Pelvic Rehab for Mom: Just as necessary as knee rehab for athletes

Seeing a physical therapist after spraining an ankle or sustaining an ACL injury is a fairly common practice for athletes and weekend warriors. There is a fault somewhere in the athlete’s system. It needs some TLC. If the athlete wants to obtain pre-injury level of activity (ie return to football or marathon running), physical therapy is important. Most people would concur, no questions asked.

And then there is diastasis recti, perineal tearing or c-section scarring. And hip pain, low back or SI joint pain. Women have just gone through 9 months of carrying and growing a baby. And the marathon or ultramarathon of labor and delivery. And yet, at our 6 week follow-up (6 weeks!?) we are told all looks good. You can resume life. And for some women, this is true. But for MOST women, it is not.

Many women continue for months (even years!) to experience pain with intercourse, pressure/heaviness in the pelvis, sneeze pee, pain with bowel movements and difficulty restoring pre-baby physical function. There is a fault somewhere in the woman’s system. It also needs TLC. Every woman deserves therapeutic guidance when it comes to reclaiming her body. After all, we wouldn’t blindly let an injured football player figure out his own rehab or even worse let him return to the game without any rehab. WHY SHOULD POSTPARTUM PELVIC REHAB BE ANY DIFFERENT?

I have good news. There is a specialized physical therapist just for you, to help you navigate the aftermath of being postpartum. I believe every woman should see a specialized physical therapist after the arrival of baby (or even before). I believe every woman should know this is even an option. I believe every woman deserves basic education and guidance on postpartum pelvic health. I believe that one day this will be the standard of practice.

 

Kegels and Crunches Are Out, Hello Reflexive Core

Understanding the Reflexive Core

The Reflexive Core is comprised of the respiratory diaphragm, deep abdominal muscles and the pelvic muscles. This is a pressurized system among all of these muscles (think of a full balloon). The respiratory diaphragm and pelvic muscles are the exact inverse of each other, so these muscles make up the top and bottom of the balloon. The abdominals start at the front, wrap around your sides and connect in your back so think of them as 360 degrees around the center of the balloon.

 

 

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How it works:

Some functional anatomy, here it goes! The diaphragm, abs and pelvic muscles are connected. These muscles have to coordinate and communicate with each other in order for the reflexive core system to function appropriately. See this video for what actually happens every time we inhale and exhale.

  • Inhalation:  diaphragm lowers, pelvic muscles yield to the pressure change, abs open and release.

  • Exhalation:  diaphragm elevates (recoils), pelvic muscles recoil from elongated position, abs engage.

  • This is a balanced system and what it should look/feel like in every person when we breath correctly

  • This system should activate ‘reflexively’ (ie pelvic muscles tighten, abs engage) with movement or any time there is increased pressure through our center (think: moving sit to stand, bending to lift weights/children, coughing, sneezing, running, jumping, etc)

Sometimes, there is a fault SOMEWHERE in this system. It could be due to:

  • Diastasis Recti-a separation of the ab muscles. Think about a slit down the center of the balloon

  • C-section or perineal scarring-This can inhibit the elasticity/stretch of parts of the balloon

  • Weak pelvic muscles-not enough support/recruitment at the bottom of balloon to respond to changes in pressure inside the balloon

  • Pelvic muscles that are too tight-what if the bottom of the balloon was so taut that you couldn’t breath into it and get it to open and expand? Due to its decrease in elasticity, It certainly can’t absorb any pressure/force. Tight pelvic muscles= WEAKNESS.

  • Over-gripped abdominals-Think about just squeezing the center of the balloon. Where does the pressure go? This makes for very unhappy and compressed/descended pelvic organs.

  • Decreased awareness of alignment/posture-the ‘lean back & butt tuck’ posture or ‘slumped’ posture make for a balloon that isn’t stacked. These muscles can’t communicate!

  • Poor body mechanics/exercise techniques-breath holding, bending incorrectly, or exercise techniques that isolate only 1 part of the core system. What if only center of the balloon gets exercised?

  • Hormonal changes that occur throughout the lifespan

A fault somewhere in the system leads to SYMPTOMS that may include:

  • urinary incontinence-ANY involuntary loss of urine

  • urinary urgency-intense urge to urinate, with or without urine loss

  • urinary frequency-more than 7x/day, 0-1x/night

  • pelvic organ prolapse-heaviness/pressure into the pelvis or vagina

  • bowel incontinence, urgency, frequency, constipation

  • pain with intercourse, pelvic pain, low back pain, hip pain, perineal pain, c-section pain

What does this mean?

