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In this episode of Life Intended, host Kelly Berry sits down with Susan Winograd, P.T., Founder of Pelvicore Rehab & Wellness, to challenge the myths that surround pelvic health, especially for women navigating postpartum recovery, perimenopause symptoms, and the overwhelming quest for hormone balance.
Whether you're a young mom wondering if it's normal to leak when you sneeze, or a high-performing professional trying to get your brain back during perimenopause, this conversation is for you.
Susan shares how her biopsychosocial approach - integrating nervous system healing, physical therapy, education, and personalized care - is changing the way we think about pelvic floor therapy and long-term health.
And yes, we’re talking about the truth behind Kegels, pelvic gadgets, and those tempting quick fixes too.
Your body has a story. Your symptoms are chapters. But healing? That’s about reading the whole book, not just flipping to one page.
In this episode, you'll learn why pelvic health matters more than you think and how to finally get answers that go deeper than "just do some Kegels."
Here’s what we’re diving into:
“Just wait until you’re done having kids.”
“Leaking is just part of getting older.”
Sound familiar?
Susan explains why common doesn’t mean normal - especially when it comes to leaking, pain with sex, or postpartum symptoms. These issues may be frequent, but that doesn't mean you have to live with them.
We also hear how cultural messaging (and yes, multi-million dollar undergarment ads) have taught us to tolerate things we can treat.
Her message is clear: if you feel something, say something. Pelvic health is not a luxury - it’s foundational.
Here’s a dangerous assumption: that pain is purely physical.
Susan breaks down how emotional stress, trauma, and nervous system dysregulation directly affect chronic pain and pelvic dysfunction. This is where her biopsychosocial approach shines - treating not just the muscles, but the messaging between your brain and body.
Think your pelvic pain is “all in your head”? Susan says: it’s in your nervous system, and that’s very real.
Her practice uses assessments to understand depression, anxiety, somatic dysregulation, and more then builds a plan to support not just movement, but confidence and long-term healing.
Spoiler: Sometimes Kegels make things worse.
Susan busts some serious pelvic floor myths, especially the overuse of one-size-fits-all exercises like Kegels. In fact, many women with tight pelvic floors are making their symptoms worse by contracting muscles that need to relax.
And those 10,000-Kegel chairs? Susan doesn’t hold back. Quick fixes might feel good in the moment, but they rarely lead to lasting strength, function, or confidence.
If it sounds too good to be true, she says it probably is.
Can't think straight? Forgetting things? Losing your edge?
You're not alone - and you’re not broken.
Susan talks about the brain fog, fatigue, and hormonal chaos of perimenopause that often leave women wondering if they're getting early dementia. Her message? There’s help.
Through her partnership with hormone expert Kelly Maple and her integrative wellness lens, she’s seeing life-changing outcomes in women who finally feel like themselves again.
You don’t have to settle for less clarity, energy, or confidence just because you’re entering a new season.
Not all green lights mean “go run a marathon.”
Susan shares stories of women who returned to exercise too early and paid the price.
Postpartum healing isn’t a timeline, it’s a process. And the best recovery plans consider your goals, your stress, your sleep, your pelvic health - and yes, your nervous system.
The worst way? Jumping back into movement without proper guidance.
The best way? Starting with a personalized evaluation and support from someone who looks at your whole body.
“What's common isn't normal and that applies to leaking, pelvic pain, and brain fog.” — Susan Winograd
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“If you're doing Kegels on a tight pelvic floor, you're just contracting over tension - and that makes it worse.” — Susan Winograd
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“Healing isn’t in my hands - it’s in yours. My job is to teach you how to use your body so you can trust it again.” — Susan Winograd
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“Just because you're cleared at 6 weeks doesn’t mean you're ready to run a marathon.” — Susan Winograd
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“Our nervous system is queen and if it’s not addressed, physical healing won’t last.” — Susan Winograd
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00:00 What is Pelvic Health and Why It Matters
03:59 Susan Winograd’s Journey into Pelvic Floor Therapy
06:54 Using the Biopsychosocial Model in Physical Therapy
09:19 Empowering Women Through Education and Health Advocacy
12:28 The Power of Individualized Pelvic Health Plans
15:13 Why Common Pelvic Symptoms Aren’t Normal
17:58 Proactive Wellness: Postpartum to Perimenopause
20:53 Hormone Balance and Perimenopause Symptoms
23:43 Nervous System Healing and Chronic Pain
26:21 Connecting Mental Health and Physical Pain
29:23 Educating for Long-Term Pelvic Floor Health
30:12 Understanding the Mind-Body Connection in Healing
34:16 Why Self-Healing Requires Education and Agency
38:13 Pelvic Floor Myths: Kegels and Quick Fixes
43:16 How to Choose the Right Pelvic Health Provider
47:05 Building a Holistic Wellness Community
Kelly Berry (01:05)
Hi everyone. Today I have Susan Winograd here and we are going to have an amazing conversation that I think you will love. Susan is a licensed physical therapist and the founder of Pelvicore Rehab and Wellness, a pelvic health and wellness practice based in Boca Raton, Florida. Through her work, Susan specializes in women's health and men's health and pre and postnatal care.
supporting patients through challenges related to menopause, digestion, bowel and bladder health, and sexual function. With a passion for whole person care, Susan integrates a biopsychosocial framework, I'll let her talk about that a little bit more, and comprehensive wellness programs into her practice. Her approach helps clients move beyond symptoms to address root causes, which she's very, very passionate about, empowering them to overcome issues like fatigue, brain fog, autoimmune conditions,
hormonal imbalances and gut health concerns. Susan and her team use a hands-on personalized approach that educates and inspires patients to achieve long-term healing and health independence. In addition to her clinical work, she's a dedicated educator teaching workshops locally and is deeply committed to helping people relieve pain, restore optimal function and improve their overall quality of life. Sounds amazing. Welcome, Susan. I'm so happy to have you here.
