Spy on my session with a pain specialist to fix my back

It Happened To Me: A few weeks ago, I tweaked my back while lifting.

I didn’t panic, partly because I know that panic can actually make the pain cycle worse: We get scared, our body tenses, adding (unhelpful) tension on top of the (helpful) tension our muscles have engaged in to protect ourselves and heal. So the pain worsens, we avoid movement, and the cycle continues.

And injury is just incredibly normal! It happens for all kinds of reasons — and, frankly, I think it’s a lot likelier to happen (and to be a lot worse) if we are inactive. You might injure yourself during exercise, but moving is a lot less dangerous than not moving. (I’d take tweaking my back while deadlifting over tweaking my neck while sneezing any day.)

Anyway, it still sucked, and I complained about it on Substack, and my lovely Substack friend Dr. Cait Van Damm [author of Adventures in vaginas (and other parts)] texted me to ask if everything was ok. Cait is a pelvic floor OT and a chronic pain specialist who exclusively does virtual care, and she offered me a 1:1 session. I jumped (gently) at the chance, and asked if we could film it, because I thought you might be interested in seeing what this kind of session actually looks like.

That session, and the full conversation we had afterwards, is above. I’m not going to share the transcript of the session itself, because it was very movement-focused and would be a little weird to read (it’s about the first 30 minutes of the video). But I am sharing a lightly edited version of our post-session Q&A below for your reading enjoyment — I especially want to make sure you hear all about Cait’s brand-new platform, Tidal Work, which I will be returning to anytime I’m dealing with a cranky back or a flareup of pelvic floor symptoms, or really any tricky body shit.

Before we get into that, here are a couple of the other great collabs Cait and I have done in the past. I am such a pelvic health nerd (complimentary) and it is always a blast to get to work with her!

The tyranny and utter chaos of “illegal kegels”

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March 18, 2025

I don’t do much ranting here on How to Move (which is funny because it’s something I do a lot of… like, a lot of…in my regular life!), but I’ve got one for you today. I actually saw this Instagram post a couple of weeks ago and made myself step away from the phone immediately because I didn’t want to get too reactive! But I’m still highly annoyed, so I’m finally allowing myself to rant.

Interviews

Where do fitness and pelvic health overlap?

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July 9, 2025

If you’ve been around here for a while, you know I’m at least mildly obsessed with the pelvic floor. It’s an area of focus for my work, and I’ve personally witnessed how powerful it can be when you get relief from symptoms of pelvic floor dysfunction:

On to our chat!

Anna: I love the way your work prioritizes safety, but not in that sort of scary “this is safe and this is unsafe” way. You’re all about feeling safe within your body and feeling confident in the way that you move, and not... And I think that this [session] is making me feel like, okay, I feel more safe to continue on, like I’m not just sort of “let’s see what happens today,” I don’t know. So I totally love that.

Cait: Yeah, no, I appreciate that. I mean, I feel pretty radicalized around the fact that I actually don’t know what it feels like to be in your body, right? So that’s how I treat it, I think. You know, I can certainly say from my training, and a lot of my colleagues’ training, just, you know, behind closed doors, like we’re kind of taught that we know best and we’re going to tell you what to do. And I just don’t feel like that serves anyone. I think the greatest gift I can give you is a better understanding of what is working for your body and how you can feel safe and connected to it vis-a-vis specific movements, right? So, like, exercises are temporary, autonomy and safety are forever.

Anna: Yeah, I love it, I love it. So this was kind of like a very small taste of what a session with you might be like, and I have some experience with this kind of work. But for folks who think, “I’m in pain, I have to go to see an OT or PT in person,” was this kind of like a typical session for you? How does it vary? Do people have wild misconceptions about what it means to do virtual care like this?

Cait: Yeah, that’s a really great question. So I think this is a great little sliver of a session when we’re thinking about, like, a purely biomechanical case, which is to say you didn’t come in saying that you had been in extensive chronic pain for, you know, 30 years, and had seen every single type of specialist, and all of what comes with that set of concerns. And so when someone’s coming in and they’re just like, “my back hurts, please help,” or “it hurts to have sex, please help,” or “I’m peeing everywhere, please assist,” right, this is a great insight into one of those sessions in terms of, like, okay, what are your goals, what brings you joy, and how does it hurt? Let’s get curious about your body, and then let’s progressively build back to what brings you joy, right?

I think the biggest misconception about virtual work is that it’s not gonna work. And I think the funny thing about it is that I think it works better for folks, because it does place a little bit of, like, “oh, I have to be curious about what’s going to work for my body,” right? When someone’s ready for that and they’re open to it, and there is absolutely nothing wrong — I always say there’s nothing wrong — with just wanting to go in and be like, “I need some manual therapy, just let me feel better,” right? Like, we all get burned out, we all need that kind of care, and that’s a really special space and thing that people provide. But I think that, in terms of the long-term understanding of what movement patterns are driving chronic dysfunction, I chose to leave a very successful in-person practice because I really believe in this work.

