This week on Steeped in Wellness, we dive into pelvic floor health with physical therapist Danielle Pasquale. Pelvic health isn't just for women, but critical for men too. Danielle explains her path into specializing in pelvic health, noting that a deep connection to working with women led her to this niche. She shares that pelvic floor strength is foundational for all movement, impacting athletes and non-athletes alike, and that dysfunctions can present subtly, like through chronic constipation or recurring injuries.
We move into misconceptions, like the idea that a strong pelvic floor equals a functional one. Danielle stresses that full range of motion and neuromuscular control are more important than brute strength. We discuss how symptoms like hemorrhoids, urinary leakage, and even shoulder issues can stem from poor pelvic stability. Danielle walks us through basic breathing techniques crucial for pelvic health, emphasizing that exhalation should coincide with muscle contraction to properly manage internal pressure.
We even discuss vaginal weights and Kegels, with Danielle explaining that Kegels alone miss key muscle groups, and that proper pelvic floor activations require more comprehensive engagement. We also talk about how pelvic floor health affects sexual wellness, with Danielle noting that too much tension, rather than weakness, often impairs sexual function and orgasm, for both women and men.
Danielle explains internal pelvic exams and how she creates a comforting environment, reassuring listeners that therapy can be customized to their comfort level, including skippig that internal exam when necessary. We touch on common injuries tied to poor pelvic health, like back pain and core separation.. Danielle explains how dry needling can be used to release tension and improve mobility.
More:
Performance Optimal Health: https://www.performanceoptimalhealth.com
Danielle Pasquale’s Instagram: https://www.instagram.com/dr.danielle.dpt
We shift to pregnancy, where Danielle outlines her trimester-based approach to maintaining pelvic floor health, preparing for labor, and supporting postpartum recovery. We also briefly explore cycle syncing workouts, with Danielle sharing how she tailors her strength and cardio based on hormonal fluctuations throughout her cycle.
We close by learning more about Danielle’s practice at Performance Optimal Health and her virtual offerings. The episode is filled with approachable advice, practical breathing techniques, and encouragement for everyone, at any stage of life, to prioritize pelvic health.
Danielle Video
Speakers: Diana Weil, Elara Hadjipateras, Danielle Pasquale, & Jon Gay
[Music Playing]
Voiceover (00:01):
Welcome to Steeped in Wellness, brought to you by matcha.com. Here we spill the tea on wellness trends, personal growth, and the latest health news. Now here are your hosts, licensed dietitian Diana Weil and medical journalist Elara Hadjipateras.
Diana Weil (00:18):
Hello everyone. Welcome to this week's episode.
Elara Hadjipateras (00:21):
This week we are joined by Danielle Pasquale. She is a PT and a DPT, a physical therapist specializing in women's pelvic health, pre and postnatal fitness and dry needling.
With a doctorate from Ithaca College and a background in biomechanics research, Danielle brings both expertise and heart to her work. She's passionate about helping women stay active during and after pregnancy and believes that trust and compassion are key to lasting results.
When she's not at the clinic, you'll find her trying different workouts, doing hot yoga, or hanging with her super cute dog named Callie. Welcome Danielle.
Danielle Pasquale (00:59):
Thank you for having me.
Elara Hadjipateras (01:01):
Yeah, of course. So, this topic, pelvic floor health is near and dear to my heart. Just having had a baby, being pregnant right now, Diana just had a baby. Jon, pelvic health, also very relevant to men these days, so I hear.
Jon Gay (01:15):
I will say as a 44-year-old man where things don't bounce back like they used to, I can tell you for example, I slept too hard last night and woke up with a sore neck this morning. So, I know that hips and pelvis and that whole area, I know how important that is to overall health. So, I'm looking forward to this conversation too.
Elara Hadjipateras (01:32):
Before we delve into, I guess, pelvic health and how it affects women and then also men, what kind of drew you to this field in the first place of physical therapy and then specializing in pre and postnatal care and pelvic floor health?
Danielle Pasquale (01:45):
I think I probably have a bit of an unconventional route coming to it. If you had asked me in college if I was going to specialize in pelvic floor, I would've laughed in your face. I definitely was never really interested in it.
And I started working. I'd been at the same company for my entire career, and I started working with a lot of young athletes and I loved working with them, but I just didn't have that same passion and connection with as many of that demographic as I would've liked to.
And so, as I got further into my career, I was like, “Okay, I need to figure out what I'm actually going to do for the rest of it. And what little niche practice I can really hone in on?”
And so, I started thinking, I was like, “Okay, what demographic do I like working with the most?” And I was like, “I love working with females who are my age to older.” I just really connected the most with them and that's when I found pelvic floor. So, here we are (laughs).
Diana Weil (02:48):
One thing that stood out to me was that you worked with athletes, and I think that there's a really big misconception that it's just women who have had babies that need pelvic floor help. And I feel like actually it's a lot of athletes that need pelvic floor help both men and women. Could you touch a little bit on that, on if you're an athlete and why maybe you need to think about pelvic floor?
Danielle Pasquale (03:09):
Yeah, so I mean your pelvic floor and the muscles that make it up are your internal stability. So, it's the basis of how your body is going to move around each other. Everything comes from where your pelvis is, your hip movement, your trunk movement, even shoulder movement coming from your trunk.
It all goes back to how stable your inner core is, which your inner core is your actual core, your pelvic floor, and then some of the accessory muscles. So, as an athlete, if you don't have that inner stability, you're going to have all of these secondary injuries and it may come out in a hip injury, a knee injury, even a foot injury.
And it all could be stemming from not having enough stability in your pelvic floor, in your core, in that stability part of your body. So, I do think that a lot of athletes don't know how to really have a well-rounded training program that doesn't just do what their sport is but also trains them to have that stability for their body to do more dynamic explosive force production movements.
And along with that, which I'm sure we're going to talk a lot about as I get into stuff later, but the way that your body can manage pressure as well, so your abdomen holds onto a lot of pressure.
If there's an increase in pressure in your abdomen, which you find a lot of endurance athletes like runners, cross country runners, marathon runners hold a lot of tension in their abdomen just from the nature of their sport in that constant low mid-range breathing throughout a long period of time, that buildup of pressure actually puts more strain on your pelvic floor and over time can create a lot of other issues that they may not even realize are attributed to their sport.
So, yeah, it could go really across the entire board on who's affected by pelvic floor dysfunctions.
Elara Hadjipateras (05:13):
Would you say that some people genetically are just predisposed to have a stronger pelvic floor?
