A Pregnant Physical Therapist’s Top Tips for Your Healthy Pregnancy

Navigating the pregnancy literature on proper posture, exercise and sleeping alignment can be overwhelming and the guidelines presented are often not a “one size fits all”. Afterall, everyone’s pregnancy is unique. Below you will find some quick and easy tips that I utilized and found helpful throughout my pregnancy that kept me fit, aligned and pain free throughout my work day as a physical therapist at EMH.

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PelviCorFit™ by EMH Physical Therapy Grand Opening

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Have you been working out for years, but neglecting a crucial muscle group??

At EMH Physical Therapy we recently launched our brand new PelviCoreFit™ program designed to whip your pelvic floor muscles into shape. Proper firing of pelvic floor muscles is not only essential for pelvic health but is also a key factor in overall core strength and fitness.

Visualize this:

screen-shot-2016-09-20-at-2-03-35-pm

The pelvic floor muscles form a sling that transmit forces from the ground up and from your head down. If pelvic floor muscles are weak and unaccustomed to firing during exercise, you could be promoting a faulty movement pattern in the chain. Neglecting the Pelvic floor muscles can potentially lead to more serious conditions such as chronic hip, back or pelvic pain, urinary or fecal incontinence, GI and bowel disorders, and erectile or sexual dysfunction. At EMH Physical Therapy we will help you identify and strengthen the pelvic muscles during your general workouts to help prevent future dysfunction!

Additionally, did you know that the pelvic floor muscles play a fundamental role in breathing through connections to the diaphragm?  Think about doing cardio, executing a heavy lift, or performing a Vinyasa flow with a sub optimal breathing pattern. Strengthening the pelvic floor muscles can improve breathing which will help to optimize your workout efficiency.

Come try out our discounted  PelviCoreFit™ program, learn about proper activation of the pelvic floor muscles and bring your workouts to the next level!

We offer 2 options:

“PelviCorFit™ #1” – One fifty minute session with a DPT + Fitness Guru that includes 15 minute pelvic floor/core education followed by a 30 minute PelviCorFit™ workout, then Q&A. Regular price is $200. New Client price is $50

“PelviCorFit™ Pack” – Three (3) fifty minute sessions with your DPT + Fitness Guru. The first session is similar to the description above. The 2 follow up sessions include 45 minute PelviCorFit™ workouts plus instruction on how to implement pelvic floor awareness into your fitness program. Regular price is $500 for 3 sessions. New Client price is $130

To register call 212-288-2242

or

email info@emhphysicaltherapy.com

For more information click here

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Having trouble losing the “Mom Belly” Post Baby?

Why diastasis recti may be your problem and how you may be making it worse…

checkyoself

 

If you’re doing a million crunches to get your abs back post baby but can’t seem to lose that last little “pooch,” STOP!! You may be experiencing a very common postpartum complaint: diastasis recti.

 

What is diastasis recti?
It’s a separation of your rectus abdominis (6-pack muscles). As your belly expands during pregnancy, the connective tissue between the right and left sides of the muscle (called the linea alba) stretches to accommodate your growing baby. This separation may persist postpartum and in some women does not naturally reduce. This gap leaves your abdominals less functional, weaker and allows the other soft tissues to hang out. This causes that little belly that most new moms learn to hate.

Do I have diastasis recti?
Lay on your back with your knees bent and feet flat on the floor. Place 2 fingers at your belly button. Now lift your head like you’re trying to look at your belly while keeping your abs relaxed. Do you feel a gap along the midline of your abs at your belly botton, how about above or below the belly button? If you can fit more than 2 fingers in this “gap” you have a moderate-severe case of diastasis recti.test

What can I do about it?
Don’t freak out! You can learn a simple exercise to “brace” your abdominals that will begin to close this gap. Begin on your back with knees bent, feet flat and try to engage your deep abdominals by inhaling and bringing the navel to the spine as you exhale. See the exercise program below (“Other Resources” at the bottom of this blog) for a beginner plan geared towards closing the gap of your diastasis recti. If your goal is to get back to running, yoga, barre classes, spin classes etc., it’s recommended that you attend a few (anywhere from 2-12) PT sessions in order to strengthen your abdominals and avoid stressors that you’re not ready for. For example, planks and crunches are too challenging for abdominals weakened by diastasis recti and can worsen the separation if done improperly or too soon.

