Right from the start, the biggest, one of the biggest pieces, is just really understanding your body and knowing what it's telling you. Because I think so many of us are walking around dissociated and disconnected and just like so used to pushing symptoms down that we don't realize anything's wrong until it's like, too late and everything's everything's wrong, everything's hilarious.
Welcome back. Today, we are talking about mystery diagnoses that are far more common than most of us realize. These are conditions that often go undetected, are misunderstood or dismissed in women's health, we're talking about EDS, hypermobility and pots. If you've ever felt like your symptoms didn't add up, or if you've been told everything looks normal when you knew something was off, this conversation is for you. I am joined by expert Nicole Woodruff, an occupational therapist based out of Tampa, Florida. Nicole isn't your typical therapist. Yes, she has spent over 13 years studying pelvic health fascia, chronic illness, but she also comes at this from the perspective of having lived and managed EDS and pots in her own life, she knows firsthand what it feels like to live with these conditions, and that perspective has been really helpful in shaping the way that she approaches her patients. Nicole is the founder of intuitive therapies in pelvic health, where she helps women with complex conditions feel more confident in their bodies. Again, she blends advanced therapy techniques with empathy and meeting women where they are and helping them build real, sustainable strategies for healing, movement and daily life. In this episode, we're diving into EDS and pots. So if you've heard these terms, but you don't know exactly what they are, now you're going to learn. We're going to talk about what they are, how they impact you, and what it really looks like to navigate life and health care with these conditions. She's telling us how to find help. She's telling us how to tailor a treatment plan for you, and she talks about how she helps other women do this helps them juggle their chronic illness, pelvic health challenges, while living their ordinary, everyday lives. We're going to touch on big topics like sensory overload, hypermobility, and the question we hear most often, which is, is there hope? I am really excited for this very valuable conversation. It is practical, but also deeply validating. So I hope you enjoy. If you do enjoy, leave me a message. Leave us a review, share with a friend. We really need to get the word out on these conditions, but also we want to keep sharing good information for women in general, and having you share these episodes and leave reviews is exactly how we do that. So let's get started.
What are some things I can put inside my toolbox, my personal toolbox, to help me manage that symptom? It's helping people kind of break down the pieces of their day to day life and find strategies that don't seem so hard that don't seem so complicated.
Well, Nicole, thank you so much for being on today. This is a really important topic we're going to be covering, and actually a mix of topics, but something that I don't think enough women still know about. So we're talking about hypermobility, Ehlers-Danlos Syndrome, and pots and kind of all of the things that go into that. And I think there's going to be lots of learning here, because I do think a lot of people still don't really know what those things are. So thank you for being here. Yes, thank you so much for having me. And absolutely, it's the biggest part of my journey, and honestly, the like, one of my biggest parts of my mission is to educate people about these conditions and how they can often be misdiagnosed or like delayed diagnosis for so many years, and in the meantime, so many women and men you know, are just left honestly misunderstanding their bodies for a very Long time. So yeah, you've dedicated your career really, to this subset of people and women who have this connective tissue difference and how that affects their pelvic health. So I'm really excited to dive in. So let's get started. First of all, I'd love it if you could share a little bit of your own experience, because you're coming at this topic from the perspective of a practitioner who has studied this and worked with lots of patients, but also from your own lived experience, would you mind sharing a little bit about that journey of how you came to be so passionate about these topics? Yes, absolutely. So it's kind of an interesting journey as I look back, but essentially, I ended up with, like, chronic pain in my 20s. So I didn't quite understand what was going on or why I was experiencing symptoms that I was but I just noticed that say I'd be, like, out shopping with my friends at the mall, like this, like back pain and like this huge urge to sit down and just feeling fatigued after a short amount of time, and I'd look around at my friends, and I was 25 at the time, so to be something that's so challenging, and my friends are like, they could go, go, Go For hours, and I'm like, There's something different here about me. And my sister had already been diagnosed with fibromyalgia, and my mom had some chronic pain.
