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

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.

Confession time...When I was 11, I was in a family band.Don't laugh yet. It gets better.Dad on fiddle. My sister on pian...
08/29/2026

Confession time...When I was 11, I was in a family band.

Don't laugh yet. It gets better.

Dad on fiddle. My sister on piano. Me on banjo. The running joke was that my toddler brother played havoc.

I don't remember learning to sing "9 to 5." I didn't know it was from a movie. I didn't know it was a Dolly song. I definitely did not understand a single word I was singing.

Picture a tween claw-hammering her way on a banjo through a song about getting worked over at your job.

I hadn't thought about that in years.

Then the morning after Dolly died, my gym coach played a few of Dolly's songs in tribute during our warm up at the gym. 9 to 5 came on.

And there I was. 50 years old. Plugging away on the ski erg. Knowing EVERY. SINGLE. WORD.

(I cannot tell you what I had for dinner last night. Peri. IYKYK.)

Here's the crazy part.

The Dolly I knew as a kid in the 80s was sequins and fringe and tiny outfits. A character. A costume.

Did I have any idea that in 1984 she collapsed on stage, was bleeding internally, and was diagnosed with endometriosis? That at 38 she had a partial hysterectomy that ended any chance of having her own kids?

Not a clue. Because in 1984 you didn't say endometriosis out loud.

I've spent 26 years working with women with endo. I know what that pain does to a person. I know what it costs to be told for years that it's just part of being a woman.

She carried all of that. And still showed up in rhinestones, clapped back at the haters, and kept giving. And giving. And giving.

I wondered out loud with a friend this week — do they make women like her anymore? Women who crawl out of poverty with their worth questioned at every single step? And still keep giving?

Maybe they always did. We just weren't looking past the cover.

I'm glad the Dolly my kids know is less about what she looked like and so much more about she was and who each of us can be.

RIP Dolly. ❤️

What's the Dolly song that takes you straight back? Share 👇

Lots of new faces here after the UTMB post. Hi.I'm the one who's been asking those women questions on the Active Mom Pos...
08/29/2026

Lots of new faces here after the UTMB post. Hi.

I'm the one who's been asking those women questions on the Active Mom Postpartum Podcast since 2022, and asking them in pelvic health for 26+ years.

Doctor of Physical Therapy, double board certified in orthopedics and women's health. Mom of two teenagers and a border terrier. Runner since 7th grade. Aspirational Nordic skier. Currently headfirst into my own pelvic floor issues in peri.

I spent my whole career a step behind my own body — going looking for answers that weren't there yet, then handing them to whoever came next.

No postpartum return-to-run plan when I needed one.
No evidence behind what I'd been taught to tell postpartum women.
So started looking for my own answers so I could keep going and eventually I found the people doing the research and started asking them my questions out loud.

What you'll find here: Pregnancy, Postpartum, Peri/menopause. Prolapse. Leakage. Diastasis. Pelvic pain. Running — all the stages of life.

And a steady amount of myth-busting, because a lot of what we were all taught doesn't hold up.

Every woman in that Chamonix carousel has a full episode. Rachel Drake, Leah Yingling, Sophie Power with SheRACES, Sophie Carter, Amy Leedham, Lauren Puretz, and Dr. Margie Davenport.

Start wherever you recognize a name — or wherever you don't. They've all got a story to tell and something you can learn.

Still in clinic every week, problem-solving with patients, sifting through new research or recording a pod episode. Otherwise I'm out running on the Arlington bike paths figuring out my own stuff at 50, or working my second job as a teenager chauffeur.

Share your story. Ask a question. Let's find the answers together.

Pod Episodes drop weekly. Link in bio.

Lots of new faces here after the UTMB post. Hi.I'm the one who's been asking those women questions on the Active Mom Pod...
08/28/2026

Lots of new faces here after the UTMB post. Hi.

I'm the one who's been asking those women questions on the Active Mom Podcast for 4+ years, and asking them in pelvic health for 26+.

Doctor of Physical Therapy, double board certified clinical specialist in orthopedics and women's health, mom of 2 teenagers (and 1 border terrier); currently diving headfirst into my own pelvic floor issues in peri.