Bracing Steps (standing & lying down)

abdominal_brace_blog

bracing1

 

 

Other Resources:

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Home exercise program for beginners: View at www.my-exercise-code.com using code: TGQQAGV

http://mumafit.com.au/  A site created by an aussie mom of 3, Maternal Wellbeing Specialist, and International Holistic Life and Wellness Coach. She also has a very popular app that has quick and easy exercise programs for during and after pregnancy.

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The TOP 5 Exercises to Reduce Pelvic Pain

Written by Kirsten Hober, PT, DPT

If you are experiencing pelvic, abdominal, hip, and pelvic floor dysfunction these 5 exercises can help your body relax, allowing more oxygen to flow to loosen tight muscles and fascia that may be causing your pain.

 

1.) Diaphragmatic breathing

Deep breathing is an excellent way to calm the nervous system and relax.  In particular, diaphragmatic breathing is a specific pattern of breathing closely related to the functioning of the pelvic floor and enables relaxation of those muscles.

The diaphragm is a dome-shaped muscle that lies below the rib cage. As the diaphragm contracts, it expands downwards and resulting pressure pulls air into the lungs. This downward pressure and expansion of the muscle also results in descending movement upon our internal organs. As this happens, the pelvic floor muscles receive a gentle stretch and expansion as well, facilitating a relaxation of those muscles. This pelvic floor expansion can be felt upon inhale with a diaphragmatic breath.

Diagram of how human breathe

Exercise

To begin, lie on your back in a comfortable position with one hand over your chest and one hand over your abdomen just below the rib cage. Breathing in through your nose, let the air fill your belly and feel the expansion of your abdomen as your hand rises. Meanwhile the hand that is placed over your chest should remain still and you should not feel any chest expansion upon the inhale. As you exhale, feel the abdomen drop back down towards your spine. Continue to breathe, feeling your belly rise and fall with each inhale and exhale. Performing this exercise for 5-10 minutes per day will help allow the pelvic floor muscles to relax.

Once you have become comfortable with diaphragmatic breathing while lying on your back, you may also try the same techniques for this breathing pattern in sitting, and even standing.

Incorporating diaphragmatic breathing into the following four pelvic floor exercises will increase your awareness and ability to fully relax these muscles.

Diaphragmatic breathing exercise diagram

 

2.) Deep Squat

Bringing your legs wider than your hips, squat down towards the ground until a stretch is felt through your legs and you reach the deepest comfortable position.  You may choose to hold onto a stable surface for support, or you can bring your arms inside your legs as a counterbalance. Hold this pose for 30 seconds as you breathe deeply into the belly using the diaphragmatic breathing. Try to feel the expansion of the pelvic floor muscles in this open position. Repeat 5 times throughout the course of the day.

Deep squat pelvic floor exercise holding on to something sturdyDeep squat balancing pelvic floor exercise

 

3.) Happy Baby

 

Lie on your back on a comfortable surface. Bend your knees and lift your legs off the ground, gripping the outside of your feet or your ankles with your hands as you separate your legs wider than your torso. Remain in this posture for 30 seconds and breathe deeply using diaphragmatic breathing to expand the belly. As you inhale feel the expansion of the pelvic floor muscles. Repeat 3-5 times throughout the day.

Happy baby yoga pose

4.) Child’s Pose

 

Begin by kneeling on the ground on a comfortable surface. Separate your knees so that they are open wider than your torso. Bend forward at the hips and bring your forehead to rest on the ground or a pillow. You can either reach your arms forward in front of your head or back to rest by your hips. Bring your hips back so that they are resting by your heels. Relax into this position, letting your body fall towards the ground, releasing all tension in your body. Once you feel relaxed fully, focus on diaphragmatic breathing. Allow your belly to expand into the space between your knees as you inhale. Feel your pelvic floor muscles relax and melt towards your hips and feet as you inhale. Remain in this position for 30 seconds to 1 minute. Repeat 3-5 times per day.

Child's pose in yoga with arms frontYoga pose child's pose with arms back

5.) Legs Up Wall

Sit down with your hip 5-6 inches from a wall. Lie down and swing your legs up onto the wall so that your heels are resting supported against the wall and your legs are relaxed. You may choose to let your legs fall out to the sides so that you feel a stretch through the inner thighs or you can allow your legs to remain closer together. Once you have found a comfortable position, focus on diaphragmatic breathing. Allow your inhale to increase the expansion of your pelvic floor muscles as your belly expands. Breathe deeply in this position for 3-5 minutes.

