor before a few more questions?

Charisse:  Yes, let’s stop the stigma about talking about our vaginas and the functions of our pelvic floor. It is important to discuss these things to bring awareness to them so that issues (if any) can be addressed and you can be helped.  Many moms I talk to think that they are committed to a life of incontinence after giving birth due to a perineal tear - this is not true! Know that there are things you can do to help - but you can’t get help if you aren’t able to discuss it. 

Tracy: Girl, I hear you.  I’m originally from the South and modesty is a pretty big part of how I grew up and that includes not talking about your “privates” and the like.  Now being in the panty business, I talk with women all the time about their intimates – I have had to open my mind and it’s a refreshing thing to see more and more women opening up and discussing not just their booty when it comes to panties, but how things cover and fit their other lady areas.  Hopefully we are moving in the right discussion to feel more comfortable discussing our bodies.  So, I want to jump into your yoga practice as that is a huge part of you as well.  I’m familiar with yoga and physical therapy, but can you explain what is Physioga?

Charisse:  Physioga is my own personal blend of therapeutic yoga. I use the evidence-based practices and extensive knowledge of anatomy and kinesiology to inform the therapeutic yoga I use to address patient’s needs. My goal is to educate and therefore empower my clients with knowledge about their bodies so that they are aware of how to move in a healthy way to prevent/minimize injury and maximize their quality of life. I believe life is not merely to be alive, but to be well. 

Tracy:  Very clever.  I love your blending of your PT expertise and yoga.  Also, I think you just gave us one our next quotes for social media – Life is not merely to be alive, but to be well.  If that isn’t a statement to be healthy, I don’t know what is.  Now, I know you have trained in yoga, but you can let us know more specifically what area(s)?

Charisse:  I have pursued my yogic studies in the art of Restorative Yoga, Yin Yoga and Prenatal Yoga to best serve my client population.

In today’s society, productivity and “doing” and is applauded. This can result in an imbalance  n one’s nervous system, resulting in chronic stress. Restorative yoga aims to soothe the nervous system, as one’s body is completely supported by props. Each pose is held for at least 20 minutes to allow for one’s nervous system and body to completely release into the support of the pose. Regular restorative yoga practice has been proven to decrease chronic stress, decrease cholesterol, decrease overall excess muscle tension and improve sleep. (This is my absolute favorite yoga practice!).

Yin Yoga focuses on release of the fascial system. The practice entails low load stretching held for at least 3 minutes. This is SO important, as with injuries and trauma the fascial system maintains holding patterns which, over time, becomes restricted and prevents the flow of information in the body resulting in suboptimal functioning of various systems of the body. Your fascia is like an internal spiderweb that connects everything inside of your body. When healthy, it is hydrated and soft. Unhealthy fascia becomes hard and restricted. 

Prenatal/postnatal yoga takes into consideration the specific physiological and anatomical changes that occur during pregnancy. Movements are designed to minimize injury due to the increased mobility that occurs with hormonal changes during pregnancy. Postnatal yoga focuses on sequences and poses that promote strengthening of the pelvic floor and deep core to counteract the effects pregnancy had on mobility and laxity.  I use all of these tools therapeutically to serve my patient’s wellness needs. 

Tracy: I am learning something new every time you explain what you do!!  I enjoy yoga from time to time, but now I feel like I need to search out specific styles now knowing this.  Not to mention go to one of your classes next time out in San Francisco. 

I know you are extremely passionate about your work, but I also know that you are the crazy dog lady too – just kidding, but you do love dogs and you foster them and so much more right?  Could you tell us a little bit about that?

Charisse:  I have a definite soft spot for all dogs (I call them furry soulmates). When I was a little girl, I wanted to be a Vet.  I learned that this would be impossible for me because I would never be able to euthanize a dog, nor would I have the emotional capacity to see all the sad things that happen to dogs when they come into the vet clinic.  Instead of being a vet, I’ve shown my love for dogs in other ways.  I’m that person that will try to chase down a loose dog on a busy street so that it doesn’t get hit by a car and keep the dog at my house until I find the owner (true story on multiple occasions!).  Amongst my friends, I have gained the reputation of the “dog rescuer” and over time friends and family would come to me when they were looking for a new furry member of the family. I find joy in finding dogs in need (i.e. shelter dogs or dogs that are being given up by their families for whatever reason) and matching them with a forever home.  Friends and family learned this and would go to me give me dogs in need to find homes for.  I will also foster dogs in need, socialize them and care for them until I find them the best home possible. I WISH I could have acres of land and have a dog rescue, but because I live in SF, I try to do my part - one dog at a time.  I call my rescue “better together pet match”.  So far, I’ve placed 6 pups =) 

Tracy: That is wonderful!  You have such a huge heart and I know do so much for all the furbabies out there.  Well if you ever find a way to open a large dog facility, let me know, you know I am a huge dog lover as well.  “Better together pet match”…you need to hashtag that by the way 😊

Only a couple more questions, I know you need to get back to helping people/work.  You do so much career wise and personal wise, how do you stay motivated - what motivates you?

