Today I’m talking with Barbara Loomis, aka Alignment Monkey. She is a Restorative Exercise™ Specialist, a certified practitioner and educator of the Arvigo Techniques of Maya Abdominal Therapy®, as well as a certified Chi Nei Tsang and a Visceral Manipulation™ therapist. She brings all of these super powers together for the good of reproductive, digestive and pelvic floor health, and today she is sharing her vast uterine wisdom with us.
We talk about the surprising symptoms that can spring from uterine malpositioning- such as urinary incontinence, constipation, and even knee pain with ovulation. We also talk about the normal movement of the uterus, what we can do to keep it in as happy a position as possible, and some of the cultural things that contribute to a malpositioned uterus. We also talk about hysterectomies and the controversies that sometimes spring up around whether or not women should lift weights- i.e. does the contribute to uterine malpositioning and is it problematic in pregnancy?
Brooke: You have a unique specialty and also a number of therapies that you combine in your practice. To start, can you describe your work?
Barbara: Sure. I specialize in reproductive and digestive health using manual therapies. I would say there are four main things I draw from my toolbox. There are others but the main things are the Arvigo Techniques of Maya Abdominal Therapy®. I’m also a practitioner and educator for the Arvigo Institute and I’m a certified Chi Nei Tsang practitioner which is Chinese abdominal therapy. I’m trained in Visceral Manipulation TM and incorporate this into the practice as well as Restorative Exercise.
Brooke: Could you describe some of the common uterine issues that you see?
Barbara: I should start by saying that uterus should be able to move, it has intrinsic motility and mobility. The uterus sits between the bladder and the rectum. The problem is when it’s stuck in any one position affecting its motility or mobility. Common positions, I see the uterus in, where it causes issues are retroversion- when the uterus is tipped back towards the rectum. Keep in mind, the uterus weighs about four ounces when you’re not menstruating and can double in size to eight ounces right before and during your period. That’s a lot of extra weight on the rectum if it’s tipped back, or the bladder if it’s tipped forward. There is an anteflexed position where the uterus is in a forward bend. It can also be retroflexed where it’s tipped back and flexed backwards. It could also be tipped back but flex forward. The uterus could also tip to the left or to the right causing issues with vascular flow. There’s also a situation called prolapse and there are different degrees of all of any one position. Some of the issues that I see with a retroversion could be thinner stools right before your period due to the uterus pressing against the rectum making the passageway narrow. One may also have painful periods, backache with your periods and fertility challenges. It’s not the ideal situation for an embryo to grow. The uterus may be lacking proper nutrients if vascular flow is inhibited. If the uterus is tipped forward, then you may experience incontinence or frequent urination. When you have to pee, you have this urgency but not a lot of pee comes out, which could be from the uterus pressing down on the bladder
Brooke: I’m really fascinated lately by how we segment things in a way where can never get to the root cause of the problem. I’m just thinking about things when people are dealing with the chronic urge like frequent urination and they’ll go to a doctor and they’ll get some medication to make them need to pee less but maybe it’s an issue of uterine position, just these things that we don’t think about. We don’t build bridges a lot of times between structure and function, medical pathology and position and alignment.
Barbara: Yeah. It’s really fascinating because even the bladder issues could be caused from something going on in the liver. I felt someone’s median ligament of their bladder was really taut but the listening took me to the liver and the falciform ligament was taut as well. I mobilized the liver and her bladder issues went away. The whole line from umbilicus to the liver and the umbilicus to the bladder all relaxed. I learned with the visceral manipulation through the Barral Institute- the body knows. You have all this knowledge but you have to put it on the back burner. If you read someone’s intake form and it says, “this is going on, it must be this.” It’s all good knowledge but when you ask the body it may take you somewhere else. It’s just everything’s connected, it’s not separate.
Brooke: For a lot of people they might be unfamiliar with what [all these different therapies are] like. Could you give us a description of what each of those two things were like the visceral work and the Maya abdominal massage work? People who are listening to us are probably a little more familiar with the Restorative Exercise that you also mentioned because I’ve interviewed Katy Bowman...
Barbara: Sure. The Arvigo Technique of Maya Abdominal Therapy® was developed by Dr. Rosita Arvigo. She’s a naprapathic physician. She specializes in ligaments and muscles. She did her apprenticeship with Don Elijio Panti -Don Elijio was one of the last Maya shamans- I believe [she apprenticed with him] for 13 years. The techniques are a combination of her work specializing in the ligaments and muscles, the Maya traditional therapies and the abdominal therapies. Then there’s one thing people don’t realize is that half of the treatments are on the posterior side of the body, the sacrum, the tailbone and lumbar area. Since the suspensory ligaments of the ovaries attached way up into around L3 and contained blood, lymph and nerve flows- we work around those muscles as well. I incorporate some other supportive modalities. The Chi Nei Tsang is the Chinese abdominal therapy which is based on Qi Gong, breath work and abdominal massage. The Visceral Manipulation TM is based on gentle osteopathic manipulations to reduce restrictions in the internal organs to improve their motility and mobility. The Restorative Exercise TM piece, as you mentioned, was developed by Katy Bowman, a biomechanist. I really took her training for my own benefit and my husband’s. I realized while during my training that this [alignment] is such an important piece for reproductive and digestive health. Say, if a woman comes in with a retroverted uterus and I helped correct the position. Eventually she puts on her high-heels and she goes back to work and sits all day with a posterior tilted pelvis. This position is pushing everything out of alignment again. It’s [Restorative ExerciseTM] a very important piece [to maintaining uterine position].