Danielle Pasquale (05:18):
Yeah, I mean I do think that genetics do play a role and that's going to play a role in just muscle tone in general. Some people are just more muscular people or can put on muscle easier. So, those people may have a stronger pelvic floor.
But what I've really found in this career is that just because a strong pelvic floor doesn't necessarily mean that it's functional and doing what it needs to do. So, people need to have not only a strong pelvic floor, but good neuromuscular control.
So, brain body awareness and being able to use muscles through full ranges of motion. If a muscle can't move through a full range of motion, it's not going to have its optimal level of activation.
So, I like to use the analogy of if you think of a bicep muscle and if your elbow's starting, and your bicep is already flexed and then from here to here, if you only tested it from here to here, it may seem that it's strong because this is the optimal point of that muscle. It can contract at this point.
But if you bring it all the way into its lengthened position and then ask it to contract, does it still have that same strength? So, making sure that even though a pelvic floor may be strong, it doesn't mean that it has the full strength through its full mobility which would allow someone to have that optimal level of muscle strength.
Diana Weil (06:48):
How would you know, is there a way while we're doing this podcast for example, for us to know? If we have full range of movement? (Laughs)
Danielle Pasquale (06:57):
Yeah. So, I mean obviously with what I do, I would actually test that out. But just from a standpoint of someone who's just an athlete or even anyone my age, older who's just an active person moving around throughout their day. One, there's a lot of different ways that it can also present.
So, if someone has a really tight pelvic floor meaning that those muscles are really contracted and they may have strength in that contracted position, which is why they don't get symptoms of urinary leakage or pain or feeling of heaviness.
What they may get is they may have another type of symptom; they may have chronic constipation and chronic constipation is actually a type of pelvic floor dysfunction. And a lot of the times chronic constipation is caused by this over pressure in your abdomen, putting pressure on the pelvic floor and making it contract in this very limited range and just holding onto it for long periods of time.
So, people may not even realize that having constipation, even if it's intermittent, could be a result of what their pelvic floor is doing throughout the day.
Diana Weil (08:16):
So, I've had a couple clients who've come to me for constipation. And everything about their diet looks perfect and they've seen doctors, they've seen GI specialists, they've seen me as a dietitian and I'm like, “I don't know what to tell you because you're eating enough fiber, you're drinking enough water, we're doing all of these relaxation exercises.”
And now it's making me wonder about pelvic floor health. Would that affect men as well as women?
Danielle Pasquale (08:41):
A hundred percent. Yeah, men also have a pelvic floor. While they don't always have as much dysfunction just due to the nature of not giving birth to a child, they do still have a pelvic floor, and it can definitely come out in the form of constipation as well. Yeah.
Elara Hadjipateras (08:59):
What about hemorrhoids? Would that be something related to pelvic floor health?
Danielle Pasquale (09:04):
Yes.
Elara Hadjipateras (09:04):
I don't know. Danielle maybe knows what I'm talking about here because she's actually … yeah.
Danielle Pasquale (09:08):
That plays into that pressure management thing that I was talking about. If you can't manage the pressure in your abdomen and it's putting pressure down on your pelvic floor, that could come out in the result as well of hemorrhoids.
And I think that people who are lifters and lifting weights and a heavy weight, and they're straining their body and they're not using proper breathing techniques as they're doing it or building pressure in their abdomen, putting pressure down on their pelvic floor.
Therefore, it could come out in something like a hemorrhoid as well, which I'm sure if you've talked to any weightlifters, usually people have had hemorrhoids at some point in their lifting career.
Elara Hadjipateras (09:48):
So, I know you mentioned that mid-range runners sometimes have a lot of pelvic floor issues. Then you have the heavy weightlifters that are having issues with hemorrhoids and pelvic floor pain. Is there any exercises or different fitness regimes or the ideal or optimum type of movement for your pelvic floor health? Maybe it's dancing, maybe it's swimming.
Danielle Pasquale (10:13):
So, my biggest thing with that is breathing techniques and learning how to do proper breathing techniques to manage your pressure. Not only when you're just doing that sport but training your body for that time.
So, I don't go for a run and think about how I'm breathing the entire time because I'm focused on running and how far I've gone and what's going on in my surroundings. I'm not thinking about how I'm breathing the whole time; however, I've trained my breathing enough to work with the muscles appropriately so that it's muscle memory and I'm just doing that more naturally.
Same with weightlifting, when I'm doing CrossFit during workouts, I don't — especially a fast, high-speed workout, I don't sit there and think about exactly how I'm breathing with each movement, but I've trained my body enough through these breathing techniques that it's muscle memory and that's how my body is breathing as I'm going through the motions.
Diana Weil (11:13):
Can you walk us through some of those, just some basic tips for breathing and how people should think about breath work in their pelvic floor?
Danielle Pasquale (11:20):
Yeah, so I always tell people you always inhale as you relax, and you exhale as you contract. The exhalation is supposed to be when you exert yourself so that you're exhaling and you're breathing out as those muscles are contracting and building pressure.
So, the muscle contraction is going to build pressure in your abdomen, so your diaphragm sits on top and then your muscles sit down here. If you think core pelvic floor, all of that, that stability portion, as you inhale your diaphragm actually moves down.
So, if you're contracting those muscles as your diaphragm is inhaling and moving down, you're getting this jamming motion in here in the midline of your body. And if you think about it, where's that pressure going to go?
The only two places it can go are number one, push back down onto the pelvic floor or number two, which comes into more pregnancy related and postpartum, will push out into your core, which if you've ever heard of like separation or diastasis in postpartum, that's going to further separate the core because you're adding pressure out into something that's trying to heal.
So, as you inhale, those muscles should relax and move down and as you exhale and that diaphragm recoils back up is when you should be contracting. So, you're getting this nice rocking motion and fluid motion and not this jamming motion of your midline.
Jon Gay (12:44):
For those of you listening to the audio version of the podcast, as Danielle is explaining this- Elara, Diana and I are all inhaling and exhaling and I saw you two doing it and I was doing it too where you're we're visualizing exactly what Danielle's explaining and I'm like, “Oh that makes total sense now that she's explaining it.” (Laughter)
Elara Hadjipateras (13:04):
Yeah, totally makes sense. The other thing that just came to mind Danielle is people using weights, weight training for their pelvic floor. Can you just explain a little bit of that and if you think that's a good thing, bad thing, necessary?
Diana Weil (13:21):
Wait, do you mean like putting something like up there?
Elara Hadjipateras (13:23):
Yeah, like-
Danielle Pasquale (13:23):
Like vaginal weights. Right?
