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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“Rewire Me” The Source for Your Healing Journey

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I am fascinated by how the body and mind work together to heal from pain and injury.  To learn more about healing and how physical therapists can help patients be committed to their healing process, I interviewed my good friend Rose Caiola, founder of Rewire Me, a company with a wealth of resources, writings and teachers in fields of physical, spiritual and emotional health, all thoroughly researched and curated by Rose and her team at Rewire Me.

Here are some of the gems I gleaned from our interview:

Evelyn: Why did you start Rewire Me?

Rose: Rewire Me evolved from life lessons I’ve learned from age 13 onward, meeting various teachers and mentors who helped me on my life’s healing journey. Connecting with these teachers proved more beneficial than trying to “fix things on my own.”

Many people feel alone when dealing with life’s challenges and don’t know how to ask for help or even where to look for guidance. One method or teacher may not resonate for every person, so I thought “Wouldn’t it be wonderful to have a site with a range of authentic experts, teachers, and healers?” People can seek and access these teachers’ wisdom through writings, books and classes to help them on their healing journey”.

Rewire Me’s website includes a range of experts on topics such as relationships, parenting, physical health, spiritual growth,  dealing with illness and loss –  incorporating all aspects of life.

E: How can people with physical pain start their healing process?

R: The first step is to acknowledge that there is something wrong. Many people don’t want to acknowledge that they are feeling pain, so they bury it or pretend it is not there. Once you acknowledge there is a problem, then you can reach out to a friend, call a medical professional, research on professional medical websites like WebMD and go on to Rewire Me to find teachers who may inspire them.
People may reject acknowledging pain or injury due to fear of the unknown.  Others may feel that asking for help is a sign of weakness, especially if they are used to being in charge or control.  Pain can make a person feel out of control. In essence what this really translates into is, ‘I don’t feel worthy enough to have somebody help me. I don’t love myself enough to get the help I need.’

E: How can one rewire fear-based thinking that stumps taking positive action?

R: Set a little time in the morning before you have to start your day. Sit up, feet on the floor to ground yourself and spend 5 minutes focusing on your breath, feeling and focusing your attention to the breath moving in and out, at whatever pace. This centers you to the present.

After the 5 minutes of quiet breath, ask “What do I want to happen today so I can achieve good health, or be successful as a parent or attain a work goal”

Envision your hero, or person of history who inspires you, for example, Amelia Earhart. What would it feel to be like her? Envision and embody the emotion of Amelia‘s courage, risk taking, forward thinking. How do you think she felt when she was flying solo in the starry night sky?

E: How can we help patients stay motivated and the course of treatment; to understand that their home program as physical therapy is not a “quick fix?”

R: Well, one I think is to have faith in the healing process. So that might become their mantra. ‘Today I’m going to do what I can to heal myself.’ ‘Today I’m going to take that first step.’ ‘Today I’m going to do my physical therapy exercises.’ Not worrying about tomorrow, not thinking about anything else, but having faith that they can overcome. When and if they come up to a crossroad or a flare up, don’t give up. Tell yourself “It’s okay.” Acknowledge that it’s painful and that you’ve hit a rock or a wall. Figure out how you can go around the wall instead of letting yourself get stuck. Avoid the “Oh poor me.’ ‘This always happens to me.’ ‘This is my life.’ If you keep repeating that story, you’re never going to get anywhere. Replace them with positive statements. The brain and body are listening!

The second thing to do is Practice. Practice your home exercises, self care techniques, say your positive affirmations out loud.  With practice different parts of our brain light up and those neural networks become bonded over time, overriding faulty pain patterns. If you play a sport you have to practice to compete well.  But, if you don’t practice, you won’t play as well. My kids are on sports teams and if they don’t practice, they get benched. They’ll say: “Why did the coach do that? I’m so angry…the coach hasn’t put me in play for the last 3 games!” Well, if you don’t practice, why would that coach put you in the game? It’s the same with committing and doing your home program, practice allows your body to change for the better.

Third, Schedule the 2-3 times a day in your calendar where you know you can do your physical therapy exercises. They don’t take long, right?

E: No. People wouldn’t do them otherwise, so we keep them short and manageable.

R: That’s great, so patients start to feel better, get stronger and over time they’ll see the many benefits of committing to their treatment.

E: Yes!  You’ve used the term “healing journey.” What does that means to you?