Susan Winograd (02:24)
I'm so happy to be here. Thank you so much for having me. I'm super excited to have this conversation.
Kelly Berry (02:31)
Yeah,
I think my audience is probably going to be very, very interested in a lot of the things that you had to talk about. think that the profile of women specifically that you work with describes a lot of my listeners. So I can't wait for you to share a lot of what I know that you do and problems that you help your patients solve. But before we get into all of that, you've been a physical therapist for a long time. And your journey
throughout that time has shifted and pivoted. So I would like just to give you a little bit of time to talk about how you've gotten where you are today and what that has looked like.
Susan Winograd (03:05)
Yeah, so I always tell people, people always ask me, how did you get into pelvic health? And my answer is, is I don't think anybody finds pelvic health. I think pelvic health finds them. I've been, pelvic health definitely found me. I think it was really meant to be my purpose, but I've been a physical therapist for 30 years. And I really started
Kelly Berry (03:17)
Okay.
Susan Winograd (03:29)
You know, I started in hospital, I did pediatrics for five years. And when I was raising my children, my primary goal was to be able to send my children off to school in the morning and then be home with dinner ready when they got home. That was my goal professionally when my kids were growing up. But I always knew that I wanted to work, I wanted to stay active professionally. And then when my kids were grown, I was like, okay, now it's my turn. And at that time,
my goal really was to provide people with the kind of care that I knew that they deserved and they wanted. So I launched a company called Home Advantage Rehab where I went to people's homes providing orthopedic physical therapy, really one-on-one.
individualized, really meeting their goals and digging beneath the surface already. It wasn't like that shake and bake type of orthopedics that a lot of people know about where you're going to a physical therapy place, you come in, they put a hot pack on you, then they do another modality, then someone takes you to a bike. I really wanted to get to the root cause already at that point.
point and it was going great. And over the years what I was finding and this really happened at a point where I was working with one physician who was sending me a lot of clients for balance issues. And when I got to people's homes, I was realizing that they were they didn't have balance issues at all. They were falling because they were running to the bathroom and they couldn't make it in time. They were having urinary urgency or fecal urgency and they were running to the bathroom.
This was like an older demographic at that point that I was missing and I started dabbling in you know, bowel and bladder health at that time and quickly realized that I was really changing people's lives and People were saying to me. Why didn't anybody ever talk to me about this? No one asked me if I was leaking. No one asked me if I was running to the bathroom No one even asked me why I felt you know, so that really
Kelly Berry (05:32)
and ⁓
Susan Winograd (05:34)
started to get me interested in pelvic health and wellness. And then the universe heard me. And at that point, a physician called me randomly and said, Hey, Susan, I treat men with prostate cancer and none of the men that I treat are complaining about prostate cancer. They're complaining about their pelvic health issues. Will you learn how to treat them? So I went home that night and I told my husband I'm reinventing myself.
And he looked at me again and said, yep, again. And I went off to Minnesota. That physician paid for my first course in pelvic health. It was a Herman and Wallace male pelvic health course. So I actually entered the world of pelvic health, the reverse of other people that, yep, I did it then for the first year.
Kelly Berry (06:23)
That's interesting.
Susan Winograd (06:28)
I developed a pre-prostate surgery program for this physician. And after a year, I was like, this is what I want to do. I learned pelvic health. I drank the Kool-Aid and I just never stopped drinking it. And then I went out on my own because I wanted to treat men and women. And it has just been the most incredible journey. My practice has definitely evolved over
over the years to meet the needs of my clients. So for example, we definitely, I think have a little bit more of a complex demographic in my practice. And I quickly realized that just treating people's bodies was not going to get them long-term healing and wellness. So I had the greatest honor to work under one of my mentors who helped us completely integrate a biopsychosocial approach into our practice.
asking people about depression, anxiety, stress, worry, catastrophization, somatosensory dysregulation, self-efficacy, because what we know now is, is that people have a high degree of worry, they have much less
of a good chance to overcome their pain long term. If people have a sensitive nervous system and we don't address that, they're never going to get good long-term musculoskeletal healing. The nervous system is king, it's queen. So we have to really address it as an individualized program, just like we address the musculoskeletal system.
So we integrated that and our results became transformative. And again, people were like, why hasn't any other practitioner really looked at this the way that you have?
And then over the years again, I started looking at pregnancy and postpartum a different way and expanding our services to individualize for those clients as well. And then more recently, as I went into perimenopause and menopause, and I started talking to other high performing, high achieving women who were suddenly having brain fog and hot flashes. And it was really, really disrupting not only their quality
of life, but the degree to which they were used to performing professionally, and I really dove into the world of hormone balance, hormone therapy, and I partnered with an incredible nurse practitioner. Her name is Kelly Maple, and now we all. Amazing. Yes.
