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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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.

 

 

Pelvic physical therapy is an effective non invasive treatment for Pelvic Organ Prolapse vs “high risk” transvaginal mesh surgery

The FDA recently deemed use of transvaginal mesh surgery to be “high risk” to repair pelvic organ prolapse.  See news link below:

http://www.philly.com/philly/health/womenshealth/HealthDay687309_20140429_FDA_Moves_Female_Incontinence_Device_to__High_Risk__Status.html

Pelvic physical therapy is a more effective and non invasive option.

In a 2014 study of 800 women with pelvic floor dysfunction (which includes pelvic organ prolapse) by University of Missouri, researchers found that ” incontinence, constipation, and/or pain improve by 80% with pelvic physical therapy”. Research shows that pelvic physical therapy plus a prescribed home exercise program works better than just engaging in one option.

Pelvic physical therapy teaches patients with pelvic organ prolapse how to build up the “floor” or muscular base of the pelvis. The pelvic floor muscles provide the main support for all pelvic organs. Kegels alone are not the only treatment option. If there is tension in the pelvic floor muscles, they need to to be released via manual therapies or risk further dysfunction. Sitting posture and good voiding habits are addressed, exercises are prescribed and body awareness improved.

EMH Physical Therapy has been providing successful pelvic physical therapy for 18 years in NYC. We have helped thousands of women return to better function. Call us today to get your prescription for pelvic health.

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.

 

 

Pelvic Health Physical Therapy app Launches November 2013

Watch for the launch of my new app: “Pelvic Health PT, The Hecht Program“. Launch Date: November 2013!!

Pelvic floor dysfunction (PFD) affects women (6 out of 10) and men (#’s unknown) and includes painful intercourse (women), painful or lack of erection (men),  constipation, incontinence after prostatectomy surgery (men), leaking of urine and/or feces with laughing, exercise or with the urge to go.  PFD can cause abdominal  bloating, urinary urgency,  straining during bowel movements,  pain in the pelvic/groin, lower back and hips.

The app, Pelvic Health PT, The Hecht Program” is a tool that I designed along with Kalpesh Wireless, a software company, to help men and women suffering from PFD, some too embarrassed to talk to their doctor about it, take action. By following some of my tips, techniques and exercises, you can regain a healthy pelvic floor.  This app is best used while working with a licensed physical therapist who specializes in pelvic floor rehabilitation.

When your physicians have run medical tests and all are negative for infection or inflammation and medication does not help, the most likely cause of your symptoms could be due to muscle and fascial restrictions, trigger points, weakness and incoordination of the internal and external muscle of the pelvis. The pelvic nerves  become pinched as they travel from your sacrum through the gluteal, hip and pelvic muscles to innervate the pelvic floor region leading to further dysfunction and pain.

For over 17 years, my practice has healed thousands of men and women with PFD by lengthening  restrictions, mobilizing the skin, muscle and nerves, teaching a tailored stretching and strengthening and postural home program.

The Pelvic Health PT, The Hecht Program  has over 50 exercises and awareness techniques to regain a healthy pelvis and pelvic function. Improved sexual function, decreased pain, improved bowel and bladder habits, and a stronger core are the results.

The  app has 4 parts: 1) Symptom Tracker 2)  Set Reminder, 3) Pelvic Relaxation & Stretching, 4) Pelvic Floor and Core Strengthening.

1) Symptom Tracker: Before starting some of my exercises and awareness techniques, go to the “My Symptoms” page and input each one of your symptoms /dysfunction. Be as detailed and descriptive as you want. Then for each symptom/dysfunction, rate the level of pain or discomfort on scale of 0 to 10, 0 = no pain or no trouble and 10 = worst pain or the most difficult.  After you input this detailed information, start to incorporate some of the awareness techniques and exercises that your pelvic floor physical therapist recommends.  If you do not have a pelvic floor physical therapist and working independently under the care of your physician, start slowly with the gentle tips/exercises incorporating one or two new things at a time. No exercise should increase your pain or symptom for more than 3 days following the exercise.  If this happens, stop the exercise and consult with a pelvic floor physical therapist.  If all is progressing well, at the 2 week or 1 month from starting Pelvic Health  PT, The Hecht Program, go to “My Symptoms” page and rate your symptoms at that point.  After 2 months, you should see some functional progress.   The symptom tracking helps you see that your body CAN change and motivates you to continue doing what you have started.

2) Set Reminder: You can program a reminder in your I-phone for an exercise or awareness technique that needs to be done many times a day. For example, a quick way to lower stress is to perform the Diaphragmatic Meditative Breath.  Program your reminder in the app for this exercise every 2 hours. You can become more calm during the day and prevent the build up of muscle tension, shallow breath and decreased oxygenation.

3) Pelvic Floor Relaxation and Stretching: Most people with PFD need to do the awareness techniques and pelvic floor relaxation BEFORE they start to do the strengthening, or, “Lengthen before Strengthen”  Anyone with pain should also do the relaxation exercises, assess their postures during the day (via photograph), adjust poor postures and do not start any strengthening exercises when first starting my program. Contracting or shortening an already tight muscle/fascial group will  cause further tension and result in increased pain.  Your pelvic floor physical therapist will guide you to become aware of your pelvic muscles, teach you how to relax and  lengthen all the muscles that attach onto the pelvis (hamstrings, inner thighs, hip flexors, plus more) before doing any strengthening.