R: A healing journey means learning to love myself. Learning to forgive myself, including what happened in my past.  Incorporating growth and love from others and building this Rewire Me community is all about healing. Healing your heart. Healing your physical, emotional and spiritual well-being

Check out Rewireme.com to be inspired and continue on your healing journey!

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A Pelvic Physical Therapist’s Approach to PGAD: Persistent Genital Arousal Disorder

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What’s your first reaction to this image? Laugh? Sigh and Roll your eyes at the tasteless joke?  Did you think: “How can anyone REALLY have this?”

What if you were experiencing sexual arousal or multiple orgasms on a daily basis, for hours at a time, day or night, with no one medication or method to relieve symptoms on a consistent basis?

What if you had the guts to talk to your doctor about the embarrassing (or what may even feel like devastating) symptoms and find out that your doctor either never heard about PGAD, or worse was a medical professional that did not believe you?

This is the suffering that people with PGAD or PSAS, Persistent Genital Arousal Disorder or Persistent Sexual Arousal Syndrome, experience and continue to endure. Sadly, the condition has even led some patients end their own lives as recently as a few months ago in 2016.

What  is PGAD?

Persistant Genital Arousal Disorder, a “monster sexual dysfunction”, as coined by Irwin Goldstein, MD (1) is a condition characterized by 6+ months symptoms of high levels of genital sexual arousal in the absence of desire (2). Genital arousal does not dissipate, with orgasm nor by medication alone.

PGAD sufferers describe their symptoms as intrusive, unwelcome, unpleasant and sometimes painful. Multiple, frequent disturbing orgasms (not pleasurable) occur spontaneously, at work, home, school and create tremendous embarrassment and anxiety, which eventually can lead to depression, frustration, and social withdrawal. It causes major stress for personal relationships. Seventy five percent (75%) of women with PGAD report moderate to high distress levels and report feelings of shame, isolation and suicidal thoughts (3).

PGAD: Subset of Chronic Pelvic/Abdominal Pain

PGAD has similar qualities, fluctuations, flares like and is starting to be viewed as a subset of chronic pelvic/abdominal pain.

Chronic pelvic/abdominal pain diagnosis is also made after 6 months of pain, burning, stabbing, cramping  + other symptoms involving 1 or more “private “areas: bladder (urinary frequency and bladder pain) bowel, (IBS) reproductive organs (endometriosis, vulvodynia), groin, buttocks and pelvic floor muscle pain.

As chronic pain takes 6 months to develop, the tissues that were involved at the initial onset of insult or trauma  may not be the main or only source currently producing chronic symptoms.  Rather, a highly sensitive brain/nervous system that is persistently on High Alert, “Danger-Danger!” mode perpetuates the symptoms.

PGAD Research

PGAD alone has not been researched extensively. We do not know the cause, the amount of women and men with symptoms, nor do we have effective, evidence based treatment – yet. With the push of some PGAD “warriors” and a relatively young organization, International Society of the Study of Women’s Sexual Health (ISSWSH), www.isswsh.org, research on PGAD is now being conducted. ISSWSH will have their annual conference in February 2017 where the PGAD Significant Interest Group will present state of the art research as well as testimonials from sufferers.

PAIN comes from the BRAIN

Chronic pain research has made amazing strides in the last 10 years due to the ability to incorporate MRI studies of the brain in all sorts of pain research. Our brain’s main job is to protect us. For example, we don’t keep our hand on the hot stove, or step down further onto the nail under our foot as the brain instantly weighs information coming from sensory nerves and makes a decision on how to react – i.e. PROTECT.  Pain is the brain’s response to incoming nerve reports.

Research shows hundreds of areas in our brain “light up,” or simultaneously become active when experiencing pain, including areas in the brain that process Sensation, Movement, Emotions and Memory. This knowledge helps us understand how a certain movement, emotion or even noise & light can lead to a pain reaction, especially if the brain is persistently on the faulty “Danger-Danger!” mode.

“Neuroplascity” is the ability for the brain to make new neural connections throughout our whole lifetime, to adjust, to change.

How can we help our brain change from being on a highly sensitive “Danger Danger!” mode to a more functional mode?