Kelly Berry (09:01)
Yeah, Kelly was a podcast guest last fall. I knew you knew her, she, yes, she came
on and talked all about hormones and hormone balance. Yeah, she's a really great person to work with. ⁓
Susan Winograd (09:14)
So
Kelly is our strategic partner and she does hormone therapy for pelvic or rehab, which could be life changing for people. So, you know, I am very, very driven to listen to my clients. What do they want? What do they need? And not have them conform to what I know and a protocol that I treat, but that I am
Kelly Berry (09:19)
Okay.
Susan Winograd (09:40)
constantly expanding and meeting the needs of the people that are before me and really, really listening to them.
Kelly Berry (09:47)
Mm-hmm. Gosh, there's so much goodness in there that I want to go back and touch on. I'm sure everybody listening is like, how do I find a Susan near me? So one of the things, and I know you and I have had a conversation about this before, and Kelly's a big advocate for this too, is kind of like being the CEO of your own health, but working with a team that is integrated and that sees the whole person instead of like,
trying to treat one thing at a time. And I your description of the impact of your nervous system, of how much you worry, of how much anxiety you have on, has like physical impact on your body. think that one, I think it's becoming like more common knowledge that all of that is interlinked. But the more that you can find someone who will help you with the whole picture, the more likely you are to have success. And also,
I think I've had a lot of experience with physical therapy. I was a runner for a really long time. I probably will be again one day. I've just taken a break, but I'll say like an ultra runner. did a lot of triathlon, so very high volume. was always injured, always different injuries and always in physical therapy. And I felt like every time I went to physical therapy, did not matter what my injury was. There were two things that they told me. It's like,
core strength and glute strength. it would give me the same, you know, it's like go in, ride the bike for 10 minutes, do these exercises, come in for how many sessions and then they turn you loose and then you're injured again, you know, and there's no like digging beneath the surface and it's a frustrating experience.
Susan Winograd (11:25)
Yeah. So I think that I hope that the paradigm for how we treat people is changing and that we're really looking at every individual as their own unique puzzle and really kind of zooming out and looking a little more globally. So for example, I love the example that you gave as a runner. I used to be a runner. Now I'm a Galloper because that's what I enjoy doing now. But, you know, we, when we
Kelly Berry (11:38)
Mm-hmm.
Thank
Susan Winograd (11:53)
have a client that comes to us for running, we really have to look at so many different...
Aspects of what's going on in their life. We have a return to running program for people that have given birth That looks very very very different than someone who is has not had a baby recently or has never had children and is really in you know, a professional athlete so is important glute strength is important, but are they using their core properly are we looking at how their foot is striking the
floor and how that affects everything up the chain? Are we looking at their sleep? Are we looking at their stress levels and their cortisol levels? So I think that that's such a beautiful example because even just return to running, you think that they that may be able to be generalized, but it's not. We have to look at what that
person's athletic goals are and where they are at in their life. You know, what season of life are they in and what's going on in their life at that time. And that's all aside from the musculoskeletal stuff that we do. So when we're looking at outcomes, we always want to think about long-term outcomes, long-term healing. And I truly believe that in order to get that, we need to look at
the person globally. I always tell people there's no one magic bullet. You are a unique puzzle and my job is to look at all of those pieces of the puzzle and make them fit together to what looks like a beautiful healthy picture. And that's really, really what we do and I think that's what everybody should do. I think it should be the standard. I hope it's becoming the standard.
Kelly Berry (13:44)
Mm-hmm, yeah. And it sounds like, I think in my example, I didn't get asked any questions. It's like, I think you get asked the questions that seem like very relevant, like what's your weekly mileage? What kind of shoes are you wearing? What terrain do you run on? But no one asked me about my nutrition. Nobody asked me about my strength training or my sleep or my stress or anything else. And it just, you would think if you're a recurring...
If the door is rotating for you, then somebody at some point is finally going to say, hey, let's look a little bit deeper. But that was not my experience.
Susan Winograd (14:12)
Yeah.
Yeah.
I actually have two stories that I feel compelled to share about running, which I think your listeners would, you know, it would resonate. Years ago, I had a client who was a marathon runner, and she had a baby, and she went to her doctor for her six week visit, and the doctor gave her the green light to go ahead.
And what do you think when she got the green light? She started training for her next marathon when she was three months postpartum. Well, in the middle of her marathon, her 26 mile marathon, her bladder collapsed.
Kelly Berry (14:45)
Okay.
Susan Winograd (14:54)
She was not ready to go back, nevermind to running a 26 mile marathon. She was not ready to go back to running period. She was never told that in order to go back to a certain degree or level or intensity of fitness, you need certain training. She got the green light. So I think that's like an extreme story, but I think we all have to be our own best advocate. When your doctor says, I'm giving you the green light to do what you want, the green light for what?
Kelly Berry (15:13)
Mm-hmm.
Mm-hmm.
Susan Winograd (15:24)
green light to have sex, the green light to run a marathon, the green light to do core exercises, or even better yet, it should be the green light to go see a pelvic floor physical therapist so that you can address your fitness goals in the best way possible for your long term health and goals. So that was like one, you know, extreme story. And the other one is I had a very young mother recently who had stress urinary incontinence, which meant that she leaked urine when she
did something that required exertion. And she had four children, she had never gone to pelvic floor physical therapy, and what finally inspired her to do so was that her daughter, her little daughter, started running into the street and my client ran after her. And when she caught up to her, her daughter looked at her and said, mommy, I never knew you could run.
Kelly Berry (16:16)
Mm-hmm.