And then the other layer that I think is important to say is that I love treating complex chronic pain, and I’m trained in something called pain reprocessing therapy. Thinking about how do we feel safe in our bodies, and how can we establish safety, either through movement or kind of whatever works for you — so just very important to say that I don’t believe in any specific, like, “oh, just breathe this specific way and you’ll be healed,” right? Like, if that worked everyone would be fine, right? But people are different, and so I feel very radically client- and individual-oriented, in terms of how can we create collectively, and how can I help facilitate safety in a client’s body, whatever that means for them.

Anna: It’s so amazing, it’s so powerful. And yeah, people becoming more self-directed and building their own connection and intuition about movement, amazing. So the other thing I definitely wanted to talk to you about is — when we were texting about all this a few days ago, you were like, “I have a couple of videos that might help with this on my platform, which is launching soon, and I would love for you to be able to try those.” And they were incredible, so helpful. I did this standing sequence, it was only like 10 minutes, it was exercises I’ve never seen, or I mean it was like a hinge but done in a very specific way with very specific cueing. And I felt better immediately, I’ve been incorporating those in the last few days. So I was like, we have to tell my people about this! So many people come to me because they want to learn to exercise, and then they, you know, they discover some interesting things about how certain movements feel, and they ask me questions about their pain, and I have to kind of say, like, “well, I cannot diagnose or treat your pain, I, you know, I’m not a specialist in that.”

So I’m very excited about this resource to be able to share with my people. So I want you to talk to me about your new platform: what it is, who it’s for, how it works, and tell everybody how to sign up.

Cait: That is so kind, thank you so much, I’m so thrilled it was helpful, because that’s literally the intention, right? So my platform is called Tidal Work, and the tagline is “Therapeutic movement for pelvic health and complex bodies.” So, it is not a progressive overload program like yours: Like, I just felt like you could do it better, right? Like, other people could do that kind of work better. What I wanted to create was a space for folks who need specific therapeutic movement — which, don’t we all, at some point, right? Whether you’ve had a baby, or I like to say postpartum is forever, or you are going through menopause, whatever, or you just got a cranky back, or you’ve got pelvic pain. Pelvic health is so central, I feel like that’s all I ever write about, that it really is like a full body job. So even though I’m a pelvic floor specialist, it’s full body movement, and it’s also, like, how can we house short, effective therapeutic sequences, which you’ve never seen before, because I built them over my 15-year career? It’s my favorite part about my job, is like making stuff up and being like, “that feels really good,” and then also kind of combining this deeper work of, like, body autonomy.

So many of the folks that I see feel really disenfranchised by the medical system, by the rehabilitation system, by exercise culture, whether you live in a larger body, or whether you’re chronically ill or neurodivergent, or whatever, and there’s this whole yucky paradigm of like, “Well, just do what I do and you’ll be fine.” I really wanted to create a space where people could come and start to actively say, “I’m gonna listen to my body.” And so, you know, yes, there are these therapeutic tutorials, and there are also, like, somatic practices, where it’s just like, “let’s just breathe and move,” in ways that feel really good. And then there’s also kind of the anchor of the platform, which is this idea of open practice, where it’s like, okay, can we sit with our sensations and respond via movement accordingly? And I want you to do whatever you wanna do, and get used to being like, “oh, I’m not gonna follow along with me or whoever.” How can we kind of build that skillset of actually listening and dynamically responding, so that you can confidently walk into an exercise class and do what feels good for you, and say, “no, thank you” to what doesn’t, or say, like, “I’d like to make this really spicy and challenging, and I’m going to do this wild thing because it feels awesome.” Like, volume up, volume down, respond accordingly. So that’s Tidal Work, and I would be honored if anyone wanted to try it.

Anna: It’s amazing, it’s such a good resource. To your point, all bodies have their issues, and, you know, you may have a hip issue one day and a pelvic pain issue the next day, and shoulder, or whatever, you know, there’s just so many things. So having this resource, you know, it doesn’t necessarily replace, you know, an evaluation, or somebody saying, “this is what I’m,” from a professional perspective, “noticing,” but it is such a great, like, just to have something at your fingertips, um, to help you build these sort of connections and these tools for yourself. So it’s Ti—say it again?

Cait: Tidal Work, yes.

Anna: Okay, and it’s T-I-D-A-L, not T-I-T-L-E.

Cait: Like a wave. Tidal Work, tides of your life, of movement, of your body.

Anna: Yes, it’s beautiful. How does it work? Like, is it, what, how do you access it, what’s the subscription situation?