Pain. So I thought maybe that was what was going on. And so after a little while, I got, you know, just evaluated by my general practitioner, and eventually was given the fibromyalgia diagnosis. But the interesting thing is, I just didn't really ever feel like attached to that diagnosis. I hid it from a lot of people. I didn't talk about it much. I, you know, try to feed medications. I did physical therapy, I did massage, chiropractic, yoga, like all the things that they say to do when you have chronic pain. But I just never really felt good with all that. I managed, right? And I was in my 20s, so it's a little bit easier to kind of bounce through chronic pain at that age. But it really wasn't until I became a mom in my early 30s that I started to see more going on here, and honestly, it was after the birth of my second that I listened to a podcast about EDS and pots, and I just knew immediately I was like this. This is it like this. This explains, I feel like, explains my whole life. And so I looked up I live in the Tampa Bay area, so I looked up a specialist, and was able to get in a few months later, and I was diagnosed with both conditions and that appointment. And I do consider myself lucky. I know a lot of people really struggle with the process of getting that diagnosis and finding a specialist, and we can get into that more than but I feel very fortunate that I was able to find a doctor and felt supported in knowing Okay, there, there is more to the story here, and be able to, like, make sense of the symptoms I had honestly experienced on and off since childhood that I did not even know were not normal. There were so many things I thought were just normal to live with, and I want to get into that a little more of like, what do people feel like who have these conditions and and maybe that is where we'll go next, because I want to see both sides of it. You know, what does it feel like to have these conditions? But then what do we do about it? And what did you do about it as an individual? But also, what? What are you doing about it as a practitioner? So maybe we'll just take a little jog here, if you'll continue your story. What? What happened then that got you feeling where you were more in control of things and feeling better. Yeah, so I guess just to go back, just a little bit like to what I experienced like throughout my life. Was systemic. GI issues was a big thing. I was always bloated, always had stomach pain, and just never felt good after eating. And again, when you feel like that your whole life, you just think that it's normal to feel kind of icky after you eat a meal. So I lived with that my entire life. And then obviously I was I mentioned the chronic pain piece, but then the pots part was the really interesting thing to me. And honestly, what pulled me into making actually want to pursue a diagnosis. As a healthcare practitioner, I've, I've been an OT for 13 years, and I've met patients in my in my time, earlier, earlier in my career, who had pots, and I thought it was more passing out and having, you know, significant cardiac issues. And I thought that can't possibly be me, yeah, until I learned that there's a lot more that's involved with that condition, and when I heard more of the spectrum of symptoms, I fit into that criteria, for sure. So that's what made me want to get diagnosed. And that initial Doctor Who I evaluated me did prescribe some medications for pots at that first visit, and I was super nervous. I don't think I took them for over a month. I like, I'm always scared to try new things and take new meds, because you don't know how your body is going to respond. Yeah, but I am somebody who lives with chronically low blood pressure, so one of the medications is mid Adrian, which helps to bring up your blood pressure somewhat. And when I finally tried it, I was like, This is life changing. Oh my gosh. Like, I love a concert, and I feel okay standing for a longer period of time. And I learned more about the importance of not just hydrating with water, but hydrating with electrolytes, and I made that a big priority for myself. And I also learned to listen to, like, the inner cues of my body I was so used to my entire life just pushing through and honestly, kind of gaslighting myself into thinking that I'm just lazy or, why are you? Why do you feel this way? Everybody else is fine. Just get up off the couch. Just go do what you need to do. And now I know when I have certain symptoms or I feel that heaviness and that fatigue hit me, it's okay to rest. It's okay to take 1015, minutes on the couch and be horizontal because.
When I get up from that little horizontal break, I usually feel better. That's what my body and my nervous system needed in that moment. So from a POTS perspective, those were some things I did almost immediately that made a significant difference for me. And then with the EDS piece, it was, and it still continues to be a journey with managing chronic pain and finding modalities that work for me in physical therapy, finding the right like manual therapy, tools that help with sticky fascia and fascist that that's too tight and restricted. So those are some of the biggest things that have helped me the most since my diagnosis, and it's still a journey. I'm still things that have made a big difference, that can make a big difference for those symptoms, and just understanding it's lifelong management, and things will change as you get older, as your hormones change and and all
Well, I love that. I feel like that's like a sneak peek of where we're headed, talking about what you do for women. So let's go back then and help us understand what is we can start with EDS or pots. We can start with EDS. What is EDS and what does that feel like? What are the symptoms that go along with it? And also, if you can tie in a little bit of that physiology, like, what's different about I use women because that's what we that's what we treat here. What's different about a woman with EDS, as opposed to not? Yeah, so EDS stands for Ehlers Danlos Syndrome, and there are 13 different types of EDS. The most common type is hypermobile EDS, and it is the only type of the Ehlers Danlos syndromes that does not currently have a genetic marker that can come up on lab work, so oftentimes it is underdiagnosed or misdiagnosed. There is also another condition called hypermobility spectrum disorder, which is basically like hypermobile EDS, is like sister right there. They kind of overlap, and they often are treated the same exact way. There's just a little bit more of strict diagnostic criteria for hypermobile EDS than there is for hypermobility spectrum disorder, so symptoms can look like joint pain, joint laxity, GI issues, so many systemic features as well, like migraines and painful periods and bladder issues, the list honestly, can go on and on and on. And the reason for this is, is when you have EDS, you have altered connective tissue, and so the collagen that your body makes, which gives your connective tissue, the support systemically throughout your body, is altered in EDS, meaning it's not doesn't show up the same way that everyone else's does. It's a little bit more lax, stretchy, and it just has these differences that then cause more things like myofascial restrictions and tension, honestly, in the muscles and fascia and in certain parts of the body that can cause that chronic, deep, aching pain that a lot of people feel with BPS and because connective tissue comprises your body from head to toe, so it makes up not just your fascia, but also like your blood vessels, your visceral organs. You know everything in your body, it affects you on a systemic level. So not just showing up in the joints, but showing up in the cardiovascular system, in the digestive system, in the neurological in your nervous system. So there's a lot of overlapping symptoms here. Some of them are then classified as comorbidities, as with pots and mast cell activation disorders, pelvic floor disorders, things like that. But for many of us, zebras is what we call us with EDS. The root cause behind all of that is that altered connective tissue. It's so helpful to think about that, because oftentimes we hear about connective tissue, but if you really think mechanically, what's going on, and you picture a skeleton, right, like we've seen in biology class, hanging on, on the post. If you have a skeleton, and it's all of it, the tissues that were supposed to hold those bones together are now a little more mobile or a little more stretchy. I think two main things happen. I mean, much more than that happens, but two main things happen. One is the body is always a little more unstable, right? Things can stretch further than they need to, so the joints can pop out, or you can have these other things that the body is just too mobile. And the second part of that, that I think is not talked about enough, is that that puts the body into fight or flight. The body is constantly trying to brace against that in every way, whether that's bracing with muscles or bracing with that fight or flight, it puts the whole body into this guarded.