Charisse:  The yoga sutras motivate me to be the best version of me possible.  The teachings states that yoga is an ongoing experiential practice that you have the opportunity to practice in every single action you take on, but mostly off of the mat. The practice helps to ground me and continuously connect me to my authentic Self.  I love the Sutras because they not only motivate me but remind me to quiet the mind to connect to the (authentic) Self and ultimately feel better. The teachings remind me that I always have the liberty of choice in every action I take, which motivates me to choose to act from a place of authenticity - like, what does my GUT say about this? Is it in alignment with what really resonates with me? Or am I doing this for other reasons - the awareness of choice alone is empowerment. Of the Sutras, Sutra 2.16 says “Heyam Dukham Anagram”- avoidable is the suffering that is yet to come. Yes, in life, there is suffering, but it’s the extra suffering on top of the suffering (that my teacher says), that you can circumvent, when you use the tools from the Sutra. 

Tracy: That is powerful.  I love so much about how you think about everyday and every moment.  Having the opportunity in every single action you take, following your gut, the awareness of choice alone is empowerment…again, you are putting out some great quotes to live by! 

What keeps you going day in and day out?  What inspires you?

Charisse:  My patients inspire me on a daily basis - seeing them overcome and transform over the time I work with them is an intrinsic reward that no amount of money can replace. They are SUCH a source of inspiration.

My teachers inspire me - My sutra study teacher Kate Holcomb is the living example of the yoga sutras. The ways in which she used the teachings of the Yoga Sutra to overcome life’s challenges is mind blowing. My Prenatal yoga teacher Jane Austin has given me confidence in myself and my body as I prepare to embark on pregnancy and parenthood. She has instilled confidence in what a woman’s body is capable of during birth - what is NORMAL and EXPECTED so as to not medicalize the birthing process as an “Emergency”, rather, as a normal physiological process. She teaches a postnatal yoga class, with full on 30-40 babies and mamas, caring for crying babies as she seamlessly goes on to teach her sequence and tend to the mamas. Her strength in womanhood is such a gift to everyone she meets. My Restorative Yoga Teacher Judith Lasater - I absolutely love. She was a Yogi and went to PT school to improve herself as a yoga teacher. Her empathy, intuition, anatomical knowledge and her ability to apply it all to yoga has hugely inspired my “physioga” practice. 

All of my strong empowered girlfriends inspire me on a daily - some moms, some entrepreneurs, some doctors, some heads of companies - they each in their own way inspire me to be that much stronger and to stand in my womanhood. 

Tracy:  You are such an inspiration Charisse.  Your inspiring women seem kind of like pay it forward moments, when we are fortunate to have amazing people/women in our life that inspire us, and if they do it right, we get to inspire and help others.  You are one of the first Gena Graceful Role Models for a reason and I feel that chatting with you today, helps everyone else understand why. 

Last question, I promise…not that you aren’t busy, but what do you do when you aren’t working and saving all the doggies?

Charisse:  My work and play are SO intertwined - I guess that is on purpose! I teach yoga to my patients therapeutically but NEED to practice yoga myself to fill my cup for self-care.  Just like I give exercise prescriptions to my patients, movement is MY medicine.  Be it at yoga, a TRX class, on a hike with my pups - I need to move! I’m a sun chaser and a nature lover - nature is my medicine as well.  I find a sense of connection when visiting other countries and learning about other cultures - because of this my husband and I travel a lot. 

Tracy:  I need to take up more of your thought process and mantras versus just my coffee intake to have your energy.  HA!  Are there any final thoughts for our ladies out there or a favorite quote you have?

Charisse:  Live the life you want to live, because it’s possible…AND love your pelvic floor! 

Tracy:  Thank you so much Charisse for your time, your wise words, your energy and what you are doing for women.  You have been a wealth of information, a huge inspiration to make some changes to everyday life, and just a pleasure to chat with.  Thank you again. 

 

Be sure to follow Charisse on Instagram @balanced.physioga

Also her for more information on Pelvic Floor, Physioga, Charisse’s practice in general, please check out her website at: https://www.balancedphysioga.com/