Inverted wall stretch exercise

 

Watch Kirsten demonstrate these exercises below.

Strong Abs during Pregnancy and for New Mom’s

The staff Doctors of Physical Therapy at EMH specialize in pre and postpartum physical therapy for a healthy pregnancy and a fast recovery after delivery. Preventing Diastasis Recti is one aspect of our expertise.
Please forward to all your pregnant/new mom friends and family!

Diastasis Recti Abdominis (DRA) can occur in up to 66% of pregnant women due to hormones that allow ligaments and joints to relax, the increasing baby size in utero, improper weight lifting (ie heavy food bags, other children, furniture etc), a history of prior C-section or abdominal surgery and repetitive poor mechanics during daily activities and lack of regular exercise.

Men can also develop DRA due to faulty weight lifting mechanics, obesity and chronic medical conditions that result in frequent coughing such as bronchitis.

What is a DRA?

DRA is defined as the separation and thinning of the rectus abdominus muscles (see diagram in green) and stretching of the linea alba (see diagram in blue). The linea alba runs from the xiphoid process (base of sternum) to the symphysis pubis (center of pelvic bone). Both the rectus abdominus muscle and linea alba are the main support for the front of the abdomen, keeping the visceral organs in place and functioning well. They also maintain pelvis stability during walking, lifting, bending and squatting.

What are the symptoms of DRA?

Symptoms may include:

  • Noticeable small or large bulge in the center abdomen
  • Sharp or burning abdominal pain during bending, lifting, standing and walking
  • Lower back pain
  • Feeling like the intestines or stomach may fall out
  • Poor posture
  • Longer term problems of prolonged DRA may include Stress Urinary Incontinence, Fecal Incontinence and Pelvic Organ Prolapse.

How To Measure for a DRA?

The best way to measure is a finger width measurement. Lie on your back, knees bent, head resting on floor/pillow. Place tips of 4 fingers across the body at naval or just above/below the naval per your comfort. Now raise your head and shoulders slightly upward. If your fingers descend inbetween the parallel rectus abdominus muscles on either side of your naval, measure how many fingers move downward. If there is a true split of the linea alba, your finger will fall into a space that feels squishy (your intestines live here!). A positive DRA is one where there more than 2 fingertips (1 inch or 2.5cm width) that lower. We have measured women with 3 to 4 inches ( 8cm) wide and have helped them narrow back to 1 inch (2.5cm) wide.

 

What to Do if you have a DRA?

Best to first consult a pelvic physical therapist for a tailored postural, stabilization and home exercise program targeting the Tranversus Abdominus (deepest and lowest muscle of our abdomen), the pelvic floor muscles and the multifidi muscles (lower back stabilizers). Here are some tips to help you immediately:

  • Avoid positions that may further separate the recti muscles, like doing sit ups, crunches, strong stretches of the abdomen, quick trunk rotation movements
  • Stand and sit symmetrically (not to weight bear more on one side vs the other)
  • During standing, gently unlock your knees and gently pull your stomach inward while breathing normally
  • Self bracing of your stomach with your hands pushing the rectus together when sneezing, coughing or laughing
  • Wear a pelvic and abdominal support product to help maintain erect trunk posture and decrease pain until your muscles are aligned and strong

 

 

Diastasis Recti Abdominis (DRA) or “Split Seams” can be treated by Pelvic Physical Therapy

Diastasis Recti Abdominis (DRA) can occur in up to 66% of pregnant women due to hormones that allow ligaments and joints to relax, the increasing baby size in utero, improper weight lifting (ie heavy food bags, other children, furniture etc), a history of prior C-section or  abdominal surgery and repetitive poor mechanics during daily activities and lack of regular exercise.

Men can also develop DRA due to faulty weight lifting mechanics, obesity and chronic medical conditions that result in frequent coughing such as bronchitis.

What is a DRA?

DRA is defined as the separation and thinning of the rectus abdominus muscles (see diagram in green) and stretching of the linea alba (see diagram in blue).  The linea alba runs from the xiphoid process (base of sternum)  to the symphysis pubis (center of pelvic bone).  Both the rectus abdominus muscle and linea alba are the main support for the front of the abdomen, keeping the visceral organs in place and functioning well.  They are also maintain pelvis stability during walking, lifting, bending and squatting.

