This image portrays Snow Shoveling Safety: Protecting Your Spine in Winter Wonderland by East Tennessee Spine and Sport.

Snow Shoveling Safety: Protecting Your Spine in Winter Wonderland

Winter’s charm often comes with a hefty side of responsibility – snow shoveling. While clearing driveways and sidewalks is a common winter chore, it can take a toll on your musculoskeletal health, particularly the neck and back. Let’s delve into some eye-opening statistics, with a notable finding from the American Journal of Emergency Medicine, and essential tips to ensure you stay injury-free during this winter season.


A comprehensive study published in the American Journal of Emergency Medicine reveals a concerning trend – injuries to the lower back accounted for over 34% of all soft tissue injuries suffered from shoveling snow. This statistic underscores the specific vulnerability of the lower back during this winter activity.

Common Injuries & Conditions

Beyond low back pain, individuals may suffer from a range of injuries or conditions when shoveling snow, including strained muscles, herniated discs, and even heart-related issues in extreme cases. Understanding these risks empowers you to prioritize your musculoskeletal well-being.

Do’s and Don’ts

1. Posture Matters: Maintain a neutral spine position by bending at the hips and knees, avoiding excessive twisting.

2. Take Breaks: Pace yourself and take regular breaks to prevent muscle fatigue and reduce the risk of injury.

3. Know When to Stop: Listen to your body. If you experience pain or discomfort, it’s crucial to stop immediately and seek assistance.

Encouragement & Solution

If you’ve sustained a musculoskeletal injury while shoveling snow, don’t hesitate to seek professional help. Our spine specialists at East Tennessee Spine & Sport are here to support you. Visit to make an appointment and get expert evaluation and care.

This winter, let’s prioritize safety and well-being while enjoying the snowy landscapes. Your spine will thank you for it!

Celebrating Emily Pace: A 40 Under 40 Knoxville Honoree and Pillar of the Pelvic Health and Birth Worker Communities

This image portrays Celebrating Emily Pace: A 40 Under 40 Knoxville Honoree and Pillar of the Pelvic Health and Birth Worker Communities by East Tennessee Spine and Sport.

We are excited to share some fantastic news with our community - one of our very own, Emily Pace, has been named to Knoxville's 40 Under 40 Class of 2023! This prestigious recognition is a testament to her unwavering dedication, hard work, and remarkable contributions to both our clinic and the broader healthcare landscape. Join us in celebrating Emily as she enters this elite group of young professionals in Knoxville.

Emily's journey in the field of physical therapy has been marked by her commitment to improving the quality of life for countless patients in our clinic. Her expertise in pelvic health has not only transformed the lives of her patients but has also had a profound impact on the birth worker community in Knoxville. Here's why her recognition is so well-deserved:


  1. Pelvic Health Expertise: Emily Pace's dedication to pelvic health has been a game-changer for our patients. She has become a beacon of hope for individuals struggling with pelvic health issues, offering them a path to recovery and a better quality of life. Her compassionate care and vast knowledge in this field have touched the lives of many.
  2. Advocacy and Education: Beyond her clinical work, Emily has been actively involved in educating the community about pelvic health and raising awareness of its importance. She has hosted workshops, webinars, and events to empower individuals with knowledge about their bodies, fostering a culture of wellness and self-care.
  3. Support for Birth Workers: Emily's contributions to the birth worker community are invaluable. Her expertise in pelvic health and her willingness to collaborate with midwives, doulas, and other birth professionals have enhanced the support available to expectant mothers in Knoxville. Her efforts have contributed to safer and more comfortable childbirth experiences.
  4. Building our Practice: Emily's dedication to building up our practice outside the clinic has been instrumental in our growth. Her commitment to community engagement, networking, and outreach efforts has helped us reach a wider audience, ensuring that more people can benefit from our services.

We are incredibly proud of Emily's achievements and the positive impact she has had on the pelvic health and birth worker communities. Her recognition as one of Knoxville's 40 Under 40 is a testament to her exceptional commitment and the transformative work she does every day.