Brooke: That brings me to just wondering what are some other factors that influence the position of the uterus? What are the things that set it up to be in one of these malpositioned states?
Barbara: As the bladder and the rectum fills and empties, the uterus should move- it’s [those organs] all functionally and physically related- but say there is scar tissue from a surgery. Anytime surgery is preformed, there’s going to be adhesions that form. Inflammation can also cause adhesions in the internal organs. A fall, a traumatic fall from the monkey bars when you’re a kid and you fall on the sacrum, or chronic poor pelvic positioning like I mentioned earlier with a posterior tilt. If you’re walking around and or sitting with a posterior tilt all day long, it changes the pressure systems in the belly. It can put a lot of stress on those ligaments plus the uterosacral ligaments won’t be loaded correctly because you’re pushing the uterus back against the sacrum. Ligaments need the correct load for resiliency and proper function but if you’re not loading them they get fibrous and do not allow the uterus to move correctly. I’ve seen people come in who have been side swiped in a car accident and their whole viscera is shifted over to one side. Your organs are always moving and should be moving. It’s just when they’re pushed into one position quickly that may take more time to regain the natural position especially when there’s inflammation involved.
Brooke: Sure and trauma, I would imagine too. You mentioned loading- creating appropriate load for the ligaments. Just for people to understand, I’m assuming you mean things like not wearing high heels or other footwear that puts you in a strange position or not the tucking of the pelvis that you mentioned and things like that.
Barbara: If you have a positive-heeled shoe [the heel is higher than the ball of the foot], for every degree of rise that that shoe creates, your body has to create a counter-torque to stay upright. This [adjustment] happens in the knees, in the pelvis all the way up the body. There’s this dynamic relationship between what’s going on in the pelvic diaphragm and the respiratory diaphragm. When we shift our alignment that can change the pressure systems and how everything is loaded.
Brooke: In my experience anyway, in my practice, when I use the word load- I think we just forget that we are loaded. They’re we are in gravity and that’s happening all the time and how we’re moving affects those loads even down to, like you mentioned, the suspensory ligaments of all of our viscera, everything.
Barbara: Loads could be compressive loads as well. It could be from clothing. I had a situation where I had an anteverted uterus or anteflexed uterus. I’d have to get up a couple of times to pee. I would run down the stairs to pee and be like, “well, that was not a lot of pee [compared to the urgency].” I’d do my massage to correct the position and I’d be fine for a while but then it [the urgency] would come back and I’m like, “what am I doing to create this pattern?” I used to cycle a lot and I wore those low-rise jeans. I’d cycle with a post tilt plus the jeans would push into my belly and push everything down again. Once I changed my pelvic position, my uterus would stay in position.
Brooke: That’s so interesting- the physical activity you’re doing but also the load of the clothing, how it’s affecting you. In reading one of your articles, I found it really interesting that a retroverted uterus can also contribute directly to hormonal imbalances. How does that happen?
Barbara: There’s the feedback system between the hypothalamus that’s picking up messages from the blood, hormonal messages. Hormones are the messengers. The hypothalamus sends a signal to the anterior pituitary which sends a signal. The ovaries pick that up and send the signal back and there’s an inhibiting or stimulating cycle in that feedback loop. When the uterus is shifted out of position and immobile, it can restrict blood, lymph, nerve and energy flow. It can create pelvic congestion. It can create acidity if cellular debris is not being carried away. Ovulation needs a particular pH for it to happen. The acidity that builds up can in fact irritate the nervous system.
Brooke: Again, here’s a situation where probably a lot of women saying, maybe they’re dealing with hormonal imbalances like early menopause and they’re getting bioidentical hormones, or it’s women who are dealing with fertility issues and they’re going down that road... This is the kind of thing where we should also take into consideration that maybe some really good manual therapy is an important part of correcting hormonal imbalances too.