PGAD TREATMENT Step 1: EDUCATE yourself about Pain & Know your Triggers

Once medical diseases have been ruled out, the first step of effective treatment of PGAD is to change the brain from high alert to a healthy functional mode, by educating yourself on the science of pain (stay with me!)  and to write down all of your possible triggers for symptoms. Lorimer Moseley’s and David Butler’s Explain Pain (www.noigroup.com) and pain educational website www.retrainpain.org are great resources for pain/PGAD sufferers and their loved ones.

Write down all the actions (riding in a car, walking up stairs, showing affection to partner, etc.) and write down what fears/thoughts (not knowing the “cause” of pain, not being able to work, loss of partner, inability to care for children etc.) that stimulates PGAD symptoms (4).

Describe each symptom related to the trigger and rate the intensity of symptom on scale of 0-10. This will give you and your medical team a baseline to measure and monitor progress.  You have to be an active participant in your healing because each person’s cause of symptoms and how your brain reacts with pain/PGAD symptoms is unique.

PGAD TREATMENT Step 2: Find your T-E-A-M

Find your team of practitioners who understand PGAD and who will work with you. A Medical Doctor and a Pelvic Physical Therapist is a good start.

  1. MD/DO – for prescription medicine, trigger point injections, superficial nerve blocks, botox – treatments to  give the faulty nerves/brain activity a break
  2. Pelvic Physical Therapist – who is up-to-date with the recent pain research information, provides manual treatment and offers paced, gradual movement/exercise therapies to pelvic floor, abdomen, pudendal nerve and viscera – see below for more details
  3. Psychotherapist – to  address any possible childhood traumas/abuse issues that over 50% of PGAD sufferers experienced, as these experiences may be held (remembered) in their genital region  (see EMH Physical Therapy’s blog on Somatic Experiencing (http://www.emhphysicaltherapy.com/what-is-somatic-experiencing-and-how-does-it-heal-traumachronic-pain/1450/). Therapy can help manage the depression and anxiety that accompanies PGAD.
  4. Acupuncturist – to help lower the “high alert” brain/nervous system, releasing the “fight or flight” pattern or stimulating the sluggish, depressed pattern

PGAD TREATMENT Step 3:  Pelvic Physical Therapy

Physical therapy treatments are individualized as no patient is alike in their presentation – their symptoms of PGAD /pain may be similar, but the causes are different. Education about brain/nervous system and motivating patients to become active partners in their healing process has the best outcome.

There is no one “magic bullet,” no 1 medication or 1 technique for symptom relief. Receiving regular pelvic PT treatments plus doing a daily exercise/movement program (the brain loves movement!) is part of PGAD therapy. Treatments can include:

Manual Therapy – incorporating movement and awareness for both the external & internal muscles of the pelvis, abdominals, hips, fascia and skin; calming  the “fight or flight” reaction allows for improved blood flow, oxygenation and balances the nervous system.

  • strain / counterstain
  • myofascial release
  • connective tissue massage (aka skin rolling)
  • trigger point release
  • pudendal nerve glides
  • visceral mobilization

Biofeedback – to promote awareness of pelvic floor muscle tension and teach coordination training.

Breath and Meditation – deep diaphragmatic breath expands the front, sides, back of the ribs & abdominal cavity, relaxes the pelvic floor muscles, massages the internal organs and improves oxygenation to tissues. A simple 5 minute meditation where one focuses on the sensation of slow inhalation and exhalation calms the brain.

Desensitization Techniques:  Strategies to lower the high alert nervous system as used in treating Complex Regional Pain Syndrome, is applied to our PGAD patients with promising results.

Stretching and Stabilization Exercises to lengthen and strengthen, stimulate the core stabilizers, soften the pelvic floor. Cardiovascular exercises to improve general blood flow are performed daily at home. Exercises are paced and applied gradually as the patient reports responses in their symptoms.

Modalities such as TENS, Low Level Laser and use of dilators can also be used as part of our treatment.

Final Thoughts

PGAD, like chronic pelvic pain is complex and requires patience by both the patient and the practitioner. Results are best if patient and practitioner work consistently together and the patient performs daily home/self care exercises, paying attention to responses and slowly increasing the pace and challenge of the new movement. Neuroplasticity takes persistence and develops over time.

Further research in measuring the efficacy of all the treatment techniques mentioned above and the importance of a concurrent multi-specialty approach to PGAD still needs to be done. My team and I at EMH Physical Therapy will continue to help patients heal from PGAD.