If you'd like to learn more about the other outstanding young professionals in Knoxville who made the 40 Under 40 Class of 2023, please visit this link.

Pelvic floor physical therapist teaching patient about the pelvic floor using a pelvic model.

The Nest

You’ve asked and we’ve answered!  Our pelvic floor program is growing and we now have a stand-alone specialty clinic for all of your pelvic floor needs!  The Nest opened on February 1, 2023, and we are so excited to offer this specialty service for the greater Knoxville area.  

At the Nest, all of our physical therapists have significant training allowing us to treat pelvic health conditions like urinary incontinence, bowel incontinence, diastasis recti rehabilitation, pelvic pain, pain with intercourse, and so much more!

Pelvic floor physical therapy is for all ages and all genders because we all have pelvic floor muscles!  The pelvic floor has 5 very specific jobs:

  1. Stabilize the pelvis as a whole
  2. Support the pelvic organs (bowel, bladder, and uterus)
  3. Help with sexual function
  4. Helps with bowel & bladder function
  5. Support lymphatic function

Problems in the pelvic floor muscles can show up in any of those 5 jobs mentioned above or it can show up as pain in the back, abdomen, legs, and genitals. If your pelvic floor is doing its job, then it is not something that we think about.  When the muscles are not doing their job, it can consume so much of your brain power and put a halt to your everyday activities.

But the pelvic floor muscles don’t live on an island by themselves! So our pelvic floor therapists are also well-trained to treat all of the joints around the pelvic floor ensuring our patients get the best care possible. 

Additionally, we understand that there can be a lot of other issues that go hand and hand with pelvic floor problems and services can be hard to access.  To make this easier for our patients, The Nest will also be home to additional services provided by Kristin Williams, lactation consultant, Maggie Klotz, psychiatrist, and The 4th Trimester Fitness Method. We are so excited to have all of these amazing providers in one place. 

Call our location to set up an appointment to meet your needs. Our staff is excited to help you get back to full function and back to your life!

Mothers participate in lunge workouts with their newborns.

Female Pelvic Health Through the Lifespan

Women experience continuous changes throughout their lifespan; from puberty to childbearing years, perimenopause, and into postmenopause…the female body is an ever-evolving landscape! Oftentimes the symptoms and their effects on women’s lives is underappreciated. After all, women comprise 49.6% of the world’s population, so nearly half of the world is going through it. Pelvic Floor Therapists have a unique perspective into the struggles of women throughout their lifespan and tend to be diligent in delineating between a condition or experience being “common” versus “normal”.

It is important to not confuse the two terms; just because something is common among a population of people, does not make it normal. It is common for women to have pain during their menstrual cycles and during pregnancy. It is common for women to struggle with returning to prior levels of function, including sexual function, following the birth of a child or with the journey of menopause. It is common for women to experience bladder leakage, and have difficulties with constipation. It is common for them to develop vaginal changes affecting personal relationships during and following menopause. But – is it normal?

Being intentional to support women throughout their lifespan and the journey their body makes along with them is important. Empowering women to pursue care proven to improve quality of life measures, throughout their lifespan, is imperative. Pelvic Floor Physical Therapy can be a tremendous tool allowing women to reclaim their bodies, and often their lives.

What Is Pelvic Rehabilitation?

Pelvic floor rehab, or Pelvic Floor Physical Therapy, is treatment provided by a licensed Physical Therapist who has completed additional and specialized training for pelvic floor conditions. It involves an assessment of the low back, pelvis and hips, along with an external and internal pelvic examination. This examination is different from the one performed by a medical provider because it is assessing the “musculoskeletal” system; bones, joints, ligaments, and muscles.