Susan Winograd (16:16)
And that
made her so sad because she never ran with her kids because she was afraid of leaking. So we really have to be our own best advocates. And now she's jump roping. She's doing whatever she wants. So we really have to make sure that people are proactive and they don't wait until they have four kids and their kids don't know that they can or have the ability to run. But also really, really listen to our bodies and do things in right way.
Kelly Berry (16:23)
Hmm.
Yeah, and I think that a lot of those symptoms or I guess you would even call them like outcomes from pregnancy, I think they've almost become normalized. Like it's almost expected that women will have a hard time jumping rope or jumping in general or running is a big one. And so it's almost like the price that we pay for having children when it's not the way that
things should be. So what do you see? Did you see people like accepting it? Kind of is like, I guess that's just the way it is.
Susan Winograd (17:18)
Touch on the normalization part of it because I'm you know, you touched on a nerve here. Honestly, I will say about that number one We have to ingrain in people's mind that what's common is not normal
Kelly Berry (17:24)
Yeah.
Mm-hmm.
Susan Winograd (17:33)
If they want to normalize leaking, it's because they're making a lot of money selling undergarment, protective undergarment. So if you look at any magazine for protective undergarments, it's never like a incapacitated older person who is not mobile. It's always a young, beautiful woman wearing protective undergarments. Why is that?
because they want to normalize it, right? It's not normal. The other thing is recently, they must have taken it off the air, but recently there was a commercial with a very, very famous celebrity talking to a mother and her child and the mom was basically saying that she can't do something because she leaks.
and the celebrity takes from underneath the table a box of protective undergarments and says, you don't have to leak, you can wear these. And by the way, she points to the child and says, it's your fault that your mom leaks. So what kind of message are we sending that we're the blame on our children that we're leaking and by the way, wear protective undergarment. So.
Kelly Berry (18:36)
Yeah,
Susan Winograd (18:43)
The industry makes millions of dollars selling protective undergarments. Leaking is common but is not normal at any age. Several years ago, had a night, I tell this story at all of my workshops because it's probably my favorite story that I've ever experienced in my clinic. An 80 year old woman called me in my office and said,
Hi, is this Susan? And I said, yes, this is Susan. And she goes, Susan, I'm 80. I'm a housekeeper. And I started leaking when I pushed furniture to clean. And she said, you know, I went to my doctor. She's like, guess what my doctor told me? I'm like, oh, Lord, what did her doctor tell her? And her doctor said, you're 80. You should retire.
And she's like, Susan, do you know what I did? I looked at the doctor and I said, I didn't ask for your retirement advice. I asked you how to stop my leaking. And I walked out. I I will never walk back in there again. She said, do you think you could help me? I said, come on in. I saw her three times. Her leaking wasn't, it was a pressure management issue, number one. It was completely resolvable. And this was a woman who loved her job. She didn't want to retire. The people that she worked for were like,
Kelly Berry (19:52)
Mm-hmm.
Susan Winograd (19:56)
to her, she didn't want someone to tell her that this is the life she needed to accept. She wanted to do something about it and she did. So in answer to your question, what I'm seeing in the clinic is that a lot of people are being told, let's say in pregnancy and postpartum, just wait until you finish having your kids, then we'll do something about it. What I would say to that is find another practitioner.
Why would we build layers and layers on top of a dysfunction that will then take way longer and be more difficult to correct and not even to mention having to live with leaking during that period in your life, rather than saying, let us nip this in the bud so you don't have to deal with this and you can actually maybe prevent it as you go along in your fertility and child rearing journey?
So that's one thing I see. The other thing that I really do see on a positive note is that women are being more proactive. I see a lot of women who are entering more postpartum. We actually get people who are being proactive and they're saying, you know what, I want to get pregnant. I just want to make sure that I go into this, you know, beautiful journey as healthy as I possibly can be. So I am seeing people being more proactive.
What I do see quite a lot of is women that are going through perimenopause who never really address their health and pelvic health.
after they were postpartum and their bodies are a little less resilient now and what they could have taken care of easily postpartum are now kind of manifesting in perimenopause and menopause. So my message to women would be to take care of yourself in every season of life. If you feel something, say something, be proactive.
about it. You know, it is debilitating and perimenopause for high achieving, high performing successful women to be in a meeting and not being able to access words that, you know, will help them articulate their thought and they really are like, am I getting dementia?
Kelly Berry (22:15)
Yeah.
Susan Winograd (22:16)
They're scared. It's so much more than just hot flashes and brain fog. It is about that. Those are important. But it's like the big picture of your life. know, a lot of times in perimenopause, it's like me, women that can finally say, I devoted a lot of my life to making sure I was there as a parent or whatever your role in life was, and now it's my turn. And then all of a sudden, you get to the point where you're like, wait, but I can't think
so clearly now. ⁓ And there's so much that we can do about that. And I just encourage every woman, if you don't feel like the rock star you are, then then do something about it because there is help out there.
Kelly Berry (22:46)
Mm-hmm.
Yeah. mean, talk about something else that is so common, but not normal, like you're talking about. How many times have we heard like pregnancy brain or, you know, perimenopause fog or whatever it brain fog, just like kind of the general terms. And I have been there too. Like what is happening? I'm tired all the time. I can't think straight.
Susan Winograd (23:09)
Mm-hmm.