Barbara: Yes. The body knows what to do. We’re just giving it a little nudge and getting out of the way so it can do its job. We’re working with the body rather than trying to control it from an outside source. Typically with the Arvigo work, women may notice a different kind of blood coming out. For the first three months their periods may get worst but a lot of times they get better right away. Sometimes they’ll notice a brown blood that looks like coffee grounds which is old blood that hadn’t cleansed from the month before because if it’s [the uterus] folded over then it has to work harder to get the blood out. Usually by the third month, women will notice a bright red blood. For fertility, we recommend that you give yourself three months doing your self-care massage and receiving treatments usually once a month to give your uterus time to come back to the optimal position free of restrictions and go through a cleansing and rebuilding phase.
Brooke: One other thing, just in terms of counterintuitive, things you wouldn’t expect, you mentioned that women can also sometimes, during ovulation, have pains in front of the thigh and the knee when they’re dealing with a combo of a retroverted uterus and a tight psoas. Again, to me, I’m in structural field. I will not have the kind of person who’s not coming to see me for hormonal imbalance or infertility or painful periods, but they’ll come and see me for the knee problem. It’s just important to take that into consideration too. How does that happen? How does that create that?
Barbara: Sure, there’s a couple of ways. It may differ whether it’s pain on the left or the right. The ovaries are near the psoas, if you already have a tight psoas and the ovary is moving around and the follicle are growing during ovulation that can irritate the psoas and the genintofemoral nerve runs through the layers of the psoas and down the front of the leg into the medial knee. That happened to me as well. Every time I ovulated on the right, it would cause me pain and pain down the front of my leg. It can also be a cecum issue on the right. In 60% of women, there’s a ligament of Cleyet that goes from the cecum to the right ovary and the genitofemoral nerve passes underneath that. Pain could result from inflammation in the cecum or immobility in the cecum or in the ovary or in the ligament itself causing irritation of the nerves. On the left side- the left side is more prone to vascular congestion because of the venous return route. On the right, it [venous return] goes back directly into the vena cava. On the left, it goes into the renal vein and then the vena cava. Same thing with men and testicles, they are more prone to congestion on the left side.
Brooke: Interesting. I didn’t get to study a lot of visceral stuff. This is all very fascinating to me. I know that you mentioned already that there is supposed to be movement. There’s a normal responsiveness in the uterus. I realized that the term, “can it stay in place?” is a weird question to ask because we don’t want it to be fixed, but can these issues be resolved? Can it get into a neutral position?
Barbara: Yes, it can. It depends on how long it’s been in that position, what kind of adhesions have formed. I’ve seen cadaver videos like Gil Hedley’s, I don’t know if you’ve watched his cadaver videos they are really cool-he shows a uterus adhered to the rectum and he has to really cut through it. I don’t see manual therapy releasing that kind of adhesion but massage itself is going to improve the flow of the blood, the lymph and nerve and energy flow. I believe that even if the uterus is fixed in one positioned and can’t be corrected there’s probably other adhesions around it that may be able to be freed up, but the massage itself is going to improve flow so the body can better maintain homeostasis. Usually, I recommend, if you’re in a car accident or have a severe fall or traumatic experience that you do get in to see someone specializing in one of these therapies to help bring the uterus back to position and improve flow overall.
Brooke: It’s still very supportive thing to do regardless.
Barbara: I’ve also had a retroverted uterus. I may have all these things happen so I can experience what it’s like. I had a retroverted uterus and I was able to correct it myself. Back to the Restorative Exercise TM piece, I’m really big into self care. In the Arvigo work and Chi Nei Tsang, we teach self care. How to do your own self-care belly massage and Qi Gong and then the Restorative Exercise TM , the person is responsible for making these changes in their life that got them there in the first place.
Brooke: That’s very empowering. It’s a lot better than feeling like you have to hand yourself over to someone constantly forever.
Barbara: Yeah, definitely.
Brooke: It’s unfortunate but hysterectomy can sometimes be suggested for women who deal with some of the symptoms of a uterus that’s poorly positioned. I think, I hope, it’s done less now than in the recent years past. What are some risks of having hysterectomy before you have a chance to go through menopause?
Barbara: I’m not an expert on this but I did do a lot of research because my mom had a complete hysterectomy. I think she was around 38 years old. She also had an oophorectomy which are the ovaries removed. Now, I’ve found several studies that see an association between early oophorectomy- having ovaries removed-and dementia and other neurological issues as well such as cardiovascular diseases and anxiety. The estrogen that the ovaries are producing has a protective mechanism on the brain. My mom had dementia and was diagnosed around 55. I think it started earlier and for some reason, it got me thinking about her oophorectomy, and if that contributed it to her dementia, I don’t know. I’m sure all those things were contributing factors. Not to say that a women who had her ovaries removed is going to get one of those diseases. I don’t think they do take the ovaries out as much they did. This was back in the mid-80s when my mom had hers out.
Brooke: Yeah, I feel there has definitely a shift to try and preserve that and also just not to be as cavalier about suggesting hysterectomies in general for things like endometriosis or painful periods or things like that.