Treating Women Through The Lifespan…

Experiencing the evolution from childhood to adulthood can be challenging for many children and adolescents. The development of new body parts, changes in appearance, acne and the beginning of menstruation can make this a very confusing time for kids. It’s difficult for parents too when the language has typically been “it’s normal to have pain during your period”. But what if your child is missing school, unable to attend social events, can’t tolerate tampon use, or is having severe acne? Pelvic floor therapy can be beneficial in assisting teens and parents to navigate these challenges and provide additional medical support when necessary.
For adult women, the changes don’t stop there – there’s the journey of pregnancy and postpartum to consider as well. How do women handle the increasing demands of their bodies while making another human? Are they supposed to buy the lie that “pain is normal”? Or should they pursue additional care when their back, hips, and feet start to bother them with their advancing pregnancy? What about changes in bladder or bowel continence – when women start leaking are we really going to tell them that’s normal? Or when women aren’t able to resume previous activity, like running, strength training, or sexual relationships; do we accept that dysfunction as the new normal too? The short answer: Absolutely not.
Then there’s menopause, the final change. Menopause may bring new dysfunction; changes in vaginal and vulvar tissues, their robustness, pliability, and strength which can affect a woman’s ability to tolerate sexual relationships. There are changes that occur with new weight gain and the aches of an aging body. And then the misconception that these issues have been going on for “too long” and there’s “no helping them now”. The body is resilient! And it doesn’t matter if your urinary incontinence has been around since that first baby 30+ years ago, or if it just sprang up with the changes of menopause; pelvic floor rehab can still be beneficial.

Common conditions may include…

  • Urinary Incontinence (Leakage)
  • Urinary Frequency or Urgency
  • Pain with Urination
  • Bowel Incontinence (Smearing, or Gas)
  • Pain with Bowel Movements
  • Constipation
  • Pelvic Organ Prolapse
  • Pain with Vaginal Penetration (Dyspareunia)
  • Painful Periods (Dysmenorrhea)
  • Low Back/Pelvic Pain
  • Menstrual Management

How Are We Treating It?

Pelvic floor rehab utilizes many treatment approaches including:

  • Manual therapy: Soft tissue or muscle mobilization, joint mobilization, myofascial release
  • Therapeutic exercise: Strengthening and flexibility interventions
  • Neuromuscular re-education: Teaching your muscles how to turn on/off appropriately and improving your awareness, coordination and control
  • Therapeutic Activities: Helping you function within your specific life activities like lifting children or grandchildren, exercising and running, or being able to make it to the bathroom without leaking

What Does This Mean For You?

If you are struggling with any urinary (bladder), bowel, or reproductive/sexual health concerns, pelvic floor rehab may be appropriate and helpful for you. You do not have to live with your dysfunction, there is help – and Pelvic Floor Therapists are happy to join you in the journey.

This image portrays Physical Therapy Can Help With What? by East Tennessee Spine and Sport.

How Urinary Incontinence Helped Me Find My Calling

As a pelvic health physical therapist assistant, I am often asked by our patients why I chose to specialize in pelvic floor physical therapy or if I personally have ever experienced any type of pelvic floor dysfunction. I suppose my mother was a great influence on this decision. See, I grew up with a mother who many would deem as an “over-sharer.” Due to her lack of inhibition blended with her passion as a labor and delivery nurse, I learned, from an early age, the details about the female body, childbirth and her issues with incontinence. As a mother of three, she often experienced urinary leakage while laughing, jumping on a trampoline, or horseback riding. Just not making it to the bathroom in time, was also a common occurrence in her life. What she had endured for so many years was mixed urinary incontinence conjoined with bladder prolapse. All those embarrassing teenage years did serve a purpose, they ultimately led me to find my calling as a pelvic health professional.

In my mid-twenties, I began to struggle with my own pelvic floor dysfunction. Like many women, I was confused and a bit embarrassed. Unlike my mother, I had not had children and I was physically fit. The only time that I experienced urinary leakage was when I was dead-lifting and squatting heavy weights, as I was a power lifter. Occasionally, there would be instances when I would completely soak myself.  Black or dark colored workout leggings became as necessary as a spotter, chalk and my belt during my workout routines. So, what did I do besides modify my workout attire? I turned to Google, of course. I discovered that I was not the only female struggling with this problem. In fact, many athletes struggle with urinary incontinence due to improper breathing techniques, straining, constant demand from high impact activities, or weak/tight pelvic floor muscles. According to the internet, the answer to my problem was as simple as performing Kegel exercises. However, not all that you read on the internet is true. I wish it had been that simple or at the very least, not so misleading. Not only can this be the wrong advice if your pelvic floor muscles are too tight, but that also most women do not perform Kegels the proper way. 