I've been running since 7th grade and treating pelvic floors since 2001 (PT since 1999). Neither one saved me on the second loop of my first trail race.

That's more or less my whole career — about a step behind my own body, going looking for answers that weren't there yet, then handing them to whoever came next.

No return-to-run plan when I needed one. No evidence behind what I'd been taught to tell postpartum women. So I found the people doing the research and started asking them my questions out loud.

What you'll find here: Peri/Menopause. Prolapse. Leakage. Diastasis. Pelvic pain. Running — pregnant, postpartum, and 20+ years out.

And a steady amount of straight shooter myth-busting, because a lot of what we were all taught doesn't hold up anymore.

Every woman in that Chamonix carousel has a full episode. Rachel Drake, Leah Yingling, Sophie Power and SheRACES, Sophie Carter, Amy Leedham, Lauren Puretz, and researcher Dr. Margie Davenport.

Start wherever you recognize a name — or wherever you don't. (They're all AMAZING!)

You'll find me either in my clinic in Arlington VA seeing patients or out on our incredible bike paths. Still figuring out my own pelvic stuff at 50. Still passing down what I learn so the next mom doesn't have to guess like I did.

Podcast episodes at the link in bio. DM me if you're looking for answers!

An email landed in my inbox this week and I clicked it, because this one taunted me. That's my career in a subject line,...
08/27/2026

An email landed in my inbox this week and I clicked it, because this one taunted me. That's my career in a subject line, so of course I opened it.

I love the idea of the workout. I encourage the workout.

What I keep seeing is marketing that builds a false narrative about pelvic floor PT right next to it. That we're the same thing.

That a membership or a 28 day challenge is the equivalent of working with a PFPT, just cheaper.

I'm a big supporter of meeting women where they are. Not every woman needs pelvic floor PT. Not every woman has access to it. Options matter and I want more of them, not fewer.

A marketing advisor found the pain point in market research and wrote a pitch where Fitness and PFPT are competitors.

Fitness professionals don't have to run with it, especially when they know it isn't true.

We're colleagues. We're friends. We're collaborators. We have different skill sets.

We see women at different points of the same problem and we hand them to each other constantly. They know we don't replace each other. They know the benefits are different. That's not a secret in this industry, it's the ACTUAL working relationship.

So the ask is simple. Stop rewarding marketing that pits us against each other for the sake of sales conversions.

Because the woman who ends up paying for that narrative is the one who does the seven moves, doesn't get better, and decides the problem is her.

Has marketing ever convinced you that a program was the same thing as pelvic floor PT? I want to hear the version you were sold.

We've lost the plot on perimenopause and this is how I know.New patient intake form says new leakage, or worsening leaka...
08/26/2026

We've lost the plot on perimenopause and this is how I know.

New patient intake form says new leakage, or worsening leakage, or pressure, or that s*x started hurting. She's here because of the leakage, and she's braced for me to hand her a sheet of kegels, because that's what happened last time she did anything with her pelvic floor back when she had kids.

The first thing I look at is her age.

Then I ask her where she is in perimenopause. And she looks at me like I've changed the subject.

Nobody has ever connected those two things for her.

Not the provider who told her this is normal after kids. Not the one who ran a urine culture that came back clean and shrugged. She's been carrying a bladder problem in one hand and a perimenopause problem in the other and no one has ever suggested they might be the same hand.

That conversation is why I made this.

Because I read your posts. Hundreds of them, in group after group. You're comparing notes on fatigue and HRT and protein and strength training and the 2am wake up, and it's a good conversation, it's fantastic that we're talking about these things. BUT...

Not one of you is mentioning the bladder.

I know you're out there. You're on my schedule. You just decided somewhere along the way that this particular thing wasn't worth bringing up, probably because the last time you brought it up nothing happened.

Bring it up again.

If you've got a bladder situation you've never mentioned to anyone, what stopped you? Was it that you already tried and got nowhere, or that it never occurred to you the two things were connected? Tell me below.

Did you give up running after kids because of your pelvic floor or are you just living with the leakage and we're not talking about it?

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