Cait: Yeah, totally. So you can go to tidalworkmovement.com, I give you a seven-day pretrial. I always feel like very silly saying that. And so a kind of classic membership will open you up to my library, which is like hundreds of videos. There’s an opening kind of check-in, which you’re always welcome to skip, then there are kind of curated playlists for back pain help, pregnancy and postpartum, like there’s all of that. Or you could just be like, “okay, I just really want to, you know, I want therapeutic movement for prolapse today,” in your intro check-in, and the site will suggest a specific movement. You can also say, like, “I have five minutes, what you got for me?” and it’ll just, like, serve it right up for you. Or, like, “I really just want to be challenged,” or, “I just want to breathe,” and it’ll just, like, take you there. So that’s the kind of core membership.

There’s also an option for personalized support, which it is not medical advice, however, it is, you know, if you wanted to say, like, “hey, Cait, just tell me what to do every week,” like, “can you just hit me up with three, you know, three different classes, my back still feels a little funny,” here you go; that’s the personalized support tier. And then that also offers two weekly Zoom calls, every week. They’re group calls, they’re live, they’re not recorded, but it’s an option to just get a little extra comfy support.

Anna: Take us through the constellation of your work. Because you have your one-on-one practice, you have your newsletter, which is so great and informative, and then you have this platform. I don’t know if I’m missing something, but I’d love to just kind of hear, like, “go here for this, go here for this, go here for this.”

Cait: I think about this a lot, because my big kind of through-line of intention is to create more accessibility for pelvic health. I feel like the access to pelvic health care is really limited, there are not a ton of providers, a lot of us are out of network, right, and so the access, in multiple different ways, can be really challenging for a lot of people. And so my Substack, Adventures in vaginas (and other parts), is this like open offering to, like, let’s just have some shame-free, gender-inclusive shit-talking about all the stuff you didn’t want to ask your friend about, or your OB about, or whatever. Or if you’re like, “I live in a really rural place and I can’t get to a pelvic floor provider, and I just need some information, I need to know what to start to look for,” right, that’s Adventures in Vaginas. And then, you know, my paid tier on that is eight dollars a month, and that gives you access to, you know, some more movement, you know, an archive, I’ve been writing for four years, so there’s a ton of information on there.

And then Tidal Work is kind of like that space of, like, “okay, I kept hearing people wanting more,” right, but, like, one-on-one sessions, you know, they can be cost-prohibitive for people, that’s just a real thing, and I didn’t create the insurance system in the United States, and I didn’t create the reimbursement system. And so, you know, in order for me to kind of feel really good about having, like, it’s very, very deeply important to me to deliver value, right, like, for me to be like, “Anna, do this 10-minute thing,” and, like, no, it is not medical experience, right, but, like, you can feel better after that, right? That’s my intention with Tidal Work, is to kind of bridge that gap and help get people more access to some level of therapeutic movement that can be really helpful, with this autonomy lens.

And then my one-on-one care is for those folks who are like, “okay, I want more,” right, or a lot of who I see are the folks who are like, “I’ve seen five, six, seven other pelvic floor therapists, various specialists,” I love those cases, I love those folks, I love thinking hard. I feel like it is a privilege and an honor to serve and support everyone, really, but especially the folks who tend to find me. And so that’s kind of how I think about that continuum of offerings. And, of course, you know, like, you can pop in for one session, right, and just get, like, more of a consultation, and then if the cost is prohibitive, right, then Tidal Work is there for you, so that you have a lot of accessible content to kind of work through on your own, and then you don’t need to see me, or, you know, another out-of-network provider, maybe as often. Again, doesn’t replace medical experience, but that was kind of my thought behind it: just accessibility and value.

Anna: I love it so much. Movement is something that people are still not understanding is so powerful for pelvic health, and just education, just, true, like, how does it all work, what symptoms are what, those things make such a huge difference for people. You do not have to be on somebody’s table to be able to benefit from all of those things.

Cait: So, totally, it’s so needed, and there’s so much that we can figure out just by kind of better understanding, our movement tells us a lot about our pelvic floor, and vice versa, because it is the center of the body. And, and things that I think of are very like, “oh yeah, like one plus one equals two,” in the same way that you think about specific movement things, it’s like, yeah, duh! Like, this is just a part of my world, right? I mean, people write me every day and they’re like, “you blew my mind.” Totally. “Thoracic rotation is critical for pelvic health.” Yes, right.

I feel pelvic health is for everyone, movement is for everyone, I just want to get that out to more people.

Anna: I love it. Thank you so much. Everybody, go and check out Tidal Work and all of Cait’s other wonderful offerings. And thank you for your help with my back and my hinging, and just being your wonderful self, girl.

Cait: Anytime, thank you for having me, this was awesome.

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xo
Anna