References

1 Goldstein I. Persistent genital arousal disorder- update on the monster sexual dysfunction. J Sex Med 2013;10:2357-2358

2 Jackowich R, Pink L,Gordon A, Pukall  C. Persistent Genital Arousal Disorder: A Review of Its Conceptualizations, Potential Origins, Impact and Treatment. Sex Med Rev 2016;1-14

3 Leiblum SR, Brown C, Wan J, et al. Persistent sexual arousal  syndrome: a descriptive study. J Sex Med 2005; 2:331-337

4 Butler D,Moseley L, Explain Pain, Noigroup Publications Adelaide, Australia 2013

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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:

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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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“Cupping”: not just for Olympians

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Were you watching the Olympics this summer wondering about those red circles on Michael Phelps’ shoulders? Those marks, called “sha,” are from an ancient Chinese healing technique known as “cupping.

Cupping has been around for over 5,000 years. It’s practitioners stated it released toxins and helped correct imbalances in the flow of energy.

There were two cupping types: dry and wet. Dry cupping is performed when a glass bulb with a smooth rounded lip is suctioned onto the skin via heat. Either a cotton ball is lit on fire and used to generate heat inside the cup, or alcohol is rubbed around the rim and lit on fire before being placed on the skin.

The heat inside the bulb generates a vacuum like effect, producing a negative pressure on the connective tissue or fascia under the skin pulling the skin upwards (1).

The resulting  “sha” are painless broken skin blood vessels which heal in 3-7 days.

Wet cupping was administered in the same way, except the skin is slit prior to application to allow blood to escape (2).

This method is rarely used today.

Myofascial Decompression – cupping in the 21st century

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The modern application of cupping by physical therapists is known as “myofascial decompression.”

The purpose of myofascial decompression is to:
  • reduce adhesions, scar tissue of skin and connective tissues
  • restore normal mobility
  • improve efficiency of movement.

Instead of glass bulbs, hard plastic cups are used and instead of heat generating a vacuum, a hand pump suctions the skin. This allows for a more precise application of pressure.

The application of cupping is done with the “cup” device left in place for 5 – 10 minutes or slowly moved back and forth over the restricted area.

How can we – non super-human species – benefit?

While more studies are needed the literature thus far shows some positive effects from myofascial decompression (3), including decreased neck (4) and low back pain (5).

Empirically, we at EMH Physical Therapy observe that the cupping technique combined with functional movements reduces pain and releases tight tissues quicker for patients with painful cesarean scars, plantar fasciitis, scoliosis and other conditions.

Keep in mind that cupping is an adjunct treatment, used alongside other types of manual therapy, therapeutic exercise and neuromuscular re-education at the discretion of your physical therapist.

References

1. Kravetz, R.E., 2004. Cupping glass. The American Journal of Gastroenterology 99, 1418.
2. Xue, C.C., O’Brien, K.A., 2003. Modalities of Chinese medicine. In: Leung, P.-C., Xue, C.C., Cheng, Y.-C. (Eds.), A Comprehensive Guide to Chinese Medicine. World Scientific, Singapore, pp. 19–46.
3. Cao H, Han M, Li X, Dong S, Shang Y, Wang Q, et al. Clinical research evidence of cupping therapy in China: a systematic literature review. BMC Complementary & Alternative Medicine 2010;10:70.
4. R. Lauche, H. Cramer, K. -E. Choi et al., “The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain—a randomised controlled pilot study,” BMC Complementary and Alternative Medicine, vol. 11, article 63, 2011.
5. Y. D. Kwon and H. J. Cho, “Systematic review of cupping including bloodletting therapy for musculoskeletal diseases in Korea,” Korean Journal of Oriental Physiology & Pathology, vol. 21, pp. 789–793, 2007.

 

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Good News!: Sex & Tampons Should Not Cause Pain

Do you find that you have pain and difficulty inserting a tampon?

Is it a struggle to allow the Ob/GYN to use a speculum?

Have you experienced pain during intercourse?

Are you unable to have intercourse due to vaginal muscle spasms?

You may be experiencing vaginal muscle tightness, or a fairly common condition known as vaginismus.

What is Vaginismus?

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Vaginismus is involuntary vaginal muscle tightness or spasming that occurs when  attempting to insert something into the vaginal canal. It can be extremely painful with patients often describing symptoms as stabbing, burning, throbbing or “knife like” sensations.

