Physical therapist with focus on pelvic floor health helping patients redefine what's 'normal'

Pelvic floor health might not be the sexiest of topics, but for some, especially pregnant and post-partum women, it can be central to their daily life — and daily struggles.

"In an effort to better balance being a working mom of two active elementary school children, I started my own practice, where I am working part time as a one-woman show," says Pannullo, who lives in Apex with her husband and two kids. "Making this change has also allowed me the opportunity not only to be more available for my children, but also to offer home visits with the idea of busy mothers in mind. I can fully appreciate that finding the time for self care with today's hectic schedules is truly an art form."

I checked in with Pannullo, who also treats children and men, to learn more about what she does and why she does it. Here's a Q&A:

That small cylinder is comprised of the diaphragm from above and the pelvic floor from below. In the front, there is the transversus abdominus, which is the horizontal muscle in our lower abdomen. It is the deepest of our abdominals and is responsible for us being able to draw in when trying to fit into pants that want to give us a fit! And, in the back, are the parapinals, smaller back muscles that run along the spine.

During pregnancy, that smaller cylinder takes a beating!

A combination of the baby (or babies) growing inside of us, our posture changing to allow for this growth and pregnancy-related weight gain result in tremendous sustained stress on our inner core, specifically, the pelvic floor (the floor of our core). Over time, this area becomes lengthened and inherently weakened, leaving us prone to things like urinary incontinence.

Now, add a vaginal delivery (not to mention a bigger baby and longer pushing phase) to the mix, and our pelvic floor becomes even more susceptible to weakness, decreased support and coordination difficulties. If there is an instrument-assisted delivery or large tear associated with the delivery, this now opens us up to the possibility of pain and muscle spasm.

Scar massage and taping techniques, depending on where the scar is, can help with scar site pain or restrictions. For tailbone, lower back, pelvic, and/or hip pain, it will be important to assess the areas thoroughly to determine what structures might be weak or tight and address them with soft tissue massage, stretching and strengthening, appropriately.

Pain with sexual activity may need to be addressed with tissue mobilization (muscle stretching), scar massage, dilator stretching and positioning during activity. Upper back and cervical pain can be addressed through postural re-education, positioning, improving body mechanics and positioning to care for baby, stretching and strengthening exercises.

All of these have excellent prognoses based on the patient's ability to regularly adhere to self management techniques, home exercise program and physical therapy attendance. There are time, however, when despite this, there may be need for surgical intervention, such as with diastatis rectus abdominis or prolapse, although these are less likely, and generally require physical therapy before and after for the best outcome.

The pediatric patients come to me with a diagnosis of constipation, leakage of stool, and/or leakage of urine. Patient and parent education on fluid and fiber intake, dietary habits in general (and referring to a nutritionist when more expertise is needed), behavior modification techniques (such as timed toileting), proper toileting position and mechanics, and postural re-education and strengthening.

Being able to offer a solution that is long term and attainable by a patient based on their efforts as opposed to medications or surgical interventions is incredibly rewarding! The active female across her lifespan is a population I hold close to my heart with a particular soft spot for the pregnant and post-partum population. Being able to help them achieve their fitness goals and be part of their recovery makes my time away from my family worth it!