Carrie Pagliano Physical Therapy

Carrie Pagliano Physical Therapy I help women return to symptom free movement! Expert women's & pelvic health PT serving DC metro ar

Do you have a gut reaction when someone mentions pelvic floor surgery?That split second before you think about it. The t...
09/10/2026

Do you have a gut reaction when someone mentions pelvic floor surgery?

That split second before you think about it. The tiny thought that fires off before you've decided anything.

MESH.
That's the easy way out.
She must not have worked hard enough.
I would never.

I'm not asking to catch you. I'm asking because I've had one too in the past, and because that reaction is doing more work in these decisions than anybody wants to admit.

Here's what I keep seeing. Women who have done every single thing asked of them.

Estrogen, pessaries, real PT with a real program, testing, procedures. Years of it. Still leaking. Still bulging. And the second surgery comes up, the door shuts before the sentence is finished. Not weighed and declined. Just shut.

Women tell me surgery isn't an option because they can't go weeks without picking up their kid, and they're right, that one is real.

Then they tell me the rest. That mesh will ruin them, because of a lawsuit ad they saw on TV in 2012. That surgery means never running again, because someone's aunt had a hysterectomy at 62 and that was the end of her tennis. That it'll fail in ten years anyway, because a stranger on Reddit said so.

I tell my patients I'm not sending anybody to an operating room. I've never done that. (We DO talk about options and sometimes we land on a surgical consult referral which I absolutely do...and I work with some AMAZING surgeons.)

We do talk about sometimes, surgery, can absolutely be the best option...for them as an individual and worthy of a conversation.

What I want is for you to notice the reaction first. Sit with where it came from. Ask what those people actually knew about a woman your age doing what you want to do.

Then decide. A no you arrived at yourself is a good answer.

What's your gut reaction to the thought of having pelvic surgery? Share👇

I've wanted to ask a woman about her weighted vest for months now. On the trail, at the park, passing on the sidewalk. N...
09/09/2026

I've wanted to ask a woman about her weighted vest for months now.
On the trail, at the park, passing on the sidewalk. Never have. You cannot walk up to a stranger mid-run and start interrogating her about her gear.

(Trail faux-pax)

Then a friend from my neighborhood, went by my house before dawn in a brand new one.

Finally. Somebody I could actually ask.

And I still had to take a beat before I hit send, because I wanted her real answer, not a defensive one. So I kept it simple.

Me: "Saw you out this morning with a weighted vest. What made you decide to start wearing one?"

Her: "To improve my bone density. I was diagnosed with osteoporosis last year and my doctor recommended it."

There it was. The reason I have been guessing at for months, from someone I actually know.

For the record, I own three weighted vests. A plate carrier from doing Murph in my driveway in 2020. A ruck vest, because I got fully influenced by the Whole30 lady walking with weight. And the Amazon special I bought to try out before this whole thing became a perimenopause personality trait.

Two of the three are miserable to wear. I do not use any of them right now, because my week already has the load in it.

So this is not about the vest. Wear the vest.

What fires me up is what women are EXPECTING to get out of it. That result was never going to happen based on the evidence being used to (now) sell it. I went and read the three studies sitting underneath the promise. They do not say what she was told they say.

Swipe for what those studies actually found, and for what we do have evidence for.

She is spending her mornings and her body on this. My friend deserves better than a claim that outran its evidence.

🦺What were your expectations from wearing a weighted vest? Love it or leave it?

Full breakdown on Substack.

DM VEST for 🔗

"You're all set." That was the plan walking out of the OB 6 week visit.Then you go run and spend the whole time wonderin...
09/08/2026

"You're all set." That was the plan walking out of the OB 6 week visit.

Then you go run and spend the whole time wondering if you're wrecking something.

Two moms in on the same day, both 2 1/2 weeks postpartum.

One on her first, after a C section.

One on her second. We started things with both of them that nobody told me to do until much later, when I was the one in it. I promise you I think about that.

And I think about the women who are perimenopausal now and never got any of this.
🔹Walking only until six weeks, then good luck.
🔹Some of them are still carrying what that cost them.
🔹I'd love to run a catch up boot camp for that whole generation, quite honestly.

What the expert consensus actually supports: a minimum three week period of rest and recovery, then screening, then a timeline built around the person in front of you.

That's expert agreement, not proof. Some moms will need much longer, and often for reasons that have nothing to do with their pelvic floor.
🔹Not having access to childcare is a variable.
🔹Back to work at eight weeks is a variable.

Swipe through for what the panel agreed on and where it stops.

In my clinical experience the move is simple. Look at everything, make sure nothing is glaring, identify risk factors, educate about potential red and yellow flags, then start moving and come back and tell me how it went.

We problem solve from there.

The research primary authors are and on the Delphi consensus statements in BJSM. Shefali is on EP 257 on the Summer Rewind episode from 2024 and it's a good one

👶Where were you at 3 & 6 weeks postpartum, and what did anyone actually tell you? 🤔

None of these came from someone trying to hurt you.That's exactly why they stick. Every one of these rules was handed to...
09/07/2026

None of these came from someone trying to hurt you.