At that time, like many women, I had no idea that pelvic floor physical therapy existed. Therefore, my issue continued for years and actually worsened when I began participating in CrossFit. I have come across many CrossFit athletes who equate accidentally urinating while exercising. While indeed, they may have had great workout, and perhaps even hit a new PR, their urinary incontinence is a symptom of pelvic floor dysfunction. It is absolutely nothing to be ashamed about, however, it is also not something that should not be encouraged. Using specific training techniques, pelvic floor physical therapy not only can help with urinary leakage when lifting, running, or performing double unders, but it can also positively impact an athlete’s performance by addressing muscular imbalances and by practicing proper breathing technique. 

At East Tennessee Spine and Sport, our pelvic health team is excited to be part of your journey. Whether you are an athlete, a mom, mom to be, or if you just want to be able to perform daily activities without limitations, you are in the right place. This isn’t just part of being a woman or something you must live with. Your treatment plan will be individualized based on your needs/goals and our team will be there to direct, educate and encourage you along the way. Now, it is time to ditch those dark colored leggings and start living life with confidence.

This image portrays Services Slider by East Tennessee Spine and Sport.

The Most Common Pelvic Floor Disorders

Pelvic health physical therapists treat multiple disorders including urinary and fecal leakage, pelvic pain, urinary urgency and frequency, pelvic organ prolapse, diastasis recti, low back, hip and abdominal pain, pregnancy related pain and postpartum care, just to name a few.  While our society has led us to believe that many of the mentioned problems are normal, know that there is conservative treatment available by visiting a pelvic floor physical therapist.  


As a pelvic floor physical therapist I commonly have to ask deeper questions beyond our initial intake questionnaire that asks, “Do you ever leak urine when you laugh, cough, sneeze, exercise or jump?” as many circle “no.”  After further questioning, however, a common reply is, “Well, yea, but I’ve had two children and my mom and grandma told me that’s simply a normal part of being a female” or, “I do, but only while running or jumping and a lot of my friends do too.”  While this is a very common problem, there is conservative treatment for it…pelvic floor physical therapy! In fact, 25% of women have urinary incontinence and up to 50% of those have urinary leakage who exercise regularly. While most assume urinary leakage equates a weakness based problem, that is not always true and in some cases strengthening the pelvic floor can actually make urinary leakage worse!  There are a variety of factors that may lead to urinary incontinence some of which include a weakened pelvic floor, overactive pelvic floor muscles that have a difficult time relaxing, damaged pelvic floor muscles resulting from surgical procedures or labor and delivery. Urinary leakage can also be caused by overactive and strong pelvic floor muscles in which the patient may be using mechanisms such as breath holding while lifting a heavy object, for example, as the increased pressure finds the weakest link within the system, commonly being the pelvic floor muscles.  This is why having an evaluation by a pelvic floor physical therapist is so important to determine the contributing factors that are causing the leakage. These muscles need to be both strong in order to contract fully but also mobile to be able to relax fully to function appropriately. It is our job as pelvic floor physical therapists to train the pelvic floor muscles accordingly. 