Elara Hadjipateras (13:24):
Vaginal weights and I don't know how that would work for men if that's even an option, but I-
Jon Gay (13:29):
Uh, spoiler- it wouldn't!
(Laughter)
Elara Hadjipateras (13:30):
Well, maybe, yeah, I don't know where it would hang from.
(Laughter)
Jon Gay (13:35):
Check please, check please! Have a great show ladies. I'm done!
(Laughter)
Elara Hadjipateras (13:42):
Oh my God.
Danielle Pasquale (13:43):
I think that there's probably other pelvic floor therapists that may swear by them and use them. What I have found in the research is that there's not a huge difference in overall strength of the pelvic floor using vaginal weights versus not.
So, I don't personally use them. There's new research that's come out that just said that biofeedback and having someone tracking like how the muscles are contracting using different tools for the patient to actually feel it themselves and having someone who's evaluating it and reassessing the strength and giving exercises in different positions.
Like against gravity positions and standing or I'll have people do some type of cardio circuit and then work on pelvic floor strengthening in different positions that are more challenging or fatiguing the body and then do a more challenging pelvic floor exercise.
So, I found that that's more effective personally than having someone laying on their back in a non-functional position contracting and trying to use vaginal weights. So, yeah, and like I said, there's probably people out there that still use them just based on what I found in the research, I haven't put that in my practice at all.
Diana Weil (15:01):
I've heard a lot of people, pelvic floor specialists who get really irritated with the term Kegels, that they're like, “Oh, it's much more complex than that.” And I don't really understand why they're so frustrated with Kegels. Are you frustrated with people that are like, “Do your Kegels.” (Laughs).
Danielle Pasquale (15:16):
I wouldn't say I get too angry about it. I definitely think Kegels are not what a pelvic floor contraction is. And when I teach people how to make their pelvic floor stronger, I call them PFAs or pelvic floor activations.
And the difference between a PFA and a Kegel is that a Kegel is only addressing one muscle group out of four in the pelvic floor. And that's exactly what I was talking about before with the bicep only contracting at a small amount, you're not getting that full contraction of all the muscles that make up the pelvic floor.
So, there's actually three other muscle groups. So, the Kegel is like you're trying to stop the flow of urine. I'm sure people have heard that that's how you usually coach people to do a Kegel is like you're trying to stop the flow of urine.
That's only getting that anterior muscle group, but there's also the posterior muscle group that sits around the rectum and then there's the two lateral muscle groups. So, what people need to do is they need to learn how to activate all four of those muscle groups together to get that full range and that full lift of their pelvic floor.
Jon Gay (16:26):
I'm really glad you can only see all four of us in the waist up right now because I don't know if we’re all demonstrating what she’s explaining again.
(Laughter)
Elara Hadjipateras (16:32):
Okay. Jon, this may… maybe avert your eyes and ears, but does a weak pelvic floor for a female (I don't know about men), mean that you have a loose vagina? I have to ask it.
Danielle Pasquale (16:44):
I actually love this question. No, I love this question because it's actually the complete opposite.
Elara Hadjipateras (16:51):
Yes.
Danielle Pasquale (16:52):
Yes.
Jon Gay (16:53):
Just learned something about Elara. Okay. She celebrated that one.
Elara Hadjipateras (16:56):
I'm just saying after having a baby and occasionally like sneezing and peeing yourself, you're just like, “Oh my God.”
Danielle Pasquale (17:03):
Yeah. And people think that just because there may be some weakness in the pelvic floor, and you get a little bit of leakage that it means that your vagina's just all loose and stretched out.
And actually, what I have found way more in my practice, especially in younger females who are in pregnancy, postpartum is actually the opposite. Your bodies are still young, they're active, they're strong, they're resilient.
And what's happening is that when you actually push the baby out, regardless of C-section or vaginal delivery, when you go into labor, your pelvic floor lengthens to prepare you for that delivery. Because your bodies are really resilient, what it does postpartum in the majority of people is it actually tenses back up to try to hold everything back in.
And also, your core and your pelvic floor work together. If one is really weak, the other one's going to try to kick in to do all of the work. And I'm sure being postpartum you felt that amount of core weakness. And with that, your pelvic floor is like, “I need to do more.” So, it really tries to kick in and hold everything.
And typically, when people get that symptom of like coughing, sneezing, laughing, turning really quick to one way and they get a little leakage, what's happening is their pelvic floor is holding, holding, holding, holding.
And then you do something really quick that it can't respond too fast enough, and you get this little lapse because it can't do enough to work with that really quick reactive movement. So, you get a little lapse in muscle activation and that's when you get the leak.
Diana Weil (18:43):
Okay. And I got a question for you. It's a personal one (laughs).
Jon Gay (18:48):
(Sarcastically) Nothing so far has been, so...
Diana Weil (18:50):
(Laughs) When I was pregnant, I peed myself almost daily. And sometimes it'd be a fully peed my pants (laughs). And then (laughs) since having Elio, I don't pee at all. Is it normal to pee yourself in pregnancy and then to fully go away postpartum?
Danielle Pasquale (19:09):
Yeah, I mean everyone's so different. I would say probably for you; you just had probably a little extra of some of those hormones that really were producing a lot of relaxin and relaxin is going to make those muscles really lengthen, the ligaments lengthen.
So, I'm assuming that for you it was probably more of a hormonal thing especially since postpartum you weren't getting those same symptoms. If you didn't get rid of those symptoms, I would say that you probably have a very weak pelvic floor. However, in your case since it went away, I would assume that was more a hormonal thing.
Jon Gay (19:44):
Can I ask a follow up question? Just a really lay person's one. Could it have just been that Elio was sitting on her bladder?
Danielle Pasquale (19:52):
It definitely could have been. Yeah. And everyone, the babies all sit different as well. Yeah, I mean that's a very good point. It definitely could have been a combination of the two for sure.
Diana Weil (20:04):
For women who jump on a trampoline with their kids or run and they pee and it's just become a normal part of life, do you think it's possible for every postpartum woman to not pee themselves? Or is there like a point of if you've had five kids some leakage is normal?
Danielle Pasquale (20:25):
Yeah, that's kind of a tough question. I would like to think that for the most part I would say I do think that everyone could get to a point where they know how to manage those symptoms better, like being a little bit more aware.
So, I have some people that they used to leak every single time they went for a run or went for a long walk, and we got it to a point where, if they went for a run in the morning, they had no leakage. If they drank a bunch of water and were on their feet all day and went for a run in the late evening, they still had a little bit, but it was so much more manageable than like, just completely peeing themselves on their run.