That's exactly why they stick. Every one of these rules was handed to you by somebody who meant well, and most of them made sense when they were invented.

Healing takes time. Incisions hurt. A field with minimal guidelines went ahead and wrote some, because the alternative was nothing.

Then the field moved and the rules stayed put.

Here's what that costs:

It's the woman four years out who still rolls to her side to get out of bed. Who still thinks she can't lift more than 10-15 pounds and stopped picking up her toddler to prevent prolapse or pelvic floor problems.

It's the woman who thinks she's broken because she tried to do everything "the right way" and in reality she's deconditioned and scared.

She did exactly what she was told. That's the whole problem.

(Nobody has ever walked into my office and said "I think I rested too much." That is very often what happened.)

Waiting is not neutral. Every month you spend waiting for permission is a month your body spends getting less capable of the thing you're waiting to do. It takes a toll on your physical AND mental health

You're allowed to walk. You're allowed to sit up. You're allowed to go find out what happens instead of guessing from the couch.

And if something does show up when you go find out, that isn't proof you broke a rule. That's data.

Symptoms are information.

Which one of these myths did you think was true?

CONGRATS MAMA! just finished 12th woman at about 13 months postpartum.Back in October 2025, when Monte was 12 weeks o...
09/05/2026

CONGRATS MAMA! just finished 12th woman at about 13 months postpartum.

Back in October 2025, when Monte was 12 weeks old, she told me this:

"I don't feel the need to bounce back. It's going to be a different version of myself whenever I do."

"What I'm seeing in my postpartum journey is like I haven't forced anything yet. And I'm hoping that enables me to have a really healthful return."

She was also honest about the fear underneath it. That the sport keeps getting faster while you're gone. That the version of you who comes back might not measure up to the one who left. She said it out loud, sat with it, and decided to go anyway.

Then she went and did it.

Here's what I want you to notice: NOT FORCING IT WAS THE STRATEGY.

Not the thing she settled for while she waited to get serious. The slow hikes with the baby on her chest. The lack of motivation she named without apologizing for it. The races she deliberately staggered across years instead of cramming into one season.

That's not a lesser return. That's the return.

This was one of the most refreshing conversations I've ever had with a new mom and it's been a joy following along with her this year!

Leah also co-hosts — go listen if you want more of this perspective on the sport.

🎧 Full conversation with Leah — Episode 194 of the Active Mom Podcast. Find it where you get your podcasts.

My mom started having perimenopause symptoms in her early 40's.I found that out in a conversation that would have been e...
09/02/2026

My mom started having perimenopause symptoms in her early 40's.

I found that out in a conversation that would have been extremely useful... about six years earlier.

I missed my own symptoms. Thoroughly. But the piece of information that would have made me suspicious was sitting in my own family the whole time, and neither of us thought to pass it along.

And I understand why.
She was on hormone therapy and got pulled off it in the cancer scare. That was the moment a whole generation of women stopped treating this and stopped talking about it. She didn't withhold anything from me, it just wasn't a story about her own body had the context that we have today.

So when I was diving headfirst into peri, I built my own explanations.

The dog was too hot at night. (She sleeps on my neck...IYKYK). Work. Life stress. A rough patch of 2am wake-ups that had somehow been going on for a year.

Every one of those was individually plausible, and that is exactly why this works.

You don't miss perimenopause because you weren't paying attention. You miss it because every symptom shows up with a perfectly good excuse already attached.

And here's the part that's like a dagger to the heart...

If you're not informed enough to connect all of this yourself, walk into an appointment, and say the word out loud, lots of times you don't get help.

(I even had a patient last week WITH vasomotor symptoms at 51 told "it wasn't time yet for HRT." WTF. Really.)

The women who get taken seriously are the women who arrive having already done the reading. That is not a fair way to hand out care and I can't pretend it is.

So here's the plan: write the whole list down. Take it in. Say it. Because if you don't ask, the answer is always no.

What did you blame first, before you considered perimenopause? I blamed the dog. Share yours 👇

Someone DM'd me recently. She's designing a product for runners who leak, and she wanted to know how much a woman actual...
09/01/2026

Someone DM'd me recently. She's designing a product for runners who leak, and she wanted to know how much a woman actually leaks per hour of running so she could size it right.

That number doesn't exist. I told her so, and I told her where the best measurement work is happening. ( if you're asking)

Then I reread her message and saw the assumption underneath the question. She thought leaking gets worse late in a run because the pelvic floor fatigues. It came from her own half marathon, where she leaked more with every mile.

That's a fair read of your own body. It's also what most of us believed for a long time, me included.

But the research moved. Muscle force doesn't drop after a run. Women who leak often test the same or stronger. What actually differs is how impact travels up through the body before it ever reaches the pelvis.

So something does change over a long run. It just isn't your pelvic floor giving out.

That difference decides who gets blamed.