What are the symptoms of DRA?

Symptoms may include:

Noticeable small or large bulge in the center abdomen

Sharp or burning abdominal pain during bending, lifting, standing and walking

Lower back pain

Feeling like the intestines or stomach may fall out

Poor posture

Longer term problems of prolonged DRA may include Stress Urinary Incontinence, Fecal Incontinence and Pelvic Organ Prolapse.

 

How To Measure for a DRA?

The best way to measure is a finger width measurement.  Lie on your back, knees bent,head resting on floor/pillow. Place tips of 4 fingers across the body at naval or just above/below the naval per your comfort.  Now raise your head and shoulders slightly upward. If your fingers descend inbetween the  parallel rectus abdominus muscles on either side of your naval, measure how many fingers move downward.  If there is a true split of the linea alba, your finger will fall into a space that feels squishy (your intestines live here!).  A positive DRA is one where there more than 2 fingertips (1 inch or 2.5cm width)  that lower.  We have measured women with 3 to 4 inches ( 8cm) wide and have helped them narrow back to 2.5cm width

 

What to Do if you have a DRA?

Best to first consult a pelvic physical therapist for a tailored postural, stabilization and home exercise program targeting the Tranversus Abdominus (deepest and lowest muscle of our abdomen), the pelvic floor muscles and the multifidi muscles (lower back stabilizers).

Here are some tips that you can do immediately:

Avoid positions that may further separate the recti muscles, like doing sit ups, crunches and quick trunk rotation movements.  Avoid being on “all fours”  or on hands and knees for too long during exercise classes.  Assuming the yoga, “cow position” where your belly drops down as your head and hips arch upwards,  puts too much pressure on the already stretched linea alba.  Plus, the yoga position of  “Up dog” and extensive backward bends are not recommended.

Stand and sit symmetrically in good posture  (don’t stand on one leg or sit with crossed legs leaning on one hip for too long)

When you are standing, gently unlock your knees and pull  your stomach inward while breathing normally to give abdominal  support and prevent “hanging out” on your ligaments

When you sneeze, cough or laugh you you can self bracing of your stomach with your hands pushing each side of the rectus abdominal muscles towards the midline, or hold a pillow against your stomach for bracing

Wear a pelvic and/or  abdominal support product to help support the growing baby in uteruo , maintain erect trunk posture and decrease pain until your muscles are stronger by doing core exercises.

By keeping your core toned during pregnancy and taking the steps to prevent further widening of your recti muscles, you can prevent extensive DRA.

 

 

Women’s Pelvic Health

Women's Pelvic Health

 

 

Check out this link ( link) to see Evelyn’s interview on physical therapy for women’s pelvic health in the Los Angeles Times. The app, Pelvic Track, is now available on the Apple store.

 

 

Good Posture is Key to Healthy Body

Good posture is a key factor in preventing many pelvic, hip, lower back, mid back and neck pain.  If we spend most of our day sitting in a slumped position, our knees crossed, our shoulders  rounded forward and our head  jutting in front of our body, and do nothing to counterbalance via exercise or change of pattern, overtime, muscles  become tight, joints lose their flexibility, nerves get pinched, our breathing is compromised, our abdominals become flabby, and off to the doctor we go.  These common problems related to poor posture are treatable with the appropriate lifestyle changes, daily postural exercises taught by a physical therapist and by making ergonomic changes.

TAKE THE PHOTO CHALLENGE:

Let’s tackle some basic lifestyle/ ergonomic issues.   The first step in knowing good posture is to become aware of your postures during work and home.  An easy way is to find out is to have your coworker take some random photos of you throughout the work day (no poses!) The best shots are the side and back views where you can see your spine curves. At home, have a family member take photos of you preparing meals, reading on the couch, etc.  Later you can look at the photos and marvel how upright, centered and how you maintain your natural spine curves throughout the day (probably not!)

Just by looking at your photos, you can figure out some of the changes you need to make.  Good posture is based upon keeping the natural curves of the spine during most activities.  This is called maintaining a “neutral spine” and requires flexible muscles, joints and having strong muscles.   Our body should not be placed in extreme positions for hours at a time. For example a hyperextended position, ie standing with both knees locked can cause lower back tension, conversely, a hyperflexed position , ie sitting in a slumped, rounded posture  can cause back and pelvic pain.

