Yesterday my Facebook feed was inundated with multiple shares of this NPR article titled, “Flattening The ‘Mummy Tummy’ With 1 Exercise, 10 Minutes A Day.” After all, with a title like that who wouldn’t want to click on the article and and learn what seems to be such a simple fix for diastasis recti. The trouble is that the “Fix” is never this simple.
While I appreciate the awareness this article is bringing to the topic of diastasis recti and recovery of the partpartum core, Diastasis recti is far more complex than any one single exercise for one single muscle. Diastasis recti is not just about the abs, but moreover is about full body alignment and optimal intra-abdominal pressure regulation. One of the things that I talk to my patients about all the time is that I can give them the world’s best abdominal exercise program to perform 10-20 minutes a day, but what they are doing the other 23 hours and 40-50 minutes makes a bigger difference to their diastasis recti.
Core muscle function is so much more than static recruitment of a single abdominal muscle. Your transverse abdominal muscles, pelvic floor muscles, diaphragm, and deep back muscles form your deep core canister. They all work together to provide anticipatory stability. So few women realize that their breathing pattern is connected to their abdominal wall performance and their pelvic floor muscle function. My colleague, Julie Wiebe PT has a wonderful video about how all these muscles coordinate together on her webpage. Check it out. If we do not consider breathing pattern when rehabbing a diastasis recti, we are missing a big part of the picture. Chronic drawing in of the abdominal wall is not the answer! If we squeeze in the middle all the time, what are we doing to our pelvic floor down below… setting it up for issues down the road.
The research on diastasis recti is emerging and evolving. There is no way to prevent it during pregnancy by doing an exercise. It is a normal part of many women’s pregnancies. Don’t get me wrong, there are definitely things that you can do before and during your pregnancy to reduce your risk of a large diastasis recti and improve overall core function and support. However there other factors such as one’s genetics, overall tissue laxity, number and proximity in time of pregnancies, and singleton versus multiple pregnancy to name a few.
What’s a Woman to Do?
While this article is good to raise awareness, it barely scratches the surface of what is really needed to address the postpartum core rehabilitation. My best advice is to seek the care of a women’s health physical therapist to do a full assessment of core support system. At Legacy Physical Therapy, we see women all the time who think they are doing the right thing to rehab their core, but find that despite performing the exercises their symptoms are getting worse. If you cannot get to see a women’s health physical therapist, then please do your research when searching for solutions online. Below is a list of some of my favorite go to sites.
- Julie Wiebe PT
- Mutu System
- Brianna Battles – Everyday Battles
- Jessie Mundell
- Healthy Habits Happy Moms
If you think that you are dealing with a diastasis recti or postpartum core weakness, we can help. Give us a call at 636-225-3649 to chat with one of our women’s health physical therapist to see how we can help. If you are not sure if you have a diastasis recti and want to be checked by a professional, call us to set up a free screening appointment. We are happy to help.
In our last blog post we discussed the 10 sign that you may have pelvic floor dysfunction.
If you missed that post, CLICK HERE to read it.
Did you answer YES to any of the 10 signs in our last post? Are you wondering what you can do about it? Read on…
5 things you can do today to help pelvic floor dysfunction
- Learn to kegel. A “kegel” is a contraction or squeezing of the pelvic floor muscles. Try to contract your pelvic floor muscles as if you are trying to stop the flow of urine or hold back gas. If you can feel a squeezing sensation or successfully stop a flow of urine, then you are likely able to kegel. If you cannot kegel or aren’t sure if you are doing a kegel correctly, a pelvic physical therapist can help assess your kegel and then teach you how to properly contract your pelvic floor muscles. It is worth saying that it’s not all about squeezing your pelvic floor muscles or kegeling! The pelvic floor muscles need to be able to relax too.
- Avoid bladder irritants such as caffeine, alcohol, fried foods, citrus fruits and fruit juices, spicy foods, tomatoes and tomato based products, and/or artificial sweeteners. Once you have eliminated the potential irritants for a couple weeks, you can try to add them back in one by one to tease out which substance seems to have the most effect on your symptoms.