A condition, right? And I think that's a lot where that muscle tension comes in is the body says, hey, my head's gonna fall this way because my connective tissues that are supposed to be tight enough that the head just sits on the neck or the knee just sits together. Suddenly it's not just sitting together. It has that extra wiggle in it, and so the muscles feel like, Ooh, I better clamp down so I keep it all in line. Will you just elaborate on that from your perspective of anything that that we anything else you want to emphasize there joint subluxations and joint dislocations are very common in people with EDS. A dislocation is when the joint has to be manually put back into place, versus a subluxation can be, you know, mild to moderate, and you could be walking around with a subluxed joint and not even know it, just feel that pain there, but not know that the subluxation is what's causing it behind it. So, yeah, it the nervous system is chronically in that fight or flight, because your body, autonomically, is trying so hard to support itself, and that also can lead to that uptick in those autonomic systems that we do see in dysautonomia and pots, because the nervous system is wired to protect itself, right, to keep holding together and keep yourself upright, and that is part of the reason why a lot of people end up with so much fascial tension as well, because the body's bracing constantly, and it's not like a conscious action that the person's doing, it's just what the body's doing reflexively and typically against gravity, and that's why right positions are the hardest for people. So explain what you mean by fascial tension. How are you feeling that or seeing that, or how does that show up? I love talking about fascia because it's a big part of the work I do here, especially with my in person clients. So fascia is that stretchy connective tissue that surrounds and encapsulates everything in the body, our ligaments, tendons, muscles, organs, and connects head to toe, right? And so what happens is that we're when we're constantly in that fight or flight mode and constantly guarding that fascia tends to tighten and thicken more as a, you know, a bracing mechanism. And there's certain parts of the body where we're having more, like I've noticed just patterns with working on people, they have more of these fascial restrictions than others. And when that fascia is tight and restricted, it does lead to like these, like thickened adhesions in the body that can cause this tight and burning, deep, aching pain that so many people with EDS feel and experience and so part of that fascial spatial restrictions, it affects proprioception, and proprioception is already something that people with EDS struggle with. Proprioception is your body's awareness of where it is and what it's doing in space. So many people with EDS struggle with body mechanics, posture exercise and like feeling like they can do the exercises correctly. Does that? How does that? What do they say when they're struggling with that? Is that, like, I feel clumsy, or I fall a lot, or like, what is what are they actually saying? Yeah. So sometimes, like, you'll see these videos like, you know, online, people like bumping into the table right when they feel like they're explaining, you know, their their hypermobility. There's a big overlap with neurodivergence and EDS. There's so much research on that explain, you know, just talking about the overlap between those conditions. And there's proprioceptive, different difference, differences in people who are neurodivergent as well, but with the
fascia restrictions, specifically, if the fascia is like weighing down on the body and certain muscles, it kind of impedes the body from being able to do
to activate certain muscles correctly, if that makes sense. So from, from my perspective, just to give you an example, like, I work in pelvic health, and one muscle group that a lot of people with pelvic floor disorders have trouble with are their glutes. So almost across the board, there's so many people with EDS who have a really hard time accessing and activating their glute muscles. And it's sometimes it really is like the fascia and the connective tissue is so tight and restricted in and around that trunk and pelvic region that it's it's inhibiting the body's ability to to even access those muscles. So sometimes we have to work on release and then stabilization
it not just one or the other. It really does part that, like two fold approach.
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was able to finally put them together and have an answer that made sense, and that is why I encourage people.