Barbara: Yeah, my mom had her hysterectomy because she had bad PMS. She had a retroverted uterus. I know when she was pregnant with my little brother, she didn’t know she was pregnant for a while. She wasn’t tracking her cycle. She didn’t look pregnant because the womb was growing into the back. She had horrible back pain and constipation. If this does happen, usually around four or five months the uterus will correct itself and break away from the adhesions and fall forward. There’s also a serious complications called incarcerated uterus where the uterus is stuck in the pelvis posteriorly and can interfere with the urinary flow, can be life threatening. That’s rare and it’s a complication that you don’t hear about very often, but I wonder when people say, “my doctor says I have a retroversion but it’s normal. It’s not a big deal.” It may not be, it may not cause any symptoms especially if it’s mobile, but it definitely can be a big deal.
Brooke: Was your mom’s experience a part of what motivated you to specialize in this work?
Barbara: I don’t think so. I was a teen then. I wasn’t even thinking about this but I had bad PMS and periods. I think that motivated me. As I learned more, I put together what she was going through. I wish I could have done that for her. Yeah, I had really bad PMS and painful periods and I went to a physician and they gave me a prescription for an anti-depressant. I said, “does this mean I’ll be on anti-depressants until I reach menopause?” He said, “yes and then you’ll be on something else.”
Barbara: I was like, it doesn’t make sense. I know, crazy!? I read Dr. Northrup’s Women’s Bodies, Women’s Wisdom [resources] book when I was young. It was like, yes, finally someone is talking about this stuff and it’s not normal to have painful periods! I just started tweaking diet and getting body work. I was noticing this connection between tension in the belly and neck pain or emotions would come up when I massage the belly, that got me on that path of doing abdominal work and then I realized this is helping me, so I want to share it with other people.
Brooke: It’s wonderful. There seems to always be some controversy coming up around women and lifting and some people can really take that and run with it- “don’t lift while you’re pregnant. Don’t lift or it’s going to shift your uterus out of place.” What are your thoughts on those served debates or controversies?
Barbara: I think lifting is not always the same. There’s an appropriate way to lift that’s not going to cause excess internal pressure on the organs where you can totally keep it out of what’s happening in the organs. I wouldn’t say you want to start deadlifting when you’re pregnant if you’ve never done that before.
Brooke: Yeah, it’s probably not the time for a brand-new endeavor.
Barbara: No. Same thing with the squatting, your body has formed to how you’ve used it. There’s a progression of how to get into alignment to do certain things. I don’t think we’re designed to be frail and can’t lift things. It’s just modern life hasn’t required us to lift anything other than a grocery bag and then one day we’re handed this baby that we’re not used to holding all the time and that’s a load that we’re carrying that we’re not used to, we can tweak our pelvis or rib cage or just rest on ligaments to support that way. I think lifting is fine. It just depends on where they’re starting and what they’re lifting.
Brooke: I would imagine like you said, in our culture we’re not lifting much of anything because we’ve got these handy cars and trunks and whatever else to lift our things for us. Other things that you had mentioned previously too, our tendency, culturally, for many people a more tucked pelvis or clothing choices or shoe choices and that sets people up for either happy lifting or not happy lifting as well.
Barbara: Yeah, definitely. If you’re lifting something off the ground, you want to keep it in the posterior muscles and the glutes rather that tucking your pelvis under and carrying that load on your belly. That’s why in Restorative Exercise TM posterior leg muscle lengthening stuff is really important.
Brooke: To wrap up, I was like to have a chance to ask people what they’re currently fascinated by. If there’s anything either on your own movement practice or in your work with your clients that has got you juiced lately?
Barbara: Yeah. I would say, I started studying with Katy Bowman and reading her book Move your DNA. I’m interested in the mechanisms by which the cells convert mechanical stimulus into chemical activities. I want to learn more about how we move or don’t move, how that affects cellular expression in the reproductive and digestive organs or how adhesions and inflammation and mobile organs can affect that cellular expressions- how it plays out in different tissues, the uterus or ovaries and intestines.
Brooke: Yeah, me too. Start digging, let us know your discovered goodies. We want to hear about it.
Barbara: Yeah, definitely. Lots of digging and getting better at reading research articles.
Brooke: That is a skill. I don’t come from a research background either so I have to have my friends who are in medicine help me understand when I’m reading a good research study versus one that maybe wasn’t set up super great.
Barbara: Yeah. It can be frustrating. That’s going to take some time.
Brooke: Right. Thank you so much for doing all the work that you are doing to help women and thank you for talking with us today.
Barbara: Yeah. Thank you, Brooke.
Today we're playing with supported sitting on a neutral- i.e. not posteriorly tilted- pelvis. Give it a listen to find a way to sit that allows your spine to chill out while you sit, as well as getting better in touch with when you are tucked and when you are not.
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