Fraser Pelvic Health

10/28/2026

Big news from Libra Pelvic Health Academy! 🇨🇦

Over 700 clinicians from 33 countries are now part of the Libra community. I continue to be amazed by the interest in Libra, and I'm grateful to every one of you.

Paid subscriptions are now available in Canada!

Libra gives practical, on-the-spot pelvic health support to clinicians who don't specialize in pelvic health, or who would like a refresher. Do you see patients with incontinence or pelvic pain, or who ask questions you weren't trained to answer? Libra gives you the knowledge and patient resources to help.

New clinicians joining Libra in Canada can start with a 14-day free trial, then US$15 a month. Details and the link to join are in the comments 👇

Already registered? Your original six months of free access will be honoured. I'll be in touch about your options before your free access ends, if I haven't already.

Making pelvic health education accessible is central to Libra's mission, so clinicians in low-income countries will continue to have free access.

Canada is just the beginning. I'll introduce subscriptions in more countries over time, and I'll keep you updated.

Know a colleague who'd find Libra helpful? Please share this with them.

Thank you for your interest in Libra and for helping it grow.

Michelle 💜

09/26/2026

“Of course you have low back pain. You’re pregnant!”

My pregnant clients are often told this when they see their health care clinicians about their pain.

There are obvious reasons why pregnancy can contribute to low back pain. Increasing abdominal load, changes in posture and centre of mass, altered muscle function, fatigue, and reduced tolerance for prolonged standing are a few examples.

But “pregnancy” is not the diagnosis.

A pregnant patient with low back pain may have:
~ pregnancy-related mechanical pain
~ another musculoskeletal source
~ a visceral or obstetric cause
~ serious spinal or systemic pathology
~ or a combination of these.

The challenge is to avoid drawing the easy conclusion that low back pain in pregnancy is natural and expected, and instead ask:
“What is contributing to this patient’s pain, and is physiotherapy management appropriate right now?”

That distinction matters because it changes what we assess, what we treat, and when we refer, keeping our patients safe.

This is the focus of the new Low Back Pain in Pregnancy lesson in the Libra Pelvic Health Academy curriculum.

“Because you’re pregnant” may be part of the explanation, but it does not signal the end of the assessment.

(You may notice that my posts lately are all about pregnancy; I have been working on adding lessons to the Pregnancy Module. Thank you to those of you who have been patient with me as I make my way through.)

Image: Natalia Blauth For Unsplash+

09/12/2026

We just released the Abdominal Support lesson in the Pelvic Health Academy’s Pregnancy Module, and I could use your help with this one!

In Canada, we commonly use abdominal support to help relieve abdominal, low back, and pelvic pain in pregnancy. There is some evidence for support belts for pregnancy-related low back and pelvic girdle pain, although the certainty of the evidence remains low. What surprised me was how little direct evidence I could find for abdominal wall pain, despite anecdotal reports that support can provide relief.

An absence of evidence is not evidence that an intervention is ineffective, so I would love to hear what clinicians are seeing and doing in different settings.

What, if anything, do you use for abdominal support in pregnancy where you live?

And do you know of research that I may have missed?

Photo by Andrew Seaman on Unsplas

07/15/2026

Va**ng, Urinary Hesitancy, and One Important Question
A Clinical Reflection

Yesterday I was working with a client. She’s a young woman who has just completed her first year of university. She described how she is experiencing urinary hesitancy: when she sits down to urinate, nothing comes out. This is happening when she is using public washrooms, and it is affecting her life. If she is in a building at the university where she can’t find a private washroom, she will walk to a different building. This is quite disruptive to her life.

It would be easy to see this as a purely mechanical problem. Increased pelvic floor muscle tension would be a reasonable hypothesis, leading to a treatment plan that includes relaxation strategies, pelvic floor retraining, and improving coordination with the surrounding musculature.

My treatment plan will eventually include all of these elements.

But I wanted to know why.
What exactly was scary about using a public washroom?

At first, she was unsure. She hadn’t really thought about it. Her fear was just there.

We discussed this for a while, and the story finally became clear: as a teenager in high school, she had developed an aversion to using the washroom. Students had begun using the washrooms as places to v**e. Whenever she would enter a washroom, groups of students would be there, va**ng. They would be unwelcoming, making faces as though she shouldn’t be there. Also, the air quality was unpleasant. So she stopped going there and learned to hold her urine.

She stopped using the public washroom at school. And now she has trouble using the public washroom anywhere.

Of course, urinary hesitancy has many possible causes, and a thorough assessment remains essential. In this case, understanding her history changed how I approached treatment.

For this client, part of her treatment plan will be to understand why her fear is happening, and help her gradually relearn that using a public washroom can be safe.

Pelvic floor dysfunction is not always just about muscles.

Sometimes the pelvic floor is responding to experiences, emotions, and patterns that were learned as a form of protection.

As clinicians, understanding why a symptom developed may be just as important as knowing how to treat it.

Photo by Aryasatya Rafa Prayitno on Unsplash

07/05/2026

What does multifidus have to do with pelvic health?

We often talk about balancing the pelvic floor muscles. We also talk about retraining transversus abdominis as part of the inner core. And we understand how the diaphragm and pelvic floor move in synchrony.

But what about multifidus?

Multifidus provides segmental support to the lumbar spine and works in coordination with transversus abdominis, the pelvic floor muscles, and the thoracic diaphragm as part of the inner core.

If this muscle is not working optimally as part of the inner core, we will need to compensate during functional activities.

Some people will compensate by overusing their pelvic floor muscles, which may lead to increased resting tension.

Others may compensate by increasing their intra-abdominal pressure (performing a Valsalva manoeuvre, or holding their breath). This creates downward pressure into the pelvic floor, which will respond by activating.

Over time, these compensations may contribute to persistent increased resting tension in the pelvic floor muscles. This may lead to symptoms such as pelvic pain, urinary hesitancy, urinary incontinence, and dyspareunia.

This is why I included multifidus as part of retraining the inner core in patients with pelvic floor dysfunction.

Thank you to Natalie Fraser for creating this excellent image of the lumbar multifidus for Libra Pelvic Health Academy.

07/13/2024

I am up to something! Coming soon: Libra Pelvic Health. A social enterprise that increases access to pelvic health physiotherapy globally through small-group education for health professionals. First task: I am offering 3 pro bono training sessions so that I can develop this program with real-life experience and real-time feedback. One online training session in Nairobi, Kenya is complete, with positive feedback. Next stops: in-person sessions in Rwanda and Kenya in late 2024/early 2025. If you are inspired to support the expenditures required for this trip....please see below for details! Any donations or even best wishes are appreciated. Photo taken by me near Kigali in 2007.

LIBRA PELVIC HEALTH

05/06/2024

I am honoured and excited to be part of the Lichen Sclerosus Support Network's Wholistic Health Summit, speaking on lichen sclerosus from a pelvic health physiotherapist's perspective. Join us! https://lnkd.in/guahAYPv

07/04/2023

Hey physiotherapists! If you or anyone that you know is looking to deepen their practice and hone their clinical reasoning skills, consider The Physiotherapy Guild's mentorship program. I am excited to say that I will be the mentor this fall for the Toronto campus. Any questions? Send me a message!

06/25/2023

I am thrilled to announce that I will be diving deep into musculoskeletal physiotherapy this fall as a mentor with The Physiotherapy Guild! Next session starts in September - comment below or DM me for details!

01/30/2023