If you can, if you have somebody that you can find for a diagnosis, I find it very validating. There are people out there that don't, you know, they don't think that they need to, if they're addressing the symptoms, and they're, you know, pretty sure they have it, and if they do have comorbidities, and they have good management of those, I totally get, you know, not pursuing that diagnosis. But for me, I find it very helpful, because there are some precautions that you may have to take if you do have EDS,
if you're going blindly, like throughout your life, right, and doing other treatments, so say, like, high velocity chiropractic adjustments, like I did that for years, for years with a really bad I have a really bad neck, and I did that for a long time, not knowing that that could be causing more harm than good. Why should a woman care about getting a diagnosis other than the validation of like, okay, at least I understand the physiology of my connective tissues being being more lax. But why else would a woman care about getting the diagnosis? How does that affect how they live and and, yeah, I'll leave it there. How does that affect how they live? Yeah, so a couple of things, I think. The first thing is not just validate, having the validation, but having a, like, a new awareness and understanding of your body that you've never had before, right? Like, I was telling you some of the things, like, now I know if I have certain symptoms, I know I know I need to, like, lay down for 10 minutes, and I can get up and I feel better. Like, know that you have underlying connective tissue differences that affects your blood vessels. You know the motility of your blood vessels, then that could really you won't maybe know that there's certain interventions that you can do to treat that, and you push it down, and maybe you live with it until you just feel bad, right? Or until one day, your nervous system, like collapses. I can't take this anymore, and you have more, bigger issue in the long run. Another thing is, you know, having access to better to better treatment options, right? So then, once you have that understanding and awareness, then you can seek out tools that will actually help you make a difference in your symptoms and manage your condition better long term, versus, like, you know, throwing spaghetti at a wall trying to see what sticks at that point. So there are a lot of resources now, like there's so many support groups, patient advocate groups, the Ehlers, danlos society has a ton of resources online for patients, so that, like, you can understand like, this is if you have certain symptoms, oh, that's what that is. And that is connected to EDS, and this is where I can look and go for treatment. Another reason, I would say, is the precautions kind of like what I was telling you before. So some people with EDS do not respond well to anesthesia, especially local anesthesia, they may not like fully it may not fully work. So need to know, I think you need to know that to be able to explain to the provider that's giving you anesthesia like, Hey, I'm going to need more I'm going to need a different type. We need to work on something here, and the same thing goes for general anesthesia, right? And you're because sometimes you might have reactions, or it may not fully work in that sense too, and you may need to try.
So those are just some examples. What about stretching? Because I think a lot of people in this situation feel tight chronically because their muscles are guarding and kind of keeping them upright. And the sort of intuitive
idea, right, that the thought that a lot of people have is like, oh, I need to do more yoga. I need to do more stretching. Will you talk about that? And really, what type of movement would be best? Yes, absolutely. So it is very common in people with EDS to overstretch, to hold tight, and that they need to stretch, but then they don't feel better after they stretch. Right? So it is not always the best. You know course of action for people with EDS just to stretch, especially for prolonged periods of time, like holding a stretch for too long, because that can come out of that and feel a lot worse. But I find that working on mobility like more like functional mobility drills and active like range of motion versus sitting in a static stretch can be much more helpful in like, getting the body moving, getting blood flowing, helping that fascia kind of work its way out, like some of that restriction and tension in the body versus just holding that static stretch. I think a lot of people don't necessarily know how to breathe, and so if you take you can find, you know, a stretch or two that are not super deep, you know, into certain parts of the body, and just take some nice, deep diaphragmatic breaths there and work on calming the nervous system. I think that is something that every hypermobile person should be doing, is learning how to breathe correctly from their diaphragm. But yeah, as far as static stretching, I don't recommend a ton of that for my EDS clients. There are some who have a lot of pelvic floor.
Muscle tension. So sometimes there are a few, maybe one or two things that we might hold statically for longer than one minute while we practice that breathing, because that can be good for the pelvic floor, but for the most part, yeah, we're not advising on that because it doesn't really do it's not the problem. Yeah.
What about strength training? What about building muscle? Does that go well for people with hypermobility, or should they be doing more of it, or cautious about it? I think it's really important
BDS to strength train. It's just a matter of finding what works best for your body, and not doing too much too soon or too much at one time, I personally, like hurt my shoulder really bad, not knowing that I have, like a thoracic outlet syndrome and bad neck on this side, doing a lot of upper body strengthening and like a boot camp style class. This was before diagnosis, so
it although I thought I was doing something really good for my body, ended up injuring myself. So I think taking things slower, being way over methodical about how doing the exercises is really important. My one physical therapist used to tell me that I just need to lift, like I'm a bodybuilder, like, really slow and controlled and working on just isolating certain muscle groups, especially when I'm doing my upper body at a time, and listening to my body as I do it, versus, like, forcing myself to do anything that doesn't feel right. But man form matters so much, right? I mean, in this case, especially Exactly. And then I going back to, like, the fascia part too. If you're finding that you're working, you're trying to work on something and it just feels like super tight and just doesn't feel right when you are doing that strength training. It could be that the fascia and that part of the body is like, really tight, and sometimes doing a little bit of release work, if that feels good for the person, everybody with EDS is different. So,
you know, a lot of people do well with fascia release there, but there are, I'm not gonna say there are some people that that may not so you just have to find what works best for you. But sometimes that can be really helpful to do be prior to the strength training part, and then you have, like, better activation of the muscles. Okay, so tell us, then, where, where does someone go to be diagnosed? This is a great question. So right now, when I answer this question, I usually refer people to the Ehlers Danlos society's provider directory, because there are physicians that are on there who are knowledgeable in diagnosing and treating EDS and associated comorbidities.