Kelly Berry (23:21)
One of my big cues was I was forgetting things. I've had close to a photographic memory my entire life and I'm all of sudden forgetting things that it just would have never happened before. And so these things are, for me, they're things I'm unwilling to live with. So work with Kelly to try to rein that in.
Susan Winograd (23:38)
Yeah.
For me, it was really walking into a room and having no idea why I walked into that room. And it's you're like, my goodness, what? Why? How do I not? You know, I'd be standing in my laundry room being what did I come in here for?
Kelly Berry (23:49)
Mm-hmm.
Mm-hmm.
Susan Winograd (23:58)
And
it's very, very scary. I think the difference is a lot of women actually are like, maybe I should see a neurologist. I like, getting dementia? I like, have brain fog, I can't capture my words. And dementia is not very common in midlife, but brain fog, forgetfulness, having decreased clarity, that is more common. Forgetting where you put your keys is common in peri-mentals.
Kelly Berry (24:06)
I don't know.
Susan Winograd (24:26)
pause, forgetting what to do with your keys is more indicative of more of dementia. Now, I'm not a doctor. I give offering medical advice, but know that if you're feeling those kind of symptoms, that there is so much that is available now to help you.
really live your best life. You menopause is an opportunity. I feel like we're at the point in our lives now, perimenopause, where I don't have kids in the house anymore. It's really about my goals, my purpose. And I want to think clearly, I want to feel good. I don't want to have flashes. You know, you're at the point in your life where if you have a partner, you don't necessarily have to worry about someone barging into your room when you're being intimate. So you want to be able to
Kelly Berry (25:01)
Mm-hmm.
Susan Winograd (25:13)
embrace that and take advantage of it and enjoy it. And there's so much that we can do to help women and men too, by the way. Men have hormonal changes as they get older, they have pelvic floor changes, and I think it's important to send that message to them as well.
Kelly Berry (25:21)
Mm-hmm. Yeah.
Yeah, definitely. So talk to us more about your framework that you have, the bio, is it biopsychosocial framework? Yes. Talk to me about what that is and what that means for your patients.
Susan Winograd (25:44)
Yeah, so basically, you know, when you have a persistent pain, any time that you have pain, there automatically is an emotional component to that, right, or a stress component. And as the pain persists or as the dysfunction persists, whether it's urinary urgency or pelvic pain, or even gut issues,
You then start developing nervous system dysfunction with that as well. Our brain, just like it can strengthen certain pathways, can strengthen...
painful pathways because your nervous system's job is to protect you. So what we know now, according to evidence-based research, is that when someone has a pain syndrome or persistent pain and we only treat the body, we are not going to get long-term results. We need to treat the nervous system. So a lot of therapists who are not trained in specifically integrating a bio
psycho-social approach will do their best. They'll give people breathing strategies or they'll try to give people some strategies to calm their nervous system. But that's a little bit like throwing spaghetti at the wall and seeing what sticks. I'm not just, I am sure they're incredible therapists and they're doing their very best. But the difference is, that we are asking specifically about what is going on in that unique
person's nervous system. So we're giving them questionnaires on depression, anxiety, stress, catastrophization, worry, somatosensory dysregulation. That means is their brain perceiving what their body is feeling accurately? Self-efficacy, are they less confident in their body? And we are developing a nervous system program or plan of care
based on their self-reported answers with what's going on in their nervous system. And that really makes all the difference because what, and I wanna make the disclaimers that I'm not a psychotherapist. This is all done within the scope of my practice. So I do talk to my clients a lot about psychotherapy. If I do feel it's indicated and refer that out.
but we look at it more from what we can do within the scope of our practice. So for example, if someone is reporting a high degree of depression because of what's going on in their body, we may give them cardiovascular exercises to help release endorphins or something along those lines where if they have anxiety and stress, we are gonna give them very specific
nervous system calming and unwinding exercises. If they have worry, we're going to give them exercises to train their brains away from worry. their body is not, if their nervous system is not interpreting painful signals accurately, we're going to help retrain those pathways as well. So it's way more individualized than just giving someone breathing exercises.
a huge difference in their outcome because just like we have to approach the body, we have to also approach what the nervous system signals are telling the body. It's really a game changer, but in addition to that, we also look at sleep, right? Because if you're not getting good quality sleep,
You're probably going to be stressed during the day. Your cortisol levels may be off balance. When your cortisol levels are off balance, it can stimulate this global inflammatory process. It's a cascade effect. So we really want to look at every system in the body and make sure it's optimized to help them get the best results that they can.
Kelly Berry (29:44)
Mm-hmm. I mean, I think this makes so much sense because when I think about people who need physical therapy or the things that may have happened to them to cause them to be a patient of yours in the first place, a lot of those things are probably, you know, injuries, accidents, things that do cause stress and worry. If they've dealt with it for a long time, they may, their confidence in getting back to where they were before is probably taking a big hit.
And so being able to uncover a lot of those beliefs and work through a lot of that kind of mind-body connection, it's kind of obvious that that is such a key component to what you're talking about, actual long-term healing.
Susan Winograd (30:29)
I think the other shift in the paradigm that's really important is to first of all not not really approach people as Their fixer right healing is in their hand. So it's way more of a partnership That's how I approach my relationship with my clients. This is a partnership. I'm gonna guide you
Kelly Berry (30:40)
Mm-hmm.