If you believe you leaked because you got tired, you conclude you should have trained harder.

If you know your body was managing load differently, you go looking for what to change instead.

She wrote back and said she'd read the research and listen to the epsiodes before taking her design further. No defensiveness. She just went and did the homework.

Which is the whole point. Ten years ago there wasn't much to read. Now there is.

Swipe for what we know.

🤔What were you told about why you leak, and who told you? Doctor, coach, PT, internet, nobody at all?

The claim I hear most about hypopressives is that they'll move your organs back up.Nobody has measured that.What somebod...
08/31/2026

The claim I hear most about hypopressives is that they'll move your organs back up.

Nobody has measured that.

What somebody did finally measure is the pressure, which is the part the entire method is built on.

put a sensor in and ran it. The pressure didn't drop. The pelvic floor did switch on, modestly. And whether the women held the posture or not made no difference to either number. (Saraiva et al., 2026, Physiotherapy)

She's trained in hypopressives herself, by the way. She still teaches them. Her position is not that they're dangerous. It's that if strength is the goal, pelvic floor muscle training is still the gold standard.

In my clinical experience:
🔹I have patients ask me about these all the time.
🔹Some are already doing them. And if they're doing them and they like them, I have no reason for them to stop.
🔹If they haven't started yet, that's usually when we talk about other options for treatment, ones that may bring quicker changes in symptoms and have a lot more evidence behind them.

That's not a research finding. That's just how I handle it in the room.

🎧 The full conversation is EP 256.

Have you done hypopressives yourself or with a client? How long did you spend trying to get the posture exactly right? SHARE 👇

_________________________
Want to know what your pelvic floor is actually doing before you stack anything on top of it? The free Return to Run Readiness Screen is in my bio.

I also used to write posts exactly like that one...8 years ago.The inspirational postpartum return to run post...she hea...
08/31/2026

I also used to write posts exactly like that one...8 years ago.

The inspirational postpartum return to run post...she healed her pelvic floor, stopped fearing her symptoms, and now she's training for a big race. (Link in bio for the checklist.)

I believe her. Every word. (Not kidding.)

Back in 2020, I sold a postpartum return to run program when there were almost none out there that even considered the pelvic floor. I took it down a couple of years ago, because realized there were a lot of women it WASN'T going to help and I'm a PT...we want to help EVERYONE.

Here's the problem. They followed the same plan that worked for someone else, did every exercise in it, and stayed symptomatic anyway. So they concluded the failure was theirs.

It isn't.

I'm 26 years into treating this. I'm a runner living my own version of it. I go to the conferences, I ask the researchers what their findings mean for the woman in my office on Monday morning, and I've had a number of them on the to explain it in their own words.

So I'm going to say this with big sister energy (looking out for you)

When someone promises you a solution and their proof of concept is themselves, slow down, take a beat.

Consider that what was driving their symptoms MAY NOT be what's driving yours, and that part rarely makes it into the disclosure.

Some women respond beautifully to that programming. Some don't. Both of those things can be true, and which group you land in was never a measure of how hard you worked.

Has this ever happened to you? You did the program and got different results? Share👇
If you did everything right and you're still leaking, the full breakdown is on the Substack. DM PROBLEM for 🔗

Four years since we recorded this episode and there are so many more pelvic PTs in the running space now.I ❤️ this. Trul...
08/30/2026

Four years since we recorded this episode and there are so many more pelvic PTs in the running space now.

I ❤️ this. Truly. That's growth we did not have back then.

And I'm still hearing the same running myths, just as often.😭😭😭

Not from moms. From other PFPTs.

I see a lot of second opinions. Moms who were told by another pelvic PT that they were ready to run.

No screening. No run specific foundation work. Just a couch to 5K plan. And when it didn't go well, they were told to rest, wait a few more weeks, keep stretching, keep walking... maybe try swimming.

Swimming. Tell me you don't know runners without telling me you don't know runners.

Running yourself is not the same as being running informed.

I say that as someone who has been running a long time and still had to go learn this from the sports ortho world, because the pelvic health research on return to sport just isn't there yet. We've had to borrow. A lot of us haven't.

Swipe through for five of them. Stretching. Glutes. "You're running wrong." The thing nobody asks about. And where you actually start.

In my clinical experience, the moms who stay sidelined are often sidelined by something other than the pelvic floor. It's an old ankle. An old knee. A calf that never came back. And they spent a year working on the wrong thing while somebody told them to be patient.

Symptoms are information, not a verdict. Your body didn't break. 🔷

This one is a Summer Rewind. EP 255 // You're Not Running Wrong: Running Myths Debunked, with , Rich W***y, PT, PhD. Originally aired September 2022 and I listen to it every summer. I get something new every time. Quite honestly, that's rare.

So tell me: which of these have you been told? 👇

Update: Since recording, Rich is no longer in Montana (no, he's not planning on changing his IG handle!) He's come back east to doing research and teaching in the PT program.

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Arlington, VA
22207

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Thursday 9am - 5pm

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