Correct the faults and decrease/eliminate the symptoms.

Note: This is why performing ‘Kegels’ or traditional abdominal exercises may not be effective or allow you to meet your goals. One must consider retraining the entire core system and addressing all faults in order to be most effective for optimizing pelvic health.

So, immediate actions:

  • Watch your standing and sitting alignment. The system has to ‘stack up’

  • Breathe correctly. Breathing with your diaphragm (360 deg rib cage expansion) decreases pressure on the pelvic floor and abs and brings diastasis separation closer together

  • Exhale to activate the reflexive core when lifting, standing up from a squat, etc

  • Be mindful of exercise techniques that could be contributing to faults and symptoms (This could be an entire other blog post!)

  • Seek help from a specialized PT, of course!

How will Physical Therapy help?

We have highly specialized training and we understand the pregnant and highly complex postpartum body in depth. However, we do have training to support women throughout the entire lifespan, even through menopause and beyond!

  • Proper evaluation is key. We will look for any and all faults and customize women’s physical therapy experience

  • Manual therapy. We will used skilled touch to address internal and external soft tissue concerns. Trigger points, fascial restrictions, nerve irritations, poor musculoskeletal alignment

  • Education. This is where we make behavioral, lifestyle, postural, ergonomic, body mechanics changes needed for women to succeed in healing her condition/concern

  • Exercise. No more Kegels please! I could talk about this forever. We guide women on re-training their entire system in a very functional way (ie how to bend, lift/carry babies, run, weight lift without losing urine, etc)

Who can this approach help? 

  • moms (pregnant or postpartum)

  • female athletes

  • women in menopause

  • any female experiencing pain or inability to wear tampons, pain or inability to undergo a gynecological exam or concerns with sexual health

The good news...symptoms and conditions are highly treatable, don’t have to be endured, and it’s never too late to seek care!

If you cannot access a Physical Therapist, or need a home program to compliment your physical therapy plan of care, I highly recommend Restore Your Core ( at any point postpartum) and One Strong Mama (prenatal) because they address and incorporate all the important concepts discussed in the blog. Both being a very safe and effective approach to optimizing your core, pelvic, and whole body health! (FYI: I am an affiliate of both programs and I have been through the content extensively prior to becoming an affiliate!) 

All female bodies are unique. If you would like to talk about how the above relates to your specific condition, feel free to contact me on FB. If you'd like to read more, you can visit our blog here.

 

 

Immobility is Hazardous to Our Health

There have been several studies and articles citing the negative health effects of sitting at a desk for 40+ hours per week. Quite honestly, we can take a peek back even further to realize we have been sitting at desks, all day, since kindergarten. Between school, workstations, cars, couches and kitchen chairs, we are all spending too much time in the same alignment with little variation. Muscles and joints shorten to adapt to these positions. There is less blood flow. There is no doubt an increase in the rates of diabetes, heart conditions, metabolic disease and spinal pain. But can it be blamed only on sitting? Or is there a bigger concern?

As a PT, I can agree that we need to sit less overall but what I see as being the biggest contributor (outside of nutrition) to the decline in our health is the fact that we all need to move more. (Full disclosure is that I was sitting, reclined in my chair, with my laptop actually on my lap at the start of this blog. And then I moved).

Here is what the solutions are not

I have suggested ‘optimal’ ergonomics for my clients’ workstations for 10+ years. But fancy chairs and desks will not be able to replace our bodies innate need to move more. And a solution I can’t agree with is the popular idea to move everyone to a standing desk. While standing is certainly better, It is still not ideal to sustain ANY static postures (static = non-movement). So the problem with the standing trend is that we are just replacing one static posture for another!  Movement is essential to improving the current state of our health (or rather our un-health).

People who are ‘on board’ to improve their health get themselves to the gym for 1 hour/day. Although movement is good, the concern I have with this is that we cannot expect 1 hour of intense exercise to counter the negative side effects of otherwise being stagnant for 23 hours/day (I might be exaggerating, but only slightly). We have a  extensive lack of movement in our lives when we consider how we commute to work, sit to eat, sit to watch TV/play on the computer, sit to read, sit to socialize and lying still while sleeping. Honestly we don’t move enough. So, would 2 hours of exercise be enough? Maybe 3? I can’t find that kind of time.

So what is the solution?