So, I think that there's different goals for each person depending on the severity of their symptoms. And also depending on how many kids they had. Was it vaginal versus C-section, did they have any type of prolapse? What were the deliveries like? There are so many different factors, but I do think that everyone could have benefit in seeing a pelvic floor PT and learning how to manage the severity of the symptoms.
Elara Hadjipateras (21:36):
Would you say that there's an ideal age that people should be to start seeing a pelvic floor specialist?
Danielle Pasquale (21:42):
Not necessarily. Obviously, the earlier the better because then if you get on top of something, you're not doing this fixing kind of rehab, you're doing more of a preventative rehab, which is where I think wellness is going in general. Is this more preventative type of practice.
Right now, I actually have a patient who's 81-years-old and has been having incontinence since she had her kids in her late 30s. And it started getting worse where it was starting to affect her during the night.
And I was seeing her I think for around nine weeks. We were doing once a week for nine weeks. And then I was giving her a lot of homework and she was working with a personal trainer actually at our facility because we do personal training here as well.
And I worked with the personal trainer to make sure that her exercises were tailored towards pressure management and adding in pelvic floor contractions with different exercises. And she was having to get up and go to the bathroom seven to nine times a night.
And now she has one time a night and no incontinence during the day and she's 81. And this has been going on for however many years. So, everyone's different, but it's never too late. There are always ways that we can manage the symptoms and for her she's like, “This is better than I ever could have expected.” It's not perfect, but for her it, like, is.
Diana Weil (23:09):
So, you mentioned that birth type can kind of change what's going on with your pelvic floor. And I'm curious, is having a C-section harder on your pelvic floor because they're cutting through layers of muscle or easier because you're not pushing a baby out?
Danielle Pasquale (23:24):
Yeah, there's just differences. In terms of pushing the baby out, there's things that can happen like pelvic organ prolapse where that pressure of pushing the baby out actually causes some of the organs to descend.
And then there's also you could have actual pelvic floor tearing or avulsions, that could happen. And that typically happens more with vacuum births or even really quick deliveries where the pelvic floor doesn't have enough time to fully relax and lengthen.
Jon Gay (23:56):
What is a vacuum birth? I've got to interrupt for a second.
Danielle Pasquale (23:59):
(Laughs) they pretty much like use that type of tool to pull the baby out.
Elara Hadjipateras (24:05):
It's like the suction cup when the head's out, it's like they used to do it old school with the clamps, but now it's vacuumed to the top of the baby's head and just-
Jon Gay (24:15):
I'm learning all kinds of things today. Okay.
(Laughs)
Danielle Pasquale (24:16):
Yeah. So, it's typically more with a birth like that but can happen. And then with a C-section, yes, you are cutting through several layers of the core, there's seven layers that are cut through as they do a C-section.
And that can play a different role in just the amount of core weakness that they have in the pelvic floor needing to do more work if they're not appropriately reactivating their core, doing C-section scar massage to help the mobility of that scar.
So, it's different. Everyone can benefit from some type of pelvic floor therapy, and it needs to be tailored to what they went through.
Elara Hadjipateras (24:53):
What would be, off the top of your head, the difference between pelvic floor exercises you might give to a woman versus a man? Or would they look the same?
Danielle Pasquale (25:04):
The exercises itself would probably look pretty similar in terms of managing your pressure and adding breathing techniques in, working on the accessory muscles that help the pelvic floor, like your core, like your deep core, the lumbar multifidus and the different muscles of your low back, your glute muscles, things like that. The exercises itself would probably look very similar.
Elara Hadjipateras (25:29):
So, could you give Pete and I couples’ pelvic floor exercises to do once a day and for example, how long should our daily or weekly routine be? What should our ideal frequency be?
Danielle Pasquale (25:42):
Yeah, totally. My poor fiancé, he knows way too much about all this stuff and I don't think he really wants to all the time, but I usually do pelvic floor contractions with my breathing once a day. And I will set a timer for two or three minutes and I have started making him do it with me.
Because all it is, it's just like what I said, inhaling to relax and then exhaling and pulling all four corners of your pelvic floor up. So, that front muscle group being that anterior group that is like trying to stop the flow of urine and then the posterior muscle group working as you're trying not to pass gas.
And those two, I like to think about it almost like a flower and they're all these corners of the flower are kind of pulling in and up and then as you relax and you inhale, they all kind of lengthen back out and flatten.
And so, I just set a timer, and I breathe through it and, and do those contractions and maybe I don't do it every day because If I have five or six pelvic floor patients in a day, I've probably done enough for the week. But yeah, I think that's like such an easy way to-
Elara Hadjipateras (26:49):
And are you sitting, are you laying down? Are you standing up? Is there kind of beginner to advanced?
Danielle Pasquale (26:56):
Yeah. I typically do it sitting down, feet planted, like good posturing, pelvis steady, making sure your feet are nice and flat on the ground. But you can totally, if you want to progress that, doing it as you're going to stand up. So, sitting down and inhaling, exhaling as you try to stand up and try to lift.
Sometimes I tell people think about lifting a blueberry off the chair as they stand up. So, they're trying to grab on as they stand (laughs). So, I'll do it with yeah, sitting up from a chair. I'll be in a lunge and my knee will be down on the ground in a half kneeling position and then trying to stand up from there and lifting the blueberry as I go to stand out of the lunge.
So, different things like that can be progressions, but I think just for basic pelvic floor health, if you're sitting down and doing two to three minutes a day of really good breathing and pelvic floor activations, it's going to make a big difference in the level of the strength.
Jon Gay (27:54):
Just to clarify, you mean like picking up a blueberry with your butt cheeks? Am I understanding that right?
Danielle Pasquale (28:00):
Yeah, similar. I mean, what you want to avoid is just squeezing your glutes together. You shouldn't really see your glute muscles actually move and I mean maybe people could pick up a blueberry, but just thinking about something small sitting right there that would kind of lift around it without squeezing other muscles like your glutes or your quads, things like that.
Jon Gay (28:24):
I'm still on your flower analogy. He loves me. He loves me not, he loves me...
(Laughter)
Sorry.
Elara Hadjipateras (28:30):
I guess for a man, would it be like, for lack of a better word, the space between a man's penis and his anus, like his taint, is that where we're trying to squeeze up essentially?
Danielle Pasquale (28:44):
Yeah, exactly. Yeah, that area in between and there's a lot of muscles throughout that as well that would also be contracted, but yeah, and it's a similar area for the females as well.