- Avoid constipation and straining. Keeping your stools soft through a diet rich in fiber and plenty of fluids (ideally water) will reduce the strain and stress placed on the pelvic floor. Tools such as the “squatty potty” can position you properly to further reduce the strain on the pelvic floor making bowel movements easier. Pelvic physical therapy can also be helpful in teaching you how to properly relax your pelvic floor muscles to reduce constipation or straining with bowel movement.
- Breathe! A few repetitions of deep belly or diaphragmatic breathing throughout the day can help pelvic floor dysfunction. When you breathe diaphragmatically, as you inhale your diaphragm moves down and your belly expands, and as you exhale your belly retracts and your diaphragm goes back up. Deep breathing helps calm the nervous system and reduce urgency and pain symptoms. Not sure how to belly breathe? Pelvic physical therapists can teach you the proper technique.
- If you think you have a pelvic floor dysfunction, the best thing you can do is to have an evaluation done by a trained pelvic floor physical therapist. In your evaluation, you and the pelvic physical therapist will discuss what your symptoms and goals are; the therapist will perform an evaluation to determine the source of your problem; and you will decide together what the best treatment plan for you will be.
It is our mission at Legacy Physical Therapy to help people overcome pelvic floor dysfunction. We would be honored to partner with you in your care. If you are wondering if you are dealing with pelvic floor dysfunction and you would like to talk with one of our talented pelvic physical therapists, you can email or call us at 636-225-3649 to set up a free discovery session.
“Pelvic floor dysfunction, what’s that? I have never heard of pelvic floor dysfunction. Sure I have had a few kids, but I doubt that I have any pelvic issues. Pelvic issues only happen to little old ladies, not me”
Does this sound like what is running through your head right now? You are not alone. Many women suffer from pelvic floor dysfunction, but are unaware that the symptoms they are experiencing are related to their pelvic floor.
Have you ever experienced any of the follow?
- Bladder Leakage– Whether it be a small drop with a sneeze or a complete loss of urine while on the way to the restroom, bladder leakage is NOT NORMAL. However it is common. One in three women will experience bladder leakage in their lifetime.
- Urgency and Frequency– Do you know where all the bathrooms are in town? Do you urinate more than 7 times a day? Do you constantly feel like you need to pee? Are you getting up at night to pee? If you answered YES to any of these then you are probably dealing with urgency, frequency, and pelvic floor dysfunction.
- Fecal Incontinence– This can come in many forms: inability to control gas, staining or smearing on the underwear, fecal urgency, or complete loss of stool.
- Bladder pain or Burning with Urination– Many women think that they are dealing with frequent recurrent UTIs and subject themselves to countless rounds of anti-biotics only to have the symptoms not go away. The missing factor may be pelvic floor dysfunction.
- Constipation and/or Straining to Have Bowel Movement– We are designed to push to have a bowel movement, but not to strain. Our pelvic floor needs to relax appropriately to let the bowel movement pass We should be having regular bowel movements that are the consistency of soft log.
- Pain with Sex, Tampon Use, or Gynecological Examination– These things are not supposed to be painful. Too many women, “grin and bear it” thinking that pain with sex is just part of it. I am here to tell you that it is NOT!
- Vaginal Heaviness, Bulging, or Feeling of Falling Out– These symptoms are common signs of a pelvic organ prolapse, where one or more of the pelvic organs starts to push into the vaginal canal and cause these symptoms. TOO MANY WOMEN are told that these symptoms are normal after having children and they just need to live with it until the symptoms are bothersome enough that surgery is needed. This is NOT THE CASE for many women. By identifying and working to rehabilitate their pelvic floor dysfunction, many women can alleviate these symptoms.
- Low Back Pain, Abdominal Pain, or Pelvic Pain– Many women are surprised to learn that their low back pain may be caused by pelvic floor dysfunction. The pelvic floor is part of our core support system, so if it is not working appropriately then we can get extra stress and strain on our low back, abdominals, or hips.