If you are somewhere where there is no provider listed, then you can print the diagnostic criteria from the EDS Society website, and you can take it to your primary care provider and say, Hey, I've gone through this criteria. I think I might have this condition, and explains a lot of my symptoms. Would you be willing to go through this with me and give me your opinion, and if they're not well, then maybe ask, can you refer me to somebody who might be able to help me with this truly advocate for yourself in that way,
one step and one part of the diagnostic criteria is to rule, especially for hypermobile EDS. Is what I'm referring to here, is to rule out other connective tissue disorders or other types of EDS. So doing a genetic test, which can be done like through there's various like third party companies, right? You can do the saliva test, and then you can send that out, get your results back, and you can rule it out that way, so it doesn't have to be this super complicated thing. But I feel like a lot of medical providers are, like, scared to go there, or you just aren't familiar enough with it, yeah, and I'm hoping that as time goes on and more people are speaking out about it and understanding it more, that will not be the case forever. Yeah, yeah. Now, what about finding practitioners other than the practitioners that diagnose so body work practitioners, physical therapists, occupational therapists? Do? They have a directory for that as well? Or is that more of a Google search? Yes, we are all on the same provider directory. So it could be doctors, yeah, physical therapists, occupational therapists, massage therapists, mental health therapist. So there are various types of providers that are on on that directory. And you mentioned a lot of this before, but will you reiterate, like, what is, what are some of the things that maybe we haven't emphasized in terms of symptoms, or things that, you know, if a woman is listening and she's like, hi, I wonder if this could be me. Will you just rattle off the list of the things that go along with this diagnosis?
This that would really help someone listening say, oh gosh, I have every one of those things that she just listed. Yes. Okay, so let me go from like a head to toe kind of perspective, and kind of go from there. So from thinking of the head like brain fog, any sort of neuro divergence, so ADHD or autism, right? If you have any of those comorbidities, any sort of dental crowding, a high palate that can be often seen people EDS, neck or shoulder pain or problems, any sort of disc herniation, chronic neck pain, TMJ pain, so hypermobile jaw and noticing that clicking and popping all the time, you might have some sinus issues. A lot of people with EDS have throat issues. They'll have like a chronic sore throat or chronic redness in their throat, just feeling like irritation. You might lose your voice easily. You might have trouble swallowing and then going down more like Thoracic Outlet Syndrome is very common that will overlap with, sometimes, neck and, you know, just general shoulder pain, dislocations of any kind. So if you're, say, a high school athlete, middle school athlete, you're like, dislocating your shoulder all the time, dislocating your knee, your hip, those are all, you know, big red flags. And then acid reflux is another common thing you might see, feeling generally bloated,
unwell after eating. IBS is a huge red flag. Functional gi disorders are very, very common in people with EDS, so having chronic constipation and or diarrhea like on a regular basis, having multiple food intolerances, and then thinking about the skin, so allergies, hides, rashes, eczema, all of that can be involved. I know the list goes on and on and going down into the pelvis, so we might think about things like endometriosis, chronic pelvic pain, bladder urgency and frequency, painful periods, pain with intercourse, all of those things can be involved. You might see like a dryness of the skin, dryness of the eyes, dryness of the mouth. And with pots, specifically things like, because it's I'm just thinking about the overlap with EDS, dizziness, lightheadedness, High Heart high, resting heart rate that increases upon standing and orthostatic intolerance, meaning it's hard to stand for extended periods of time, and then joint pain, muscle pain, muscle aches, And feeling like poor proprioception, like body awareness, feeling clumsy, kind of like your injury prone. What else? I think that covers a lot of things. Yeah, yeah. One question was with patients who have that much going on, it seems like there's also a higher sensitivity, and of course, some of that can go with the neuro divergence, but sensitivity to sounds or sensitivity to touch? Is that something that, like, they call them highly sensitive people, right? HSPs, of having that higher sensitivity. Does that go along with that as well? Yeah, absolutely. And I would say, you know, it's somewhere at the intersection of, you know, connective tissue differences and neuro divergence. Not sure which one, you know, takes, you know, takes the cap for that, but yeah, I would say it's very common.
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off of a loom box. You can also find it on our favorite products page at uplift for her.com now back to the show well, walk us through, because your specialty in hypermobility is actually pelvic floor in addition to everything else, walk us through. What does that look like when a patient comes in either knew that she had hypermobility or you're finding that that that's part of the situation and they're having pelvic floor issues. What does that look like? How do you help someone really feel better once they're they're in a situation where they're struggling? Yeah, so I was working in a general pelvic floor therapy practice, and just noticed that i.