Elara Hadjipateras (28:56):
And you mentioned, there's four different areas. And you mentioned one is kind of imagine not trying to fart. The other one is imagine not trying to pee, any other kind of simple analogies for the other two?
Danielle Pasquale (29:07):
Yeah, so those other two muscles that are sitting on the sides there, I usually have people sitting in a chair when they start so that you feel your two sit bones on either side planted on the chair, those are called your ischial tuberosities.
And those two sit bones, I tell people they usually feel like this sitting, I tell them to think that they're pulling those two bones towards their midline and it's very hard to feel at first. And even sometimes if I haven't done it in a few days, like it'll actually feel a little shaky for me when I'm trying to activate those muscles.
But I think those two sit bones are trying to pull towards the midline as they contract and typically it's easier to feel the front and the back. So, if someone's getting really overwhelmed, I usually have them just do the front and the back for a couple weeks and set their timer every day, breathe through it, think about the front and the back muscles pulling towards each other and up.
And then as they start to feel stronger and more confident with that, then I add in those two, the sit bone analogy where they're trying to bring those lateral muscles in as well.
Elara Hadjipateras (30:13):
Would a booty band help at all with people feeling those muscles or is that using the wrong muscles? Because I'm thinking of if I'm sitting here and imagining if I had a booty band around my legs and I'm separating my legs. Or like that machine at gyms, it's like abductor, inductor, I don't know. The one where you can basically try and open your legs or try and close your legs, would that help build those muscles?
Danielle Pasquale (30:38):
So, those machines are going to be a little bit more for global big muscle groups. These are so small that even those are going to be a little bit too global. I actually will usually roll a towel roll in this, I want to say called, the hotdog way. So, it's like this way.
Jon Gay (30:58):
Lengthwise.
Danielle Pasquale (30:58):
Yeah, there we go. Lengthwise. And then I have them sit on that, so it's going right down the middle. So, they have some feedback as they're going to pull the four muscle groups in. They're trying to almost like scrunch into the towel a little bit.
And it usually gives good feedback of are the muscles actually doing something? And I also will test it out manually as well so I could feel for them and then I can let them know “Okay, you're definitely getting that anterior group, but like you're not getting the posterior group at all.”
So, when people come in here and I test it out, I usually know before I give them the exercise, if they're actually doing it correctly or not, so-
Diana Weil (31:39):
Danielle, can you talk about pelvic floor health and sex? Does it make your sex life better?
Danielle Pasquale (31:45):
So, yes. Having a strong pelvic floor does, it increases circulation of the area. If you think about muscles the muscles itself, like the stronger they are and the more mobility they have, being able to move through that full range are going to be able to create more lubrication as well. It allows for a healthier hormone balance. Yeah, so it plays a big role in sex health in the way that the muscles function and the way that the hormone levels are and circulation in the area.
Diana Weil (32:16):
What about too strong? What if the pelvic floor muscles are like too strong, could that impact? Do you also want to be able to like-
Elara Hadjipateras (32:23):
Release in and contract, like that's the goal.
Danielle Pasquale (32:25):
And exactly what I said before, they may not be too strong necessarily, but they would be too tight, which obviously would create pain and discomfort. If you are trying to have sex and you're not able to relax those muscles as well, it's almost like you're just fighting against it, and it would be painful for you.
Elara Hadjipateras (32:45):
So, would you say that there could be a correlation between women that have very tight pelvic floor muscles, also may struggle with the ability to have an orgasm just because basically they just can't relax?
Danielle Pasquale (32:59):
A hundred percent. Yeah. And that's a part of what I do and work with people on is teaching them techniques to help with the relaxation and different training techniques especially for at home that they can start to use because yeah, I mean if they're very contracted and tight, they're not able to enjoy it, they're absolutely not going to be able to orgasm.
Elara Hadjipateras (33:19):
Is that going to be applicable for men as well?
Danielle Pasquale (33:22):
Yes. Yeah, it's the same kind of principle. Yeah.
Diana Weil (33:26):
That's how we get men to go see pelvic floor specialists.
Danielle Pasquale (33:29):
Yes. There we go.
Jon Gay (33:30):
You know how to talk to a guy, Diana.
(Laughter).
Elara Hadjipateras (33:34):
That's the rub.
Diana Weil (33:35):
Danielle, you also mentioned I'm guessing that you do internal exams, right?
Danielle Pasquale (33:39):
Yes.
Diana Weil (33:40):
If someone comes in. Can you talk to, maybe if someone who feels really intimidated by that or uncomfortable with that, who's listening to this and wants to go see a pelvic floor specialist, but that feels uncomfortable for them?
Danielle Pasquale (33:52):
Yeah, so I mean, number one, when I do an internal exam, it's in a much different environment than a gynecologist. I have low lighting; I have sheets on the bed. I try to make it more of a wellness feel less so of a medical room feel.
So, yeah, I try to make it a little bit more calming. There are no stirrups, there's no nothing like that. You're just laying on a bed; you get to have a sheet over you. Usually, I obviously examine, but when I'm actually doing any kind of work, I typically am not really even looking.
I'm kind of like talking to the patient, we'll be having a conversation, I'll be kind of evaluating, I'll talk them through breathing what I'm doing, but I'm really face to face with them, not necessarily just like head down there, like when you go to the gynecologist or the OB and they're just all the way down at the bottom of a bed and they're not even looking at you. It's not like that.
And I don't always do an internal exam on the first day and I don't force it. I don't require it. I've had multiple people actually this week that we took a long time talking and I gave them some homework on things to do, but we didn't do the internal exam this week because they were just really overwhelmed by the whole process and what they're going through and weren't ready for it.
And that was totally fine. It doesn't mean that I can't do anything. I gave them a lot of pressure management techniques and core activations and things that they can do for the next week so that they can get more comfortable working with me, and we'll try again next time.
Elara Hadjipateras (35:28):
Now, are there any alternatives that you can give to your patients besides an internal exam? I guess this comes back to the whole thing of the vaginal weights are possibly a sort device that they can use in their own time that then would give you maybe the feedback or data that you need.
Danielle Pasquale (35:44):
If someone has a very tight pelvic floor and usually based on the symptoms, I can tell what people have without actually even examining. There's some that I need to do an examination, but most of the time I can tell just based off our conversation what the issue actually is.
And with that there's something called dilator training, which is exactly what it sounds like. There are different sizes of dilators that people will use. And I have a guide that I've created on how to use them, but I had someone the other day that wasn't comfortable with an internal exam. They have pain with insertion, they can't even use a tampon at this point.