- Difficulty Starting Urine Stream or a Hesitant Urine Stream– We were not designed to push to pee, but many women feel like they need to push to get the urine to come out.
- Inability to ‘Kegel’– A kegel exercise is the generic name for a pelvic floor muscle contraction. Contracting the pelvic floor prevents urine or feces from escaping. Research has shown that over 40% of women think they are doing a Kegel exercise correctly, but they are not.
If you answered YES to any of the above then you may have pelvic floor dysfunction. The National Institutes of Health found that pelvic floor disorders affect 10% of women ages 20-39; 27% of women ages 40-59, 37% of women ages 60-79 and nearly 50% of women over 80.
If you have experienced any of the 10 signs listed above you are a perfect candidate to explore the possibility of your pelvic floor being the cause or a contributing factor.
Remember there are treatment options for you! Don’t suffer and compromise your quality of life when the treatment is so easy! If you believe you or someone you know may be dealing with
pelvic floor dysfunction, call our office at 636-225-3649 and
we will help you determine your best treatment options.
If you are like us here at Legacy Physical Therapy, this warmer weather is inspiring you to get outside and get more active! We thought what better way to get active than to do it together!! Starting MONDAY MAY 5th join us for MONDAY WORKOUTS in MAY!! That’s right, instead of picking up the margarita for Cinco de Mayo come break a sweat at Legacy Physical Therapy instead. Every Monday in May (except Monday May 26th for Memorial Day) you can come train with the physical therapists at Legacy from 6:15-7:15pm.
WHAT: Workouts will vary but will involve a mix of cardiovascular and strength training. Workouts will happen rain or shine, but weather permitting we will go outside. Feel free to bring a yoga mat and your own set of small hand weights if you have them, but not necessary. All fitness levels are welcome as workouts can be tailored to the individual.
WHEN: Monday May 5th, May 12, May 19th & Tuesday May 27 (Because of Memorial Day) from 6:15-7:15pm
WHERE: Legacy Physical Therapy 2961 Dougherty Ferry Road Suite 105 63122
COST: Space is limited to 10 participants each class. To reserve a space, call us at 636-225-3649 and ask to sign up for any of the dates above. Classes are $8/person/class if you call ahead to reserve a spot. Classes are $10/person/class if you walk in without reserving a spot ahead of time (We cannot guarantee a spot). Whether you reserve a spot ahead of time or not payment is due at the time of class, CASH or CHECK only.
If this is well received we may continue the workouts throughout the summer! Please call 636-225-3649 with questions or to reserve your spot!
February was National Heart Awareness Month, so we wanted to take a moment and discuss the difference in heart attack symptoms between men and women.
MEN AND WOMEN ARE DIFFERENT!
Shocking…. I know. Heart attacks and heart disease are just another way that men and women differ. Although, both genders are susceptible to heart disease and heart attacks, a woman presents differently during a heart attack than a man does. Unfortunately, for us women, it is less clear that what is actually a serious concern is not “just nothing” like heartburn, the flu, or anxiety.
In fact, HEART DISEASE is the number ONE killer of women in America. So how do we know if we are having a heart attack?
- Uncomfortable pressure, squeezing, fullness or pain in the center of your chest
- Pain in one or both arms, back, neck, jaw, or stomach (MORE DIFFUSE THAN THE CLASSIC SIGNS OF LEFT ARM PAIN IN MEN)
- Shortness of breath (aka dyspnea)
- Cold sweats, nausea, lightheadedness, dizziness
- Extreme fatigue
ANY of these signs may indicate heart attack, therefore, if present, call 911 immediately.
Women are MORE LIKELY to present with atypical symptoms of heart attacks than men, however, chest pain is still a pretty good indicator to go to the nearest ER.
HOW can we prevent heart disease and heart attacks?
- Get Active! If you already have cardiac disease, or any other co-morbidity, your physical therapist is the best person to determine an exercise program for you!