Up seeing patterns, and this was after I got my diagnosis. And there's just certain clients that just don't always fit the normal mold of like improvement. And I can tell there's, there's a higher level of care that's needed and collaborate, collaborative care, honestly, for management of the conditions. And sometimes that might be like a functional medicine or a hormone specialist or gastrointestinal doctor. So I definitely have worked on getting provider directory of referrals that I can send people to, because often that's what we're managing, is a lot of comorbidities. But now that I've opened my practice and I have been marketing to clients with hypermobility for well over a year, I'm getting mostly that clientele walking in the door. Some people are diagnosed. Some people are, you know, on the fence like I think I have this, but I'm not sure. So I just kind of keep the my approach generally the same for those clients, but if they are somebody who's not diagnosed, I will then refer them to somebody that they can be, you know, they want to pursue the ability to do that, but we will look at lifestyle factors like crazy. That's I'm an occupational therapist, so I value my education in being able to meet clients where they're at and work on changing little things, you know, in the routine and habits, and tracking patterns and seeing what we can do to help improve things from a wellness and lifestyle perspective. So we dive deep into that on the initial evaluation. And honestly, at the first visit, I don't rush anyone. I let everyone tell their entire story, I don't, you know, make anyone feel like they they have to, you know, hurry up. Let's wrap it up, because so many of these women who come in here have done that many times, over and over again. And honestly, just having someone to listen is so important. So we do that, and then we work on like looking at their posture, looking at their breathing, their body mechanics, how they do certain movements, and noticing little patterns in the body, and things I can pick up on. We'll take notes of that, and then we'll do like a hands on assessment. So we'll look at the external structures, like the rib cage, the diaphragm, the abdominal wall, the inner thigh muscles, the glute muscles, the hips, the your spine. Look at spinal mobility, and then if the person is okay with it and they consent, we will do maybe an internal pelvic floor muscle assessment to check the tone and the coordination of the pelvic floor muscles. And that part is always optional, but it does provide a lot of information for us as pelvic rehab providers, to be able to put the full, you know, picture together of the treatment plan for the client, and then from there, we're working on, like, lifestyle factors. I really try to think of Exercise and Movement as a way to blend it into everyday activities versus, I don't know. A lot of clients are neurodivergent. You give them a list of exercises, it's like, I don't know what I'm going to do all these so I try to find ways to teach them how to do it within their day to day activities. I think that's so great. I think these women who struggle with hypermobility, in this list of issues that can come up, I think so many of them end up being kind of labeled as problem patients, or, you know, hypochondriacs, or, you know, they'll, they'll get the typical I go to my doctor and my doctor says, I'm sorry, you can only bring up one concern today. And this poor patient is, like, I've got like, eight things that are bothering me, and I don't know where else to go. Like, I don't know who to talk to about it. And so to have a practitioner that can say like, yeah, this makes sense. Tell me more. Tell me more. Tell me more. I think is, is really quite healing in and of itself. Will you talk a little bit more about the nervous system? Because I think what we just mentioned with with feeling, you know, dismissed or gas lit or unheard, that alone can trigger the nervous system, but the body alone as well, can trigger the nervous system to be in this state of fight or flight as the body just feels somewhat unstable. Will you talk about how you approach nervous system regulation and helping them manage that? I don't want to say manage their stress, because that's so not adequate here. But how do you help them learn how to support that nervous system piece? Yes. So I think right from the start the biggest, one of the biggest pieces, is just really understanding your body and knowing what it's telling you. Because I think so many of us are walking around dissociated and disconnected and just like so used to pushing symptoms down that we don't realize anything's wrong until it's, like, too late and everything's everything's wrong, everything's flaring, yeah, so trying to, like, pick up on the little triggers and the little signs that your body's showing you, and knowing then, okay, I have, if I experience this, what are some things I can put Inside My Toolbox, my personal toolbox, to help me manage that symptom. So from a nervous system perspective.
I like to think of it as like, we have to have the foundation before we're like, biohacking our nervous system, right? So so many people with chronic illness are not sleeping. So if you are not sleeping, you are going to feel terrible. Your autonomic nervous system is going to be out of whack. So we need to talk about ways to improve sleep. We need to talk about ways to improve, like, from a POTS perspective, making sure we're consuming enough fluids, making sure we're eating adequate calories throughout the day, and not just eating one huge meal, you know, once a day, or eating, I hate to say, like, you know, things that are just Ultra processed and sugar, fruit and all the things so working on that piece. And then, from a sensory perspective, you know, finding ways that you can, like, listen to your body, if you notice that you when you wear a certain type of clothing, it makes you feel not great, or, you know, or you feel more cautious, like, just eliminate that you don't need, yeah, don't need to wear that. I mean, even from in from a pelvic perspective, too certain types of clothes can cause more pelvic floor symptoms like high waisted or too tight of a wasted pants can make you feel like you're you can prolapse. Symptoms can be a lot more noticeable. So finding ways to
manage things just from a simple lifestyle adjustment can make a big difference for people. And sometimes I have to say, like, Hey, did you ever just think about trying this, for example? And they will say, like, I never even thought that something so simple, you know? And sometimes that is what it is. It is a simple fix, but it's helping people kind of break down the pieces of their day to day life and find strategies that don't seem so hard, that don't seem so complicated, because we we sometimes over complicate things. And if you look online, you can see like, heal your nervous system in 30 days and do this the next Right, right? Maybe some of those things are great, but for some people like that's that's overwhelming, right? And it's hard to stick with all these special plans and things that you have to do. But if you can find like two to three things that work for you, that you can do consistently, that don't feel super overwhelming, like that's how you can make a big difference, because show up for yourself every day, within your habits, your routines, the roles that you have in your life, that's how you make long term change versus just doing, you know, sauna and cold plunge once a week, right? I love I think it comes back full circle to just hearing your own healing story of these. I mean, yes, you had some medication help, and yes, you learn some things about your body, and that's been a journey for you, but so much of the value came by really, you've said it a couple times, tuning into your body and really just asking yourself, like body, what do you need? Where are you at right now? And not pushing through things, but also just having that underlying understanding of the physiology, a little bit of saying, okay, my body is going to to need these things that are different than what my friend may need or my sister may need, like I just get have to know what my body's needs are. And I think that's something that's really true for all of us, but especially true when the body may not be functioning exactly the way that it's that it's supposed to right? So I appreciate you saying, you know, sometimes we just have to say, don't push through. Just take that horizontal time. Just get that water in. Just take that nervous system, break