Susan Winograd (30:50)
I'm going to do what I need to do to balance everything, but the power is in your hands. We want to give the client as many tools as we can to help them heal themselves because ultimately,
that's what's going to help them regain their confidence and we also don't want them to depend on something for their health and wellness. Yes, they may need help in the beginning, they may need manual therapy, they may need orthopedic therapy, they may need someone to help them with a biopsychosocial approach, but my goal, and I always tell my client this, if you're in the gym and you're feeling something,
I want you to say, I know how to do this. Like, Susan taught me what to do if I'm in this situation and how to use my body in a way that supports the task that I want to do here. And a lot of times they then learn how to problem solve and prevent issues, or they may be like, you know what, I tried this and I think this is something that I may need a little tune up for. I I may need to go back because my body's telling me,
that something else needs to be optimized, but you're coming from a place of empowerment. You're not coming from a place of, know, I am limited and I need to go depend on someone for my healing. And I think that's a really important conversation.
Kelly Berry (32:12)
Yeah, it is. I love that because agency is a big topic around here. And I think that the healing being in someone's hands, know, the patient's hands is so powerful because it is so true. It's like anything. It's like coaching. It's like fitness. You cannot do things for somebody else. You cannot make them do the things you cannot. You're not a magician. You're very educated and
There are certain supports that you can give to people, but ultimately they need to own their success or their failure. Period. Yeah.
Susan Winograd (32:44)
Absolutely.
you know,
sometimes people say, Susan, you fixed me and I'm like, No, I did not. Maybe I guided you, but you healed yourself. So I think we have to first of all, it's too much of a responsibility on me, right? I feel like I feel like your your healing is not dependent on me. It's I'm going to share the knowledge I know, I'm going to teach you what you need to know in order to implement and empower yourself to heal yourself. And I think that's really important because we're with these
Kelly Berry (32:51)
you
right there.
Susan Winograd (33:16)
people for snapshot of time and we want them to go on to live their lives feeling amazing every single day. And that requires a lot of education. I do a lot of education in my practice.
Kelly Berry (33:19)
Mm-hmm.
Mm-hmm.
Yeah.
Susan Winograd (33:28)
I truly understand if you give people an exercise or a technique, that's not going to translate into their functional life and other areas. But if they understand how the body works and why I gave them that strategy and why it works, then they can then implement that and translate that into other areas of their life if need be.
Kelly Berry (33:50)
Yeah, and that type of action and result just creates more confidence that they can do it, they can figure it out, and they can carry on going forward, which is so, so important. Yeah, that's great. I love that. So I guess to kind of shift gears a little bit, like what are, if you had to name like just a couple of
Susan Winograd (34:06)
Yeah.
Kelly Berry (34:16)
scenarios that people come to you for and they think it's X but it's actually Y like the most common things that you see what what are those?
Susan Winograd (34:25)
So I think a lot of times with pain with sex, that's probably the most common thing that I see. whether they think it or they've been told it, they say it's all in my head. It's all in my head. I've had clients who have been told just have a glass of wine.
you know, just relax, which pisses me off because people could just relax, they would. So, you know, with
Kelly Berry (34:58)
Mm-hmm.
Susan Winograd (35:01)
pain with intimacy, have to look at again, what's driving the pain? What is causing the pain? Is it a nervous system thing? And by the way, if it's a nervous system thing, it's not in their head. Their nervous system is sending signals for them to feel the pain. So if you're feeling pain, your pain is real. Don't let anybody tell you otherwise. Is it a tissue issue? Are their muscles too tight or is their
system not connecting properly with their brain, with their body, or have they had a trauma? So again, I think that is like the most common thing with pain, with intimacy. People say, I think it's all in my head. I don't understand. ⁓
Kelly Berry (35:44)
Hmm.
Susan Winograd (35:45)
My doctor told me to drink a glass of wine. Everything looks fine down there. So if you feel something, your pain is real, and if someone tells you it's in your head, then don't listen to them. I feel like...
Kelly Berry (35:56)
Yeah.
Susan Winograd (35:58)
The other thing that I would say is the most common thing is that when people are leaking, they're like, just start doing Kegels. If you're Kegels and that is, think one of the biggest misconceptions I will tell you that I have just as many people who have leaking because their pelvic floor is weak that I have women that their pelvic floor is tight.
Kelly Berry (36:06)
Mm-hmm
Susan Winograd (36:26)
of women who come to me and they're like, I don't understand. I started doing Kegels and I got worse. And then I examine them. We do a pelvic floor exam and they're holding a lot of tension in their pelvic floor. So they're essentially contracting over a tight muscle, which is going to make them worse. They don't need Kegels at that time. They need to relax their pelvic floor muscles. So again, we're seeing the symptom and we're attaching the technique to a symptom when we don't really
really,
really know or understand what's going on. It's true, a tight muscle is a weak muscle.
Kelly Berry (36:58)
Mm-hmm.
Susan Winograd (37:02)
But in that situation where they have tension, we have to lengthen before we strengthen. So that is a very, very, common one. my gosh, there are so many. mean, even with constipation, people don't often realize that, you know, they're like, I have something going on with my God, I have leaky God, or that could be true, but...
mechanically, they're not pooping the right way. They're really just working against themselves instead of working with their body. you know, so often I get, and I joke about this all the time, I've had plenty of clients come in with like a painful bladder book and they'll be like, this is what I have, what should I do?