Another common disorder we treat is pelvic pain.  Again, this is another common problem that many don’t feel comfortable talking about. 14.3% of women experience pelvic pain and often take years to tell their medical provider. There are many conditions that can lead to pelvic pain including cesarean sections, episiotomies, or complicated deliveries including the need of forceps, for example. Other diagnoses that commonly lead to pelvic pain include those such as interstitial cystitis (also known as painful bladder syndrome), endometriosis, past history of trauma/abuse, or chronic pelvic pain that has been occurring for 6 months or more without explainable cause.  Pelvic pain can present differently such as sharp, stabbing pain or a deep, dull aching pain. Pelvic pain is not just limited to the pelvic area, however, as most also have discomfort in the surrounding area including the lower abdomen, hips and low back. Being orthopedically trained, we treat with an outward to inward approach meaning that we look at how the low back, the hips, core and the patient’s breathing mechanics are working first before examining the pelvic floor. Yes, even how you breathe plays a role in the function of the pelvic floor! With pelvic pain, it is common that the pelvic floor muscles spasm and are especially tight with a difficult time being able to relax.  The pelvic floor muscles have to be able to relax in order to empty the bladder and bowels, so constipation and incomplete emptying of the bladder, or needing to strain in order to empty the bladder are commonly seen with pelvic pain. At Spine and Sport, we realize that pelvic pain can be a very sensitive topic to share. With your therapist being a female and having a private treatment room, it is our goal to make your comfort our priority. If you have any questions or concerns prior to your first visit, do not hesitate to call the office and your therapist will answer any questions you may have.


Pelvic floor physical therapists also commonly treat urinary urgency and frequency.  These problems tend to have multi-faceted contributions. While there is typically a musculoskeletal involvement such as increased tone or trigger points within the pelvic floor muscles, there are typically other causes as well.  One of which being dietary choices. There is a list of commonly known foods and fluids that contribute to bladder irritation. An abbreviated list includes coffee, tea, carbonation, citrus fruits, tomato based products and fruit juices.  Additionally, not consuming enough water concentrates the urine which irritates the bladder. When the bladder becomes irritated, common side effects are urinary urgency and frequency. Your pelvic floor physical therapist may give you a bladder diary to complete for a few days to examine any possible foods or fluids that are contributing to your symptoms.  Additionally, your physical therapist may have you work on something called behavioral retraining techniques if you report voiding more than 6-8 times or more than once every 2 hours within a 24 hour period. The bladder provides the brain with two signals. The first signal is sent to the brain when the bladder is about 25% full. This is a subconscious, warning signal to become alert of knowing where a nearby restroom is.  This signal does not mean it is time to empty, though! The second signal to the brain is when it is truly time to empty the bladder due to being full. When patients use the restroom, “just in case” or more frequently than needed, this habit starts to trick the brain into feeling full before it actually is. Your pelvic floor physical therapist will educate you on behavioral retraining methods in order to prolong the time before voiding, thus being able to delay urinary urgency until that second signal tells your brain that the bladder needs to be emptied.  

Pelvic organ prolapse is a condition that pelvic floor physical therapists commonly treat.  The pelvic floor muscles are shaped like a bowl and one of their primary functions is to lift and support our organs.  When the pelvic organs descend, this is pelvic organ prolapse. Pelvic organ prolapse is categorized by the specific organ and graded based on severity, or amount, of descent ranging from grade 1 (least amount of descent) to grade 4.  Some common symptoms of this condition include a pressure or bulging sensation within the pelvis, a feeling as though “something is falling out” of the vagina, difficulty with inserting tampons, aching low back discomfort, urinary leakage or difficulty emptying the bladder or bowels.  More often than not, patients report that their symptoms are aggravated by standing, walking or lifting heavy objects for prolonged time periods. While pelvic floor physical therapists are unable to change the grade of the prolapse that was given by the patient’s medical professional, there are many different interventions that can significantly reduce the severity of symptoms a patient may experience.  Sometimes physical therapy care can completely eliminate pelvic organ prolapse symptoms! Your physical therapy may provide manual therapy, prescribe specific therapeutic exercises, and educate on how to breathe properly while performing strenuous activities to prevent breath holding among many other interventions.  


This provides a very condensed list of the disorders a pelvic floor physical therapist treats.  Our patients commonly experience low back, hip or abdominal pain, core weakness or diastasis recti after pregnancy.  We treat pregnancy related pain and postpartum care including safe return to previous level of activity and proper body mechanics for the high demand that comes with being a new mother.  If you have any questions about conditions we may treat as pelvic floor physical therapists, please do not hesitate to call any of our locations to speak with the therapist in order to determine if you are an appropriate candidate for pelvic health physical therapy. 


To learn more about our pelvic health program, visit the Pelvic Health section on our website.

To request an appointment, click this link.