And so, I have them on a dilator program and I didn't do an internal exam. They get really uncomfortable and it's very painful for them.
So, the dilator package, I had them buy the smallest package, so a size one is almost smaller than my pinky and I have them start with that and I asked them for feedback. So, she texted me yesterday and was like, “I was able to do the size one for about 30 seconds.” And my goal is that she doesn't move on to the next size until she could use it for about five minutes.
So, I'm able to still give her the therapy that she needs without actually needing to do it myself. And she also traveled a very long way to see me. So, it's a way for her to really work on progressing on her own at home and where she's comfortable versus having to come in here and have me do it.
Elara Hadjipateras (37:04):
What would you say are the top common injuries that end up being related to a weak pelvic floor or pelvic floor, not having optimal pelvic floor health, that you see?
Danielle Pasquale (37:19):
I would say a lot of muscular imbalances and I mean there's so many different things that can contribute to a pelvic floor dysfunction. That could be more medical in terms of postpartum pregnancy, prostate issues in men. It could be very targeted to that area, low back pain or chronic low back pain in your pelvic floor being affected by that.
Diastasis recti, the separation of your rectus abdominis can actually happen in men from being overweight or not working on their core properly. So, even overweight people can start to unfortunately have some separation in their core as well.
And that goes into pressure management. So, higher intensity athletes that aren't managing their pressure right and they're getting some separation in their core can play a role on their pelvic floor.
I've actually had a really high correlation that I've noticed in here with females that are younger athletes that get any type of hip surgery because of being on crutches and the inflammation in the hip and the muscular imbalances that they're facing postoperative actually play a pretty big role in the pelvic floor as well.
Jon Gay (38:33):
Is that over compensation sometimes where you can't use certain muscles and you're using the other muscles to make up for what you can't do?
Danielle Pasquale (38:39):
Yeah, exactly.
Jon Gay (38:40):
Diastasis recti, Lauren Seib talked about in her episode too, if you haven't listened to that episode, our viewers and listeners, check that out. We had a great episode and a deep dive on that with her as well.
Diana Weil (38:50):
Can you give some advice for: if someone is thinking about getting pregnant, should they come see you on day one of pregnancy, third trimester? what would be the right time for someone who's pregnant to come?
Jon Gay (39:01):
Should they move into your garage?
Diana Weil (39:03):
Yeah, should they just move in with you? (Laughs)
Danielle Pasquale (39:05):
So, over the years I've kind of put together a little bit of a program for people. Typically, what I like them to do is come in anytime in their first trimester where we get to know each other, I kind of tell them about what the process is going to be like on their body and exercise wise, what they can do, what they have been doing, what they want to continue doing.
I like to make goals for them, especially exercise, pregnancy, delivery goals, so that we can establish what they want out of their pregnancy so they feel like they have kind of this journey that they're on with someone that can support them.
So, I typically have them come in the beginning and then throughout the second trimester is when I start to focus on getting them into good shape and where they want to be and the exercises they want to be doing and teaching them modifications throughout.
A lot of the stuff, I think people start to get worried about exercise as the pregnancy progresses that they're doing any kind of damage to the baby, which research has shown that they're not, and teaching them modifications so that they can keep their own body safe as they're moving through their pregnancy.
So, usually in the second trimester it looks a lot more, I would say, training programs. And I actually have pre and postnatal trainers that I work with in here and then even more outside of here that I work with to help program for women who are wanting to stay active in their pregnancy.
And during that time as well, it's really important with different muscle groups and in the length of the muscles as their stomach is growing to help proper positioning of the baby.
So, throughout the time of, I would say between 25 and 31 or 32 weeks, I do a lot of work with women to help proper positioning of the baby to help the baby get in a good position with different muscle releases.
And the earlier the better is my theory because the smaller the baby is and the smaller the belly is, it's going to be easier to get the baby in the proper position. Sometimes as the pregnancy progresses and the baby grows a lot, it's really hard to kind of revert that once the baby's already big to get them in that position.
So, usually in the beginning of the third trimester, even really late second trimester, I start doing a lot of work on baby positioning. And then we get into the third trimester, which is usually when the PT picks up.
I also have prenatal massage therapists that work at the company with me that I usually recommend people go in to see. And then in the third trimester I do a lot of labor preparation, so pushing practice, we do perineal massage to get the perineum ready for delivery.
We go through hip mobility and hip openers, laboring positions, breathing techniques, a lot of stuff that they've been working on throughout, I teach breathing and core stuff first trimester. So, I just incorporate that into more positional things that they can incorporate into their actual laboring process.
Elara Hadjipateras (42:06):
Can we explain, real quick, to listeners and viewers perineal massage? Basics of it.
Diana Weil (42:14):
That's not comfortable by the way. Harley tried to do that to me, and I was like, “Get your hand out...”
Elara Hadjipateras (42:17):
Like it will be comfortable if your partner does it for you. I'm like, “Can we maybe just hear about how to do it for ourselves?”
Diana Weil (42:22):
It’s not nice. I don't like it.
Jon Gay (42:23):
Yeah. You mentioned earlier that's the area between right?
Danielle Pasquale (42:26):
Yeah, it's the area around the opening as well so that as the baby descends, if you've heard about the perineum tearing, grade one through grade four of tearing, perineal massage is to help mitigate the amount of tearing by loosening the tissue.
It's the same thing I was talking about before with this can be applied to any muscle of the body. If you try to do something with a muscle and go into a split and you haven't done a split in years, your muscles are going to freak out. And they're going to strain.
It's the same thing with the perineum. If it's stretched and it's stretched and it's stretched and it doesn't have enough elasticity, it could tear. So, perineal massage is a way to mitigate the amount of tearing.
And honestly, I tell people if it's comfortable you're not doing it right; because when have you ever stretched a muscle and actually felt like you were making an improvement in the amount of range when you're stretching it and been like, “That wasn't that bad.” Usually, you're kind of shaky and it's an uncomfortable feeling.
Elara Hadjipateras (43:30):
When should you start doing it, if you're pregnant?
Danielle Pasquale (43:33):
34 weeks is when they say that it's safe to start. So, I usually tell people at 34 weeks every day between 5 and 10 minutes. If someone's like, “I could do like two minutes a day,” I am like, “That's better than nothing.”
But usually 34 weeks, 5 to 10 minutes a day, I have an instructional guide as well where it shows people pictures and talks them through how to do it and if they have different lubrications that are really safe for the body. And no fragrances, things like that.