Googled and you know, that's what CHAC GPT or Google came up with their symptoms. But in the end, it couldn't have been farther from the truth. And I think that's just reminding us that we need to really get to the root cause, get a set of professional eyes on your body so we could really see what's going on. But probably the most common one I would say is people doing Kegels when they're leaking and then getting worse.
Kelly Berry (38:07)
Mm-hmm.
Yeah, yeah. And then I see also people advertising. I'm sure you have strong opinions on this. Whatever that chair is that people can sit in.
Susan Winograd (38:21)
Yeah, that in cell out day. Well, I think that I think I could be wrong, but it's like 10,000 Kegels in 10 minutes. And that sounds really scary. Number one, no, like, would you believe it if somebody said they could give you a six pack abs by doing 10,000 contractions by putting a device on. There are certain devices that could be a nice adjunct. ⁓
Kelly Berry (38:30)
Mm-hmm.
Thank
Yeah.
Susan Winograd (38:47)
So
there are some people who love devices, they love technology. And in those cases, you know, those kind of devices could be helpful as an add on, but we have to remember that we have to teach people how to use their bodies. And if you're having a device contract for you to make you stronger in that area of your body, you have to imagine that there's not going to be long term carry over or
Kelly Berry (39:04)
Mm-hmm.
Susan Winograd (39:17)
in those muscles itself and definitely functionally, we're not teaching those muscles how to work with the rest of your body. What I always tell people is that if it's too good to be true, it probably is. And sometimes I think we want to believe things for our pelvic floor that there could be a quick fix where we probably would look at someone sideways if they told us to do it in any other part of our body.
Kelly Berry (39:23)
Yeah.
Mm-hmm. Yeah.
Yeah, yeah,
probably.
Susan Winograd (39:46)
We have to start thinking of the pelvic floor muscles like any other muscle in our body. It's skeletal muscle and it needs to be addressed in the same way that other muscles in our body works. In isolation, how is it working by itself and how is it working in coordination with the rest of our body?
So yeah, think my message for that would be if it seems too good to be true, it probably is. And if you still want to use it, then maybe look at it as an add-on.
Kelly Berry (40:16)
Yeah, yeah, I love that. Yeah, because I think just like you were talking about the industry and how much money that people make on just products to help us normalize things. We are a society who wants a quick fix. We want to take a pill. We want to sign up for the thing and make it go away. And a lot of times,
you can do that, but it doesn't go away forever or it, yeah.
Susan Winograd (40:45)
You know, our bodies change over time. I had
about two years ago, had an endocrinologist call me and she's like,
great news, I got this chair for clients who are leaking and you know, it's not super expensive and I really would like you to refer your patients to me for them. And I said, well, why'd you get it? You know, what was your rationale? And she's like, well, women are leaking and they don't have time to go to physical therapy. And they also don't want to, you know, it's $500 for five, 10 minute sessions and they have to do it in six rounds, let's say.
something like that. So I said, okay, well, you you're looking at them at a certain point in their life. We're not teaching them how to use their body for the amount of time for the amount of money they're investing in using this device. You do realize that they could go to physical therapy.
probably spend less money and learn how to strengthen and use their body for the rest of their life. Right. So I feel like when you're going into something like that, you have to think of what am I trying to accomplish? Am I paying on the front end and am I going to have to pay on the back end or do I really want a quick fix? Because that's exactly what it is. It's going to be a quick fix and it's not it's going to
Kelly Berry (41:50)
Mm-hmm.
Susan Winograd (42:11)
might not work at all and it's certainly not going to last long term. So, you know, I've had people who have had vaginal lasers and they've had, you know, bad reactions to that or they've had them three or four times and they're sick of having to get them. So then they're like, you know what, I just really need to learn how to use my body and stay strong on my own. Again, we're talking about agency, right?
Kelly Berry (42:15)
Mm-hmm. Yeah.
Mm-hmm.
Susan Winograd (42:39)
Are
we gonna keep going to someone to do a vaginal laser for us every two years or three months? Or are we gonna learn how to use our body and strengthen our body so we have that power to do that and keep ourselves healthy for the rest of our lives? Which investments do you wanna make?
Kelly Berry (42:55)
Yeah, yes, I love that.
Mm-hmm, yep. Shortcuts aren't always short, yeah. This has all been really great. I have another question, but before we get to that, I do have a lot of listeners in South Florida, but I also have listeners all over the place. And so for listeners who are like, need to find a Susan.
What should they be looking for in a physical therapist or practitioner to get the kind of holistic care that you and your practice provide?
Susan Winograd (43:26)
Yeah, I think that's such an important question. You know, I have had patients who call me and they'll say, what makes you different?
there's lots of pelvic floor therapists, why am I choosing you? And I love that question because I can answer it confidently. We are different. I don't think anybody's doing pelvic floor therapy the way we are. I know I have a biased opinion, but I can confidently speak to that. So ask them that. What makes them different? What is their approach? Do they have a whole body approach? If you go to a pelvic floor therapist and they're only focusing on your pelvis or they're using the same device
Kelly Berry (43:40)
Mm-hmm.
Mm-hmm.
Susan Winograd (44:04)
for every treatment and every treatment looks the same, then you need to start thinking. But I would ask them what their approach is. Do they have a whole body approach? Do they have a holistic, integrative approach? How do they approach pelvic health? What makes them different? You really, really want someone who is looking at the body as a whole and who provides individualized care. ⁓
Kelly Berry (44:30)
Mm-hmm.