- Eat Better! Diets lower in fat and bad cholesterol are proven to lower the risk of heart disease.
- Lose weight
- Stop smoking: this is the number one risk factor for heart disease and can cut your risk of coronary heart disease in half if you QUIT!
- Manage your blood pressure: High Blood pressures may be a sign of a more serious problem, and if managed effectively, can prevent your risk of more serious issues
So, to recap, as women we have a lot of heart! We consistently put our families and loved ones first in our lives, often brushing our own needs off. It’s especially important for us to take care of health, however, so that we can live long enough and well enough to continue to make the most of time with our families!
Karla Wente, PT, DPT, CLT
Legacy Physical Therapy
Women’s Health Clinical Resident
BONE HEALTH FOR ALL AGES:
Why does bone health matter?
Healthy bones can help you stay strong and active throughout your life. If good bone health is achieved during childhood and maintained, it can help to avoid bone loss and fracture later in life. For bones to be healthy, it is important to maintain physical activity with a healthy, balanced diet full of calcium, vitamin D, and other supplements as needed.
So what is a physical therapist’s role in bone health?
Physical Therapists are experts in the movement system. They can help patients achieve peak mobility and strength, all while keeping your individualized care in mind. The advanced knowledge of PTs is especially important for patients who already have compromised bone health or risk for fracture like: osteoporosis, female athlete triad, fad dieters, obesity, post-menopause age, long-term steroid therapy, cigarette smoking, high alcohol intake. This is not a complete list! Based on information HERE: Fracture Risk Factors!
What is osteoporosis and what does it have to do with physical therapy?
Osteoporosis is a common bone disease that affects both men and women (mostly women), usually as they age. It is associated with low bone mass and increased fragility of bones, making them more susceptible to breakage. This is typically diagnosed by a physician with a bone mineral density scan, taking into account blood levels of vitamin D, calcium, and history of prior fracture. For more information about osteoporosis in general look at: National Osteoporosis Foundation!
Physical therapists are the ideal providers to create an exercise program for those individuals who have osteoporosis, osteopenia (low bone density, but not quite osteoporosis), or those who have risk factors for fracture or falling. PTs are trained, as part of their 3 year doctoral program, to understand postural alignment, movement, gait analysis, balance, and the importance of weight bearing exercise to increase bone density and prevent injury.
So what are weight-bearing exercises and how can I do them?
First off, noone who is at risk for falls, fracture, or who has a known medical condition should start an exercise program without the consultation of a physical therapist or physician first!
Second, weight-bearing exercise includes anything the stresses the bones through their long axis. This includes:
- Walking (best results for strengthening the femoral neck, thereby decreasing risk for hip fracture)
- Yoga (Controversial: may provide whole body weight-bearing, however, can increase risk of lumbar bending which can increase compression fractures; Additionally, fall risk should be assessed before performing higher level balance exercises.) Read more here: Yoga, vertebral fractures, etc.
- Dancing (Those dancing with the stars celebrities are protecting their bone density!)
- Tai Chi (TONS of benefits, see effects on bone density HERE)
So, isn’t this just for “older” people?
NO! Starting healthy habits sooner ensures more compliance later. It is much more difficult to start an exercise program after diseases or injuries have already occurred, so better sooner than later! Additionally, your peak bone mass is about 18 in women and 20 in men…. so START NOW!
For fun activities for your loved ones who are younger check out: Best Bones FOREVER!
What does posture have to do with it?
Obviously, as a physical therapist, I am biased about good posture. However, I know how hard it is to make this a habit. The reason it is so important is that proper posture can prevent injury, pain, falls, and FRACTURE. This is critical for those high risk people! Here are some tips:
- Remember the plumb line: Keep ears in line with shoulders in line with hips in line with ankles. See PLUMB LINE!
- Use pillows when sitting or lying to support yourself in a good position.
- Bend your knees and keep your back relatively straight while you lift things. Always keep loads close to your body.