Statistics show that 30% of women report pain with intercourse, however, it is difficult to determine the number of women suffering from vaginismus because women are reluctant to report the symptoms, or are unaware that this pain isn’t “NORMAL”. Many women experience vaginal pain beginning in adolescence and become so accustomed to living with discomfort, that it becomes their “normal”. They expect to have pain inserting a tampon, they expect pain with intercourse – so it never occurs to them that these actions should or could be pain-free.

At EMH, we want to make sure you are aware that inserting a tampon, getting a pap smear and engaging in intercourse should be absolutely pain-free! We have helped countless women of all ages tackle vaginismus. The key is to understand the muscles of the pelvic floor and to build a mind-body (neuromuscular) connection.

The muscle tightness you’ve been experiencing initially feels like it is completely out of your control, but luckily we know these vaginal muscles are voluntary just like most other muscles in the body. At EMH we will teach you how to identify, control, and relax the vaginal muscles using a combination of breathwork, meditation techniques, external stretching, internal vaginal stretching and dilators.

While the idea of using dilators (pictured below) may seem daunting at first, have no fear: an EMH Physical Therapist will slowly and gently guide you through the stretching process as well as initiating and progressing dilator use at a comfortable pace.

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Tips for beginning treatment:

Seek treatment early and often for best results

A pelvic physical therapist can evaluate and identify if the source of your vaginal pain is due to muscle restrictions. Make an appointment for a pelvic floor evaluation at your earliest convenience. Begin physical therapy treatment to start the healing process. In many ways, the vaginal muscles are like all othe

r muscles that you would exercise and strengthen at the gym. Commitment and dedication are key. Plan on a minimum of 2-3 times a week.

Take 5:

Take 5 minutes out of your day to focus on breathing. Lying down on your back with your knees bent, take a slow breath in, allowing your belly to expand gently on the inhale and allowing the breath to escape slowly on the exhale. Mentally focus on “melting” the vaginal muscles and allow them to unclench.

Stretch, stretch, stretch:

If you have a tendency to clench your vaginal muscles, chances are you are holding tension in many other muscles groups in your body, especially the hip, thigh and butt muscles that attach directly to the pelvis. Taking 10 minutes out of your day for a quick and easy stretching routine will go a long way in teaching your body how to begin relaxing your vaginal muscles. Don’t forget to breathe!

Some Favorite Stretches:

Figure 4, Child’s Pose and Modified Happy Baby (all pictured below)

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Cited source:

Herbenick, Debby, et al. “Pain Experienced During Vaginal and Anal Intercourse with Other‐Sex Partners: Findings from a Nationally Representative Probability Study in the United States.” The journal of sexual medicine 12.4 (2015): 1040-1051.

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How to Foam Roll Most Major Muscle Groups in 5-10 Minutes

Don’t you wish you could get a deep tissue massage every day? If you said “yes!” then I highly recommend you make a small investment in your own foam roller.

I foam roll every time I go to the gym because it’s the easiest way to self-release all of the major muscle groups. Foam rollers act on the fascia, or connective tissue, that lies above all muscles and organs of your body. When you use a foam roller, you’re making the fascia mobile, which ensures all structures underneath will function without restrictions.

When ordering remember: darker colors usually mean a firmer roller. If you are a beginner try white or a light color. If you want a deeper, firmer tissue massage go with dark grey or black.

Check out my quick video that hits most major muscle groups in just a few minutes. Happy rolling!

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)

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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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Onward and Upward: Pilates Guillotine Tower

As many of you know, we recently moved up to the 9th floor to offer our patients larger treatment rooms and a tranquil, glass enclosed exercise space. In this blog, we’d like to introduce you to the latest and greatest addition to our gym, the newly acquired Pilates Tower, known by Pilates gurus as “The Guillotine”.  While the name “Guillotine Tower” may send shudders down the spine, evoking images of the historic reign of terror, the Pilates version is actually an easy-to-use, patient friendly, device designed to develop mobility, stability and strength of the hips, pelvis and spine. At EMH, we have taken “The Guillotine” to the next level, adapting basic exercises and stretches to treat the pelvic floor muscles.