Susan Winograd (44:33)
can't
have shake and bake type of therapy for anything. If you're going and they're seeing more than one patient at a time, to me, maybe look for something different for pelvic health for sure. You want one-on-one treatment. So I think those are some of the things and some of the questions that you want to ask and there's lots of great pelvic floor therapists that take that approach all over the place.
Kelly Berry (44:46)
Mm-hmm.
Yeah,
yeah. I think what I'm hearing you say is, are they asking you questions? You know, like, when you go see them and you tell them why you're there, do they question that? they, do they try to like peel back the layers to see is what they're here for, what their problem is? Because a lot of what you talked about here has really
Susan Winograd (45:07)
Yeah.
Kelly Berry (45:17)
tied back to like your philosophy of root cause, not just symptoms. And so if you think about that as you're seeing a new practitioner, are they asking you questions to try to get to the root of the problem? Or are they just treating your symptoms so that you're gonna be like me back there on the bike or whatever it looks like in a few months?
Susan Winograd (45:29)
Absolutely.
Absolutely.
This is really interesting. I have a client now who came to me for pelvic pain, groin pain, pelvic pain, glute pain. And it turns out because of the way I assess that we determined through the assessment that her thorax, her rib cage is actually the primary driver, her feet.
The way she's bearing weight through her feet are the secondary driver and her pelvis is actually the tertiary driver in her pain and is just sort of like an innocent bystander of what's going on from the top down and bottom up. And we're doing a ton of work on her.
Kelly Berry (46:13)
No, didn't.
Susan Winograd (46:18)
thorax on her ribs, on her feet, and she's doing so great. But you can't, you have to find what's driving the symptoms. You can't treat the symptoms. So sometimes the root cause of where you're feeling the pain is at a distant site.
So if you're feeling pelvic pain, you may have some pelvic issues that need to be addressed, but that might not be what's driving the pain. That's really what you want to look for, someone that has a root cause approach.
Kelly Berry (46:36)
Mm-hmm.
Yeah.
Yep, I love that. I love that. Well, we are at time and I want to give you an opportunity to tell people where they can find you, what the process looks like to work with you and any other tidbits or wisdom that you want to share with the world.
Susan Winograd (47:06)
Okay, so my practice is an East Boca called Pelvicor Rehab. You can call to schedule a 15 minute free discovery call. I love talking to people. I feel like I've even had people from out of state say, know, can you give me some resources? I'm happy to talk to anybody.
We have a very active YouTube channel called Pelvicor Rehab Plus, which I love because we do tons of educational videos on there. We're on Facebook and Instagram at Pelvicor Rehab and Wellness. And if you Google us, we'll come up. Our website is robo.
bust and it is full of information and articles and podcasts so you can glean a lot of information just from that. think if you type you know look up Pelvicor Rehab you will be able to find us and certainly my name so please
Follow us on Instagram, on LinkedIn, on Facebook, and certainly on YouTube, and always message me. For us, it all starts with that 90 minute initial consultation, and that's kind of what determines our plan of care. And what I would say to people is, be your own best advocate.
If you feel something, say something and know that healing is possible. Our bodies are meant to heal. You have to remember that what worked for you when you were 20 may not work for you now. And also the practitioner that you saw in your 20s may not be the right practitioner to see you in perimenopause. You know the most about your body and you need to listen to that, respect that, honor that and also always remember
Remember that what is common is not always normal.
Kelly Berry (48:49)
Yeah, I love that. Susan also does like a monthly in-person workshop series where she's always partnering with other people in our community to bring in experts. And really, she is living and breathing this holistic care that she's been talking about, addressing everything, bringing awareness. But those are really great also if you're local and her schedule is on her website.
Susan Winograd (49:15)
Yeah, so it's a new initiative that I launched called Ask the Experts.
Kelly Berry (49:19)
Any
questions?
Susan Winograd (49:19)
We started last January and we've been sold out every month and we have an expert in a different area of wellness every month and we just have gotten the best response. They've been phenomenal and powerful and if you live in South Florida, please look out for those because they sell out fast and they're amazing. They're free events but you have to register for Eventbrite because we have limited capacity.
Kelly Berry (49:45)
Yeah, yeah, that's great. And all of the links that Susan just mentioned are all in the show notes. So you can find those there. Definitely, definitely look her up. She is a wealth of knowledge and her approach is unique and just so important. I don't really know a better way to say it. It's just, we need this kind of care. We need this kind of knowledge about ourselves. We need to be aware that
We are a whole person and everything is connected. You cannot treat things in isolation and expect for things to just work. And I think you said nervous system is king or queen and that is so true and your body hangs on to stuff. The body keeps the score. We know that for sure. Definitely.
Susan Winograd (50:35)
I'm actually
reading that book for like the third time now. I continue over and over again.
Kelly Berry (50:39)
Okay.
Yeah, I am listening to that. I've been listening to it for some time. For a non-medical person, it is very scientific, but it is so, so good. So good. Yeah. Well, great. Well, thank you so much for being here and sharing. know this is going to be so impactful to so many people, and they will be finding you or people like you in their area and making it.
Susan Winograd (50:49)
Yeah,
Kelly Berry (51:06)
making a difference in their lives. So thank you so much. Appreciate you.
Susan Winograd (51:09)
you. Thanks.
Kelly Berry is a strategic business leader and business coach. She is known for her operational excellence and her ability to drive growth and results across multiple industries.
She is also hosting her own podcast, Life Intended.