I am encouraging my clients (and myself!) to move more throughout the day. In current culture we are encouraged to “work smarter, not harder”. But, I would counter that we need to sometimes work harder, to get little bits of blood flow, joint loading, muscle stretch and strength organically throughout our day. It’s as simple as taking the stairs, parking a bit further away, stretching while chatting with friends/co-workers, and even sitting but with variations in position. My friend asked the other day “how can you sit on the floor like that?” Because I do it. Regularly. And that’s how my joints and muscles will continue to know how to do it.

Even bigger solution: Changing the work culture

A dynamic work station is a good start to adding more movement to your work day. This means having the ability to change positions often, quite possibly every 30 minutes or less. It means sitting across various surfaces which changes the angles on our joints and demands on our muscles. It means standing a bit, maybe to stretch our spine, chest, calves or quads while we are on the phone. It means taking a few quick laps around the office while we take screen breaks. It may even mean doing a few deep squats to release even further. What about having our meetings while walking (2 birds with one stone. Seriously). This would mean changing the typical work culture as we currently know it. Please read “Don’t Just Sit There” by Katie Bowman if you want more easy-to-implement ideas and a read which certainly inspired this blog post!

All bodies are unique. If you would like to talk about how the above relates to your specific condition or work environment, feel free to contact me on FB. If you'd like to read more, you can visit our blog here.

Response to NPR's article "Flattening the 'Mummy Tummy' With 1 Exercise 10 Minutes A Day"

The latest NPR article about “Flattening the Mummy Tummy” came into my world from 5 different directions today. I read (initially between clients) and then re-read and then re-re-read this article. I desperately wanted to agree however it has my radar up, to say the least. In all fairness, I am not familiar with this specific technique, I have never been to a class and I can only speak about the method within the context of how it was written in the article. I do have some concerns (read: major opinions) and would like to open up more dialogue around this and all exercise techniques in the postpartum period.

  1. Mummy Tummy.  We need to change the culture around the ‘flat is fit’ mentality. Let’s just focus on being functionally strong and well supported in our day to day lives!

  2. 10 min of exercise will cure DR. First of all, just no. No, no, no.  It is a major disservice to tell women that one exercise for only a few minutes a day will fix Diastasis Recti (DR). What about how we are using our bodies the other 23 hours and 50 min? I think it is way more important to consider how we sit, stand, carry babies, lift weights, bend, squat, and carry car seats! It isn’t about ‘exercising’ the core but rather about ‘re-training’ the core. I have worked with many clients with DR and I am certain it isn’t a simple or quick fix.

  3. The ‘sucking in’ idea has to go. Far, far away. Sucking in the tummy muscles can do more harm than help. Think about squeezing the center of a balloon. If we create excess tension in the center, where does the pressure in the balloon go? Up and down. Either direction is problematic, but especially concerning is down due to pressure and stress on the pelvic organs and pelvic floor.

  4. Reflexive core. I do think these instructors are focusing on the involuntary contraction of the lower abdominals by utilizing an exhaling breath. This exhale is attempting to activate the reflexive core but really it is the combined function of the diaphragm, abdominals AND pelvic muscles.  This is what should kick in for us naturally as we move and I use an exhale technique to help my clients retrain the reflexive core. But I don’t cue ‘tighter, tighter, tighter’ at the abdominals. I cue a coordinated contraction among the muscles. And cue the ability to generate only the appropriate force necessary for the demand of the task. A simple roll over in bed has a different contraction and demand than when we are running or jumping.

  5. DR doesn’t have to completely close to have a strong, functional core. Not much else needs to be said here. My goals for a client are never to decrease DR by X amount. My goal is for the client to stop peeing when they sneeze or to decrease low back pain when carrying baby.

  6. This type of exercise isn’t functional! This is already somewhat tied into my other points. But sitting cross-legged, on your hands and knees or performing this while standing doesn’t exactly replicate life. What about holding a 30 lb toddler while reaching down to pick up a heavy bag? THIS is life. And often times, the postpartum reflexive core needs to be re-trained to know how and when to kick in with variable demand situations. A suck in and hold is just not how the core system works.

  7. A piece of me feels this preys on the desperation of women. Fix DR in 10 min over 12 weeks? Lose inches off my waist without doing anything else? I will have a completely flat tummy again? And finally....Let’s all measure and compare ourselves during class? Yikes.

  8. I am biased. I believe all women should have access to a Pelvic Health Physical Therapist in the postpartum period for solid guidance and support. For BIG PICTURE pelvic health and body wellness over the long term (because postpartum bodies are more complex than DR and belly fat). I am also a strong proponent of home systems such as Restore Your Core and One Strong Mama because we all provide so much more than just ‘quick fixes’. I also want to mention the phenomenal Julie Wiebe, PT as I have learned a TON from her educational series!