 

Pilates Tower

 

Guillotine Tower Benefits:

 

  • Provides incredible feedback: which makes it a great assessment tool for stability, flexibility and articulation. Patients  can easily see when they are out of alignment or overusing a dominant side because the sliding bar will move in a jerky, uneven pattern.  When the bar glides smoothly and silently,  you know you have perfected the movement.
  • Offers  accessibility: The vertical slider allows patients with limited hamstring and lower-back flexibility (you know who you are!) to experience the full benefits of stretching and strengthening exercises.
  • Supplies versatility: Spring attachments of varying tensions can be used to create assistance or increase resistance modifying exercises for all levels in both upper and lower body exercises.
  • Targets the pelvic floor: A combination of common Pilates exercises and general pelvic floor exercises have been adapted by our expert physical therapists to address overactive or weak pelvic floor muscles that may be contributing to your specific diagnosis.

 

Pilates Tower Bar Lift Pilates Tower leg and core workout

Our Therapists Working with Pilates Tower Pilates Tower Leg Lifts

Pilates Tower Bar LIft One Leg Pilates Tower Bar Lift Two Legs

Pilates Tower Flying Back Bend Pilates Tower Core Workout

 

When Kegels Do More Harm Than Good

Sit forward, slight inward curving back to prevent a short pelvic floor

Strength Training for healthy muscle is generally good – it thickens the muscle tissue (hypertrophy), increases motor neurons activity for better awareness and reaction time, and improves muscle tone.  Kegels, a specific exercise for the pelvic floor, may help in reversing incontinence, preventing prolapse, increasing sexual pleasure, and stabilizing our core, but they don’t do the full job by itself and can be harmful.   As a pelvic physical therapist treating men and women with pelvic floor dysfunction and pain for 18+ years, I’ve found that the regular performance of Kegel exercises, especially if self-taught, may aggravate or even lead to dysfunction and pain.

How can Kegels do Harm?

Most people who experience leaking, urgency, prolapse, sexual dysfunction and pain in pelvis/groin/hip have short, or “non-relaxing” pelvic floor muscles. A short pelvic floor means just that – instead of returning to a lengthened state at rest, the muscle stays chronically short. Performing repetitive Kegel exercises to these already shortened muscles can further shorten and weaken those muscles leading to pain.  At EMH Physical Therapy, we advocate learning how to relax and lengthen the pelvic floor while recruiting other external muscles to work more effectively for best outcome.

What is the function of the Pelvic Floor?

The pelvic floor muscles attach from the pubic bone in front of the pelvis to the coccyx bone in back. During pelvic floor contraction, the muscle gently pulls the coccyx slightly forward.  The pelvic floor squeezes the urethra shut when not at the bathroom (no leaking), relaxes during urination (no hesitation) and bowel movement (no constipation), and works with the deep lower abdominal and lower back muscles to stabilize our body in preparation for movement (preventing back/hip pain).

A chronically short pelvic floor keeps the coccyx tucked forward, cannot fully relax during urination and bowel movements and because it is weak, can lead to leaking.   Research shows that pregnancy is not the main cause of pelvic floor issues, as teenaged girls, women athletes who have not been pregnant and men suffer from pelvic floor issues.

How does the Pelvic Floor become Short and How to Reverse this Habit?

Think about how you position and use your body during your day.

At the office: are you placing weight backward on the single small coccyx bone (not good) or on your two larger ischial tuberosities (good)?

Is your lower back rounded or flat (not good) or have an inward curve (good)?

At home: Avoid slouching on couches – use back pillows and support your feet.

Here are some Tips to Reverse a Short Pelvic Floor

  • Sit with your spine against the back of your chair, placing a roll or pillow in the lower back.
  • Stand up regularly.
  • Keep your gluteal muscles toned with regular squats, bridging or hip extensor exercises. Gluteal activation helps to lengthen the pelvic floor to prevent chronic shortening
  • Keep your hamstrings and inner thigh muscles flexible. STRETCH or foam roll these muscles. Tight hamstrings and adductors directly refers tension into the pelvic floor.
  • Check your pelvic floor tension throughout the day- gently squeeze this muscle first and then completely release. Feel this release for a few seconds and see if you can relax a bit further.
  • Take a deep slow inhale – allow your abdomen to expand and think of the pelvic floor widening as you inhale. Exhale as you keep the pelvic floor open.
  • Yoga positions such as Childs Pose, Happy Baby and Pigeon Pose help to open the pelvic floor and hips as you slowly breathe.  Maintain each position for 30 seconds.
  • Consult with a pelvic physical therapist for tailored therapy and home exercise program