4) Pelvic Floor and Core Strengthening: Once the muscles are stretched, the trigger points released and you are doing regular daily stretches, a gentle core strengthening program can begin. The app gives a progression from basic pelvic floor and abdominal recruitment, to full planks for maximum core stabilization training.  To insure long lasting results of pelvic floor rehabilitation, the core must be strengthened.

The app is best used while under the care of a licensed physical therapist who specializes in pelvic floor rehabilitation.   Your  physical therapist can direct you on which specific exercise to perform, teach you how to do the movements, perform manual therapies to reduce tension and trigger points and guide you on when to start a strengthening program.

Painfree sexual intercourse during Menopause: Helpful tips by a Pelvic Floor PT

Physical therapists have helped women in menopause return to painfree, satisfying sexual intercourse. These women could experience pain with intercourse, even after rehydrating their vaginal tissues under the guidance of their GYN, due to pelvic floor muscle tension.   The pelvic floor is a group of muscles located at the bottom of the pelvis  surrounding the vaginal canal.  Intercourse requires that the muscles be flexible to be able to receive the penis and strong enough to contract to provide more intense orgasms.    All healthy muscles have a normal length during rest.  Unhealthy muscles have knots/fascial restrictions so they are stuck in tight position during rest.  So with a tight pelvic floor, the penis cannot enter and women can experience pain.

How to gain a healthy pelvic floor?  Treatment by a physical therapist trained in pelvic floor dysfunctions is optimum as we provide you with tailored manual expertise and guidance to heal.  Here are some helpful tips:

1)      STRETCH HIP/GLUTEAL MUSCLES Stretch the large muscles of your hip, and buttock region as they can actively refer pain into the pelvis and cause the pelvic floor muscles to overwork or be strained.  By actively stretching the hip flexors, hip external rotators, inner thigh (adductors), groin and hamstrings,  the pelvic floor is released and can function optimally.  Hold each static stretch for 30 seconds, done twice,  2x’s times a day.

2)      VISUALIZE A RELAXED PELVIC FLOOR   Chronically tight pelvic floor muscles need many reminders to relax throughout the day.   Every time you look at the watch or your mobile phone, ask yourself, “Where is my pelvic floor?”   Think about the area softening, melting, widening. Use any visualization that is calming to you, send a healing color to your pelvis to bring awareness and “let go”.

3)      BREATHE  Diaphagramatic breathing helps to relax the abdominal and pelvic regions.   Lie on your back, pillow under your knees. Place your hands on your stomach, bent elbows resting by your sides.  Inhale slowly through your nose for a count of 5 seconds.  During your inhalation, allow your stomach expand into your hands. Visualize your pelvic floor muscles widening as well.   With each inhalation,  imagine or visualize the pelvic floor muscles expanding in all directions, front, back , left , right.  Slowly exhale for 5 seconds. Repeat 5 times. Do once in morning and at night.

4)      NEUTRAL PELVIS Set up your computer/reading/art work space to fit your body versus your body having to adjust to the environment.  The chair should be at a comfortable height so your feet are supported either on the floor or a raised footrest.  “Good posture” is when a neutral spine in maintained.  When sitting, your weight should be on center of your pelvic bowl, your lower back resting against a lumbar cushion. The lumbar cushion gently pushes your lower back forward to maintain it’s natural curve.  You should not slump back to sit on your coccyx bone, nor too far forward on your pubic bone and no sitting on one side/hip for hours at a time.      Here is where a PT can really help you gain knowledge and best position of your body.

5)      SELF STRETCHING INTRAVAGINALLY  This is a technique where you can stretch the intravaginal tissues by inserting a clean left thumb intravaginally up to the level of the first thumb joint. Gently press or sweep your thumb along the right vaginal walls providing a deep stretch.  Do a few sweeps from the midline towards bottom of the right vaginal wall.  You can hold a few areas that feel tight or uncomfortable.   Then insert the right thumb intravaginally and sweep or apply pressure points along the left side of the vaginal wall.  Repeat a few times each side. Do once a day.

6)      DILATORS Dilators are also used to help women prepare for intercourse and to apply pressure to tight spots within the vaginal walls to stretch. Your PT can guide you on how to use them.

7)      PELVIC FLOOR STRENGTH   Once your pelvic floor muscles are lengthened, a basic pelvic floor strengthening program can begin. Your physical therapist can teach you how to best recruit these muscles without co contraction of the hip adductors, hip extensors, and breath holding.  A basic pelvic floor strength exercise can be done by holding a contraction for 10 full seconds, resting/relaxing for 20 seconds. Repeat this 10x’s.   Then do 10 quick contractions and quick relaxations, repeated 10x’s to stimulate the fast twitch fibers of the pelvic floor which are innervated during orgasm

8)      SQUAT Squatting exercise helps to lengthen the pelvic floor and increases the strength of your hip and buttocks muscles.  When performing either a quarter, half or full squat in good alignment, this provides great balance of the pelvis and pelvic floor muscle function.

9)      AN ORGASM A DAY… Yes, an orgasm a day keeps all the pelvic muscles happy and healthy