in just the last couple minutes. This is not enough time. But tell us about pots and how that what it is and how that comes into this. Yes, so like I said, this is a big one for me, because it was a big game changer in getting, like, understanding my body more. But POTS is a nervous system condition. It's dysfunction of the autonomic nervous system, and it's a type of dysautonomia, and it's characterized by an increase in heart rate by over 30 beats per minute when you go from laying down to standing up. So if you are somebody who has access to be able to check your, you know, with an Apple Watch, be able to check your heart rate. And you might, you know, connect with some of the other symptoms, like dizziness or brain fog or nausea or feeling like, just generally, a sense of like, feeling out of it, then it might be helpful to look at that like, lay down for five minutes, you know, see what your resting heart rate is, and then stand up and see what it is after you stand up. So the thing about pots, that's interesting is it's often treated, or, you know, referred to be evaluated by cardiologists. But I have found, just from, you know, my experience working with so many people is that they're not always the expert in the condition, because it really is a nervous system thing, and the autonomic nervous system controls, you know, the heart rate, right? It controls our respiration rate, and it can often feel like anxiety. You.
So sometimes people are dismissed with, oh, it's just anxiety. And sometimes you can wear things, you know, throughout your like the heart monitors and the different tests that you can do. And even then, like, they're not, they're not capturing the full picture of what a person's going through. And then when it comes to, like, the actual diagnostic test, like a tilt table test, some people might get, like, a heart rate increase by like 2829
and they'll be told that they don't meet diagnostic criteria for pot. So that part can be a little frustrating, because, like I said, it is a type of dysautonomia, and dysautonomia is one of the key features of that is orthostatic intolerance, having that trouble being upright, standing still upright against gravity. And so even if you don't meet full criteria for pots, you can often still have dysautonomia. Will you explain what dysautonomia is? Yeah, so that there are different types of dysautonomia, so there's orthostatic hypertension, there's pots, there's basal vagal sympathy and various others. That's dysfunction of the autonomic nervous system, and sometimes there's an underlying root cause, like many people after like in the post covid world, with long covid, they ended up with pots and symptoms of dysautonomia Ehlers Danlos Syndrome is an underlying cause, because when you have that laxity in your connective tissue that affects your venous return, and that can cause that spike in heart rate, and because you don't have the return blood flow To the brain as you normally would expect, in with normal connective tissue. So that's dysautonomia is is a, sometimes a better term, because not all, not everyone, will be diagnosed with pots or meet that diagnostic criteria, but a lot of people can relate to the general umbrella of symptoms of dysautonomia. Yeah. So the autonomic nervous system is supposed to keep us safe. It's supposed to help us fight tigers, right? So we see a tiger, the autonomic nervous system says, oh, I should speed up my heart rate, I should raise my blood pressure, I should raise my respiratory rate so that I can sprint from this tiger. But because of various circumstances when dysautonomia happens and that's when that connection gets messed up, so we might say, like, I'm going to get up and go and we don't. The body doesn't support that. It doesn't speed up our heart rate, or it doesn't raise our blood pressure the way that it's supposed to. So you may stand up real quick and and need a little boost in blood pressure appropriately, and it just bottoms out so you'll get dizzy or lightheaded. And then the opposite can happen to where you stand up and you get get going, and it overreacts. So you have an over reactive autonomic response. That's that overreactive fight or flight. And some people get sort of a split response, where some of their body is acting like they're in fight or flight, and some of it's like they could use a little more fight or flight. And so the body just feels very disconnected
to its surroundings Absolutely. And then dysautonomia can also affect things like the GI system, just because that for gastrointestinal it's all connected exactly, is controlled by the nervous system as well. So what do we do about pots? What? What are you doing to help people? You mentioned electrolytes? Tell us a little bit more about how people and let me back up a second. I will say kind of the nice thing is that treating pots has some really safe things to try. And so even if you aren't getting that diagnosis, a lot of these things you can try anyway, and just see if you feel better. And if you feel better than by all means, do them. So walk us through some of those helpful tips absolutely so yeah, electrolytes is one great thing, and most people, when they come they already know that part. You know, you need to hide electrolytes. Compression therapy is another thing that can be helpful for people, and that's not just like compression socks. That's like a thigh high compression or abdominal compression, like up to the rib cage. There's a lot of people don't love the feeling of compression. Like, I fall into that category. I don't really like tight fitting clothes. It makes me feel like more fight or flighty, like I can't breathe. Yeah, and it's just, honestly, it's achy. So that might work for some, may not work for others. Other things we can do is elevate the head of the bed when sleeping. So either sleep on a wedge pillow, or, honestly, like, actively elevate the head of the bed, like with blocks underneath the bed that can just help with the transition of waking up in the morning. Most people with pots feel not great in the morning, that's when symptoms are usually the highest. So being able to transition from laying down all night to then getting up and starting your day, sometimes that can make that part a little bit easier. Other things we can do are working on graded exercises, and so this can be scary sometimes for people, especially if you know that exercise has been known to flare them in the past. So it really is like meeting the person where they're at and finding strategies that work for them in that stage of their life, usually starting with supine movement, working to seat it, and then eventually to greater progression, to stand.