GOOD SITTING POSTURE – Detailed

Sitting is what we do most of our day – to work, eat, learn, watch TV, read and  mostly sit during transportation.  Over time, poor sitting positions causes muscle tension, joint restrictions, strength deficits and pain that physiatrists diagnose and physical therapists treat every day.

Set up your computer/reading/art /work space to fit your body, to help support and maintain your natural spine curves instead of having your body adjust to the space.  The chair seat should be at a comfortable height, so that both feet (heels and toes) can touch the floor. Feet that are unsupported create tension in hips/legs/lumbar spine.  If your body is more of a petite size, so your feet do not touch the floor, use a footrest.

When sitting, the two bones at the bottom of the pelvis where your hamstrings attach, called Ischial Tuberosities  (IT’s), and the center of your pelvis inbetween the IT’s should be in contact with the chair seat.  Your lower back should rest against a lumbar cushion, either already built into your chair back, or purchased separately and strapped around the chair back. The lumbar cushion gently pushes your lower back forward to maintain its natural inward curve.  You should not slump backward to sit on your tail bone (coccyx) nor should you lean too far forward to bear weight on your pubic bone. Don’t sit on one side/hip as this creates imbalances at your sacroiliac joint, hip and lumbar spine.  (See photo 250)

With your lower back resting against the back of your chair against a lumbar cushion, this frees the thoracic spine , shoulders and neck to stack one on top of another, versus careening forward.  If you find yourself hunching forward to see the computer screen or to reach the keyboard, adjust the placement of this equipment so it is brought closer to you so you do not strain forward.

Lastly, during every hour of sitting, work/read/draw for 50 minutes, then get up for the last 10 minutes to take a brief walk, do a stretch, pet your dog, do something else.  Research shows that 50 min work/ 10 min of change recharges your brain/thinking powers. This timing is a great way to re-evaluate your posture and prevent build up of faulty postural patterns.

POSTURE EXERCISES

A  Upper body lift:  done either in sitting or standing position and has 3 distinct parts

If doing this exercise in sitting, keep your pelvis centered on the seat as described above, your lower back resting against the lumbar cushion. If doing this exercise in standing, keep both knees slightly bent.

1) Think of an invisible string gently lifting your sternum (the bone in front of your chest) upwards    You should feel your upper body move from a rounded upper back to a more elevated posture Hold this as you:

2) Roll your shoulders up towards your ears, then backward, then down.  This opens your front of your shoulders Maintain this position as you finally:

3) Gently tuck your chin towards your neck (think of creating a double chin position)

Hold all three positions together for a count of 20 seconds up to one minute.  Make sure to breathe slowly while holding the position   Repeat.  Do three times a day.

B  Thoracic twist combined with deep hip rotator stretch

While working at a computer we tend to get into a rounded upper back and forward head position. Our midspine, called the thoracic spine can become restricted as well as our hip muscles. Here is a simple stretch to open both areas\

R Spine twist:

Sit in a sturdy chair your buttocks slightly away from the chair back, feet comfortably touching the floor or on raised step stool

Cross the R ankle over the L knee

Place L hand on outside of R knee.

Place R hand on the chair seat behind you

Turn your upper body as far as possible to the right while gently pulling the R knee towards your L shoulder. Keep your neck centered over your chest, not to twist your neck too far

You should feel a stretch along your spine and in R buttock/hip region Hold for 10 up to 30 seconds while breathing slowly.

Return to center and repeat once more.  Repeat to the opposite side two times  Do twice a day

 

C Wall Angels

Do you remember making snow angels as a kid?  “Wall angels” are the grown up version of snow angels This exercise increases strength of  your upper back, posterior shoulder to counteract the effects of a forward head, rounded shoulders posture.

1)      Stand knees bent, your buttocks, lower back, upper back and back of your head are against a wall. Tighten your stomach to keep your core stable.  Bend your elbows comfortably by your sides with the back of your hands touching the wall.

2)      Keeping this body position, slowly slide both hands along the wall raising both arms until your hands meet overhead.    Slowly lower. Repeat 10 reps.  If it is difficult to go full range, try ½ or ¼ range.

 

There are more excellent postural exercises, for example keeping your abdominals, pelvic floor and lower back muscles flexible and strong is key.   Consult your local physical therapist to learn a tailored exercise home program  that is right for you.