All women’s bodies are unique. If you would like to talk about how the above relates to your specific condition, feel free to contact me on FB. If you'd like to read more, you can visit our other blogs here.

Why Kegels might not eliminate urinary incontinence

As a Pelvic Health PT, I’ve been at odds with the over-prescription of Kegels as a silver bullet ‘cure’ for all things wrong in the pelvis, specifically urinary incontinence (UI). This could be a much longer blog post, but I stuck to the top 3 reasons why I think Kegels are generally ineffective.

  1. Urinary incontinence may come from weak pelvic muscles, but not all weak muscles need strengthened. Weakness in the pelvic muscles can be complicated. But simply put, all muscle fibers in our body need to overlap the perfect amount to generate an optimal force. So, if a muscle is too long (over lengthened) then it will be weak because the muscle fibers don’t overlap enough. A person in this scenario may benefit from increased strength training. Conversely, if the muscle fibers overlap too much (ie the muscle is tight) this will also be weak, again because the muscle will not be able to generate force. Tight does not equal strong. Tight= tight=weak! This situation would require a release of the tension prior to focusing on strength. Now hopefully you see why more Kegels (ie tightening) will be ineffective! And as a pelvic PT, I see much more of the latter situation when it comes to the pelvic muscles.

  2. Kegels don’t replicate function. Pelvic muscles never work in isolation, so why train them that way? We are taught to do them in the car while at a stop light. And repeat over and over throughout the day. One thousand bicep curls don’t help you much with a half marathon. So an isolated contraction isn’t actually what is required when you bend to lift your toddler or when you perform burpees at the gym. We need to focus on functional re-training our core system to optimize results. 

  3. Many factors can contribute to UI. It’s just a sign that something is off somewhere in the core system. Let’s also take into account standing and sitting posture (alignment matters!). How about if someone has diastasis recti? What about a prolapse? How about someone who constantly grips their tummy muscles or who truly has a weak transversus abdominus? This list goes on….

The best way to assess all the factors that contribute to UI specific to you would be to see a Pelvic Health PT. And if you are pregnant, you would absolutely would benefit from One Strong Mama, which incorporates an effective and functional way to retrain your core system and provides such an amazing support system and network!


All women’s bodies are unique. If you would like to talk about how the above relates to your specific condition, feel free to contact me on FB. If you'd like to read more, you can visit our blog here.

It's Not a Floor

We know I don't prefer Kegels (in name or function!) I also don't prefer the word pelvic floor muscles. Because it's not a floor. A floor is a hard, solid, unyielding surface.

I like to think of the pelvic muscles like a jellyfish; dome-shaped, soft and adaptable to the ocean currents.

The pelvic floor must release downward with every inhalation and recoil gently upward with every exhalation. And just like a jelly fish, when we change the pressure within our core, the pelvic muscles respond and yield to the demand. This functional system keeps our pelvic organs supported (and keeps us continent!), provides postural support and helps us maintain good sexual health. To consider it a floor doesn't relate its function.

Women's bodies are all unique.  If you'd like to talk about how this post relates to your specific situation, feel free to email at Jessica@mindfulmotionphyiscaltherapy.com or comment below.

Next blog: Your Core Is A Can of Soda which will highlight more about the reflexive core and its function

 

Thoughts on Kegels Being Useless

Want to get back in shape after baby? Do your Kegels.

Want better sex? Do your Kegels.

Want to get rid of your pelvic pain or back pain? Do your Kegels.

Want to stop losing urine when you cough or exercise? DO MORE KEGELS .

What if I told you that Kegels are not a silver bullet exercise and I am a Women's Pelvic Health Physical Therapist? Kegel advice is still being given by doctors, trainers, and magazine articles. How many of you have done what you've been told, with little or no progress? Many of us have been here.

Kegels are an isolated exercise, and may not be effective (read: even useless!) because the pelvic muscles never work in isolation. I prefer to not even use the word Kegel because of the isolating image this projects. I prefer to talk about the reflexive core. It consists of several muscles including the respiratory diaphragm, transverse abdominals and the pelvic floor muscles. These muscles all communicate and coordinate as part of a larger system of core support.

To see the progress we truly want and need, this means shifting our perspective away from isolated exercise and consider the bigger picture of total pelvic health that includes so much more than the pelvic floor. 

*Women's bodies are all unique.  If you'd like to talk about how this post relates to your specific situation, feel free to email at Jessica@mindfulmotionphyiscaltherapy.com or comment below.

Next blog: It’s Not a Floor which will highlight more of how the pelvic muscles actually function!