Thing. So it's very much tailored to the individual. And there are protocols out there. There is the chop protocol, Levine protocol, but you don't want to necessarily just go you don't it may not work for everybody, like certain protocols. So we just try to follow
what that person needs as an individual, versus making sure they're meeting some sort of standard that not may not always work. And then other things like, kind of like I talked about before finding out if there are certain triggers that happen for you, like, certain people don't tolerate caffeine very well. Some certain people alcohol is a big trigger for a lot of people. Certain types of foods might upset your your GI system and cause and can wreak some havoc and cause more pot symptoms. And if you eat too much at one time, that can be an issue. So for a lot of people, if they eat like a big meal, then blood will then all the blood will go to work on digesting food, and then you won't have as much blood flow to the brain. And then there is an overlap. And this could honestly be like a whole other episode, but getting into pelvic venous disorders like may learner syndrome and Nutcracker syndrome, that when there is trouble with getting like that blood flow out of the pelvis, that that can cause a lot of pot symptoms, and there's a lot of overlap there, for sure, and then mast cell activation disorders. We didn't get into that too much, but there's a big overlap between mast cell triggers and pots, so sometimes working on if you can find somebody to help you with mast cell stabilization that can also help with pots and dysautonomia symptoms. So it's not one or two things, unfortunately, that, like, make all the difference, but I find I was kind of say, like, if you think of like a pie chart, you know, it's a little bit that makes up your full, you know, recovery piece, or, like, management piece, and just finding what works best for you. And it will definitely be different from person A to person B to Person C. Well, that's super helpful. What else are we missing? What? What do you really want to make sure that the messages that you're sending to women who are in this camp of this complex sort of family of diagnoses? Yeah. So I would say the biggest thing is there is there is hope. Like, I am one of you, like I totally understand and get what it's like to grow up in a body that feels chaotic and feels just unruly and not not well all the time and feels misunderstood. And it may not be a straightforward path to feeling your best. But I believe the more you understand your body, and this is why I raise so much awareness about these things, the better chance you have to feel better and to find your toolkit that works for you in managing your symptoms. You can go from being symptomatic every single day of your life to maybe having days here and there where symptoms will flare. And to me, that is that is huge. I will never say to anyone that you're going to feel 100% better because you did X, Y and Z. There might be people out there who can right, who can feel like they've recovered from these conditions, or Eds are not really recovering from, but can feel like they feel maybe more like their old self, but it is more of something that you're going to have to manage long term. But there are options, and those treatment options come from that place of understanding. And if you're at a place where you just feel like, oh, I relate to so many of so much of this, but I've never been able to put a name to it, like look into it. Go, go to the EDS Society website. You know, social media does have a lot of resources out there too, but just finding some support in understanding your body and what's going on can make a huge, such a huge difference when it comes to a connective tissue disorder like EDS, because it really does impact so many different systems that seem unrelated, but they are related as we as we've all as we've gotten to in this conversation so well. Thank you so much for sharing that I think I love that you're giving women hope, and I love that you can get hope from a practitioner space of I can I've seen people get better, and also from your own experience of I've figured out how to live in a way that feels a little more stable and feels a little more strength. You know that that you can accomplish that? Where can women find you? Nicole, how can they work with you? Yes. So my practice website is intuitive therapies, pelvic health.com, and then you can find me on Instagram and Tiktok at Nicole pelvic boutique. And, yeah, I'm constantly I'm sharing, you know, different things on there for education and awareness, and just trying to educate people who may not have known that X was connected to y. And.
To just help people learn more about their bodies. So I hope that
if you do check my content out, you'll be able to resonate with some of that. Yeah, well, thank you for your time and sharing your expertise, and I think this has been a really important conversation. So thanks for being here. Yes, thank you so much for having me. I really appreciate it. Thank you so much for tuning in to today's episode. A huge thank you to our guests for sharing their insights and time with us. We are grateful for the incredible support from our sponsors and to all of you listening. We couldn't do this without you. If you enjoyed this episode, please consider subscribing on your favorite platform. You can find us on our website, uplift for her calm YouTube, Apple podcast, Spotify, or wherever you love to listen, and if you found value here today, please share this episode with someone who would benefit from it. Leave us a comment or give us a review. It really helps us reach more listeners like you. Thank you for being part of our community. Stay tuned for our next episode. Lastly, this information is for educational purposes only and not intended to be medical advice. You.