Jon Gay (44:03):
I feel like there's a checklist as you move through the pregnancy ladies, where okay, 30 weeks is this, 32 is this, 34 for this. Particularly what you do, Danielle. But then overall with everything too, I feel like there's this massive list.
Danielle Pasquale (44:15):
Yeah, yeah. It’s a lot. And it can be overwhelming and that's why I tell people to come early on because I can help them through each stage so that they're not so overwhelmed at the end and they feel more confident in their birthing process because they've been talking about what they want and how they're going to do it the entire time, not just the last three weeks or whatever.
Jon Gay (44:39):
It's like cramming for a test almost.
Danielle Pasquale (44:40):
Exactly. Yeah. No, that's-
Elara Hadjipateras (44:43):
But you don't know what the test is going to end up being because it always goes sideways.
Danielle Pasquale (44:47):
Yeah. And we talk about a lot of different strategies. If one thing happens then what's next. And typically, after a long time of working together, we've kind of hit all the different things that can happen.
And a lot of times we'll even have husbands come in at the end or we'll FaceTime in and go through some stuff so that they could even see. And I have people write down birth plans that they want so that if they're in a lot of pain and they can't really advocate for themselves, that their husband's also been educated on what they want so that they can advocate for them as well.
Jon Gay (45:20):
Give those husbands a job in that delivery room.
Danielle Pasquale (45:22):
Right! That’s what I’m saying.
Elara Hadjipateras (45:24):
I feel like we could have a whole episode, Danielle, where we bring you back and just focus on pre and postnatal pelvic floor and just wellness.
Diana Weil (45:32):
I want to switch the conversation really quick. I mean, I don't want to switch because this is so fascinating, but I also know that you do dry needling.
Danielle Pasquale (45:38):
Yes, I do.
Diana Weil (45:38):
And do you do that for pelvic floor health or is that for?
Elara Hadjipateras (45:45):
Also, what is dry needling?
Diana Weil (45:46):
Yeah, what is it?
Danielle Pasquale (45:47):
So, dry needling is, it releases trigger points in the body to help with tension in the muscles, enhance muscle function, improve range of motion, reduce pain, improve blood flow, has a lot of different effects.
Jon Gay (46:04):
Can I interrupt for a second, Danielle? Is there a difference between dry needling and acupuncture? What's the difference there?
Danielle Pasquale (46:09):
So, the needle's exactly the same. It's the same needle as acupuncture. It's just our theory on what we're doing. Whereas that's Chinese medicine and they use a meridian to base their treatment on.
Whereas mine is more- there's a tight muscle. I'm going to feel that trigger point and I'm literally going to put a needle right into it. Yeah, so it's very anatomically driven and it's like, I usually use one needle at a time. Sometimes I'll use a few needles at a time if the muscle's bigger and I want to target the whole muscle.
But it's very localized and it causes a localized muscle twitch. So, the muscle fibers actually have a quick contraction when they release the tension in the muscle and allow it to return back to a more relaxed state.
So, it's really effective in relieving tight muscles especially in larger muscle groups. But I do use it with pelvic floor as well, especially if they're having a lot of muscle tension. Typically, like glutes, since those are some bigger muscles, and they usually have some really deep trigger points.
There are actually three different glute muscles. There's your glute max, which everyone knows is your butt muscle, but then there's your glute medius, which sits a little bit inferior to that. And then even lower is your glute min, which sits below all of those muscles.
And the gluteus minimus is really hard. I mean, I can't really palpate it that well without hitting all the other muscles too. You really can't. But the needle, there's actually a point where if I put the needle at a certain place, I can actually hit all three of those muscles and get the needle down to the gluteus minimus.
Which a lot of people do have pain and tension in that. Even more so if they have a weak core, if they have a weak pelvic floor and those accessory muscles are having to do a lot of extra work.
So, I use needling for many different reasons, but that's how I incorporate it into pelvic floor. And same with women who are having low back pain, which is very common, especially postpartum with if there’s separation in the core still that's healing, then their low back is going to have to take on a little bit more of the stress. And those muscles can get very tight.
And a lot of times I'll do dry needling in the lower back muscles as I'm working to activate the core. So, it'll offload those back muscles and allow the tension to relax. And then I follow it up with some really good deep core work so that it does get the stabilization from somewhere. It just allows those low back muscles that are becoming painful to relax.
Elara Hadjipateras (47:40):
Do you have a favorite form of movement right now?
Danielle Pasquale (47:43):
Well, you probably know this, but I do enjoy CrossFit. For the last couple years, I just feel very empowered and strong lifting weights and pushing my body to limits that I didn't really know I could. Yeah, I mean I never thought I would be a CrossFitter, but here I am.
Elara Hadjipateras (49:02):
The way that Danielle and I know each other is that we are members at the same CrossFit gym. So, I share the same enthusiasm for lifting and feeling strong. And then the other thing Danielle's being a little bit more shy about is she also has been kind of dabbling in Hyrox workouts. Which for me right now, very intimidating. I don't want to do any sort of running.
Jon Gay (49:24):
Is that part of CrossFit? Because you have to explain that term to me.
Elara Hadjipateras (49:27):
Maybe Danielle can define it. It's a little different.
Danielle Pasquale (49:30):
Yeah. So, Hyrox is a workout competition. It's an interval-based workout competition where there's running and different events. So, for instance, the beginning it's like you run a thousand meters and then you do an event and then you run another thousand meters and then you do another event.
Jon Gay (49:48):
If I didn't want to lay down before in this conversation, I think I'm there now.
Danielle Pasquale (49:54):
(Laughs) The events are very similar to CrossFit. I would say that the events are a much lighter weight than CrossFit. So, while they're not as heavy of weights, it is like a very long endurance hall that somehow, I got into about a year ago and I did one Hyrox last year and I'm doing another in the end of May. So, training's starting to pick up a little bit, but (laughs).
Elara Hadjipateras (50:16):
Yeah. Well, my goal is to hopefully do a Hyrox competition come 2026, but I'm going to get my toes wet, just setting up to be a judge, maybe an event in Boston later this fall that I'm going to force my husband to go to.
Jon Gay (50:29):
Why don't you get the baby out first?
(Laughter)
Elara Hadjipateras (50:32):
Yeah, baby out first. 2026 is a year away, Jon. Plenty of time to prepare. I have Danielle, I can have her prep me.
Diana Weil (50:38):
Yes, she's ready. Danielle, what's a wellness trend that you want to die?
(Laughter)
Danielle Pasquale (50:45):
There's so many. I just think in general; I actually think that a lot of the wellness trends are getting better. And they're working more towards this conservative treatment and natural remedies and so many good things.
I do think that some just extreme things that have been in the media, really long fasting periods and I'm not a dietitian, but just some of the really more restrictive diets and fasting periods I guess as someone who's very active, I just don't see how I would ever do something like that. And I'm not saying that no one could ever do that, but that's one thing that I just have not really loved.
Diana Weil (51:31):
Yeah. No, I'm right there with you (laughs).
Elara Hadjipateras (51:33):
How do we feel about cycle syncing with workouts?
Danielle Pasquale (51:36):
Oh, that I'm very into (laughs).
Jon Gay (51:39):
There's a whole bunch of research that's coming out on that that has surprisingly never been done.
Danielle Pasquale (51:44):
Yes. And it's so interesting because the hormones are fluctuating so much at that time and it shows that on the second half of the cycle, your energy levels are lower, your fatigue levels are going to be higher. Your estrogen levels are not going to be able to give you the same muscle strength as they did at the beginning of the cycle.
So, I actually use an Oura ring. I've had one for four years and I track my cycles to a T. The Oura ring could not be more spot on with my cycle. And I do plan my workouts and the intensity of my workouts around that.
Jon Gay (52:16):
Is there a certain period in the month where you want to be doing more cardio versus more strength?
Danielle Pasquale (52:20):
Yeah, so I typically will do more of my strength part towards the beginning of my cycle. And truthfully, I do more exercise in general at the beginning of my cycle. And once I hit the ovulation period, I try to keep it a little bit more low intensity.
And for me, doing something like a longer cardio section and a longer cardio workout where my heart rate is staying a little bit lower and I'm staying more at a zone two, zone three, I tend to do more at the latter part of my cycle.
And then some of those more high-intensity, big quick burst, high strengthening sections, I leave towards the beginning of my cycle.
Diana Weil (52:57):
Okay. I want to have you back just to talk about this because I think that this is — it's been 10 months, but I just got my cycle back after having a baby, which is exciting. And even though Elara hates the Peloton, sometimes when I can't work out, go to our gym, I'll go to the Peloton because my mom will watch our baby and then I can be on the Peloton.
Jon Gay (53:14):
I've got one right next to me. It keeps me honest.
(Laughter)
Diana Weil (53:17):
I love it. I'm so into it. But it's interesting because it tells you what your max is. Like if it was like I did a 30-minute workout and it was 243 or something points, I don't know how they'd do that. And the first day of my period, I was busting my trying to really push it and I was 50 points lower than I'd ever been before. And I thought that that was really fascinating just in what I was capable of doing.
Jon Gay (53:44):
And you're like, “Shut up Cody. I can only do so much.”
Diana Weil (53:46):
(Laughs) I know. Like, I'm trying (laughs).
Elara Hadjipateras (53:49):
No Beyonce can get me through this. Danielle, random question. Didn't prep you for it. What is something you've had to learn the hard way?
Jon Gay (53:57):
Life in general, it doesn't have to be related to your field.
Danielle Pasquale (53:59):
That I can't control everything. I'm such a control freak. And when you're in a field like this and I mean my days are busy and long and there's so many different factors like with, I'm in a bigger company here, so I have to rely on the front desk, I have assistants that work with me and I've learned that I cannot control everything and I need to adapt better.
(Laughter)
Diana Weil (54:27):
A good answer.
Elara Hadjipateras (54:28):
We're all just bobbing heads talking to you. Like, yes, yes, yes.
Diana Weil (54:31):
Still trying to learn that one (laughs).
Elara Hadjipateras (54:33):
Yep. I'm right there with you.
Diana Weil (54:34):
Okay. So, kind of the opposite. What is something that you use as a motto, or someone has taught you that you rely on? Or is there any guiding something that you've learned?
Jon Gay (54:50):
A motto, a rule for life, something like that.
Danielle Pasquale (54:53):
Yeah. My motto in life, my mom has actually always said this to me, is actions speak louder than words. So, that's just, I kind of abide by that. I could say whatever I want, but my actions need to match it. And yeah, that's kind of my life motto. I would say.
Elara Hadjipateras (55:12):
I love it. I don't know if you've seen Danielle at the gym, but I have quotation marks on my neck and people love asking what my tattoo's meaning. And that's exactly why I have it kind of on my spine. Actions over words.
Danielle Pasquale (55:27):
I love that.
Diana Weil (55:28):
I like that too. This has been so amazing, Danielle. I have learned a ton, and I do, I want you to come back to talk about cycle syncing. Because I think that that's so fascinating. But where can people find you if they wanted to work with you? Could they come and see you in person?
Danielle Pasquale (55:42):
Yeah. So, I work at Performance Optimal Health. We're located in Cos Cob, like Greenwich, Connecticut. However, we have multiple other offices. So, we have an office in Norwalk, in New Canaan and Darien and Hamden and I actually have been mentoring and working with other pelvic floor specialists.
So, I'm training people who are pelvic floor specialists that are also working out of those offices. So, we have a great team. And yeah, and really any of the offices across Connecticut here.
Diana Weil (56:15):
But you also mentioned that you have guides, if someone lived out of state, could they grab one of your guides too?
Danielle Pasquale (56:20):
Yeah, I do virtual visits, so yeah, I haven't done them in a long time since COVID, so it's kind of bringing me back to those virtual days. But yeah, I absolutely do virtual visits as well and I have a lot of guides, and I have an app through our company that I give workout programs on. And we have different programming packages as well. So, we absolutely would do virtuals too.
Jon Gay (56:39):
How would they find you online?
Danielle Pasquale (56:42):
Our website I think Elara will be sending out, and then-
Jon Gay (56:46):
It’s in the show notes. Yep.
Danielle Pasquale (56:47):
Yes. And I also have an Instagram page that's more of my professional Instagram, Dr. Danielle.DPT.
Elara Hadjipateras (56:55):
Awesome. Well, Danielle, we're going to have to come back and talk about cycle syncing soon. But until then, thank you so much. This was so much fun.
Danielle Pasquale (57:03):
Yeah. Thank you, guys, so much. I appreciate you for having me.
[Music Playing]
Voiceover (57:06):
Sip, savor, and live well with new episodes of Steeped in Wellness every Wednesday. Follow our show for free on Apple, Spotify, YouTube, or wherever you're listening right now. Leave your questions and comments below. Find us on Instagram at Steeped in Wellness Podcast or for more, click on matcha.com.