- Maintain regular fitness as staying active can prevent injuries.
Remember: By 2020, over 50% of Americans are expected to have osteoporosis. Let’s try to keep that number lower and reduce fracture risk in the future!
If you feel you are at risk or you already have osteoporosis, call us today at Legacy Physical Therapy to set up an appointment to see how physical therapy can help. 636-225-3649
Karla Wente, PT, DPT, CLT
Legacy Physical Therapy
Clinical Resident in Women’s Health Physical Therapy at Washington University in St. Louis
Did you know that there are physical therapists who focus especially on female issues? In fact, there are physical therapists here in St. Louis who are Board Certified in Women’s Health Physical Therapy (WCS).
There are multiple times in a woman’s life in which physical therapy may be appropriate. We will talk about 2 important time periods in this article: 1) during pregnancy, and 2) postpartum
Physical therapy can be a wonderful adjunct care provider during pregnancy to help with common pain complaints such as:
- Low back pain
- Sacroiliac joint dysfunction
- Carpal tunnel syndrome
- Pelvic and pubic pain
- Foot pain
- Incontinence (bladder leakage)
- Round ligament pain
Physical therapy treatment during pregnancy may include:
- Posture education to avoid injury and decrease pain
- Manual therapy to restore alignment and improve soft tissue guarding
- Therapeutic exercises for improving muscle performance and posture
- Abdominal and pelvic floor training
- Fitting for various support belts to help with stability and pain
If you are like many pregnant women, you may have concern about what exercises are appropriate during pregnancy. A physical therapist is a great resource for instruction on the do’s and don’ts of exercise during pregnancy.
The stresses of pregnancy, vaginal deliveries, and C-sections may lead to myofascial complications following the birth of the baby. Many women suffer in silence because they feel their symptoms are “Normal” after they have a baby. Fortunately, many of these symptoms can be easily treated by a physical therapist specializing in postpartum care.
Common Postpartum Complaints include:
- Low back and lower extremity pain
- Upper back and neck pain associated with breastfeeding
- Upper extremity pain or numbness associated with child care
- Diastasis recti: Separation of the abdominal muscles which commonly occurs during healthy pregnancies.
- Pain with intercourse or orgasm
- Clitoral, vaginal, rectal, pubic, or tailbone pain
- Pain and decreased mobility at scar of C-Section, episiotomy, or perineal tear
- Pelvic floor weakness
- Urinary or fecal incontinence
- Urgency and frequency
- Pelvic pain
How Physical Therapy Can Help:
- Soft tissue mobilization, myofascial release, deep tissue massage
- Therapeutic exercise for improving abdominal and pelvic floor muscle performance
- Posture, lifting techniques and biomechanics
- Home exercise program
- Abdominal binder/brace fitting
- Scar massage
- Therapeutic ultrasound to breakup clogged milk ducts
- Modalities for pain control
- Instruction in return to exercise safely
- Instruction in proper lifting/carrying of baby, stroller walking, and other activities of daily living to avoid injury
Pregnancy, childbirth and childcare are all events that result in significant physical changes and new stresses on a woman’s body. Women’s Health Physical Therapists are specifically trained to meet the special needs of women during this time of their lives and beyond.
Call us today at 636-225-3649 to set up your FREE SCREENING to see if physical therapy is right for you.
The American Physical Therapy Association (APTA) and fellow members of the Therapy Cap Coalition, a group of almost 50 associations, organizations, patient and consumer groups, are working together to make sure Congress addresses the Medicare therapy cap before December 31, 2013.
APTA representatives have been a constant presence on Capitol Hill all year long, advocating for a permanent repeal of the Medicare therapy cap, but it’s crucial that legislators hear from their constituents. Thus, the Therapy Cap Coalition has created several coordinated grassroots opportunities to maximize impact.
Already, the coalition raised awareness with a 24-hour social media and e-mail effort on November 3, 60 days ahead of the expiration of the therapy cap exceptions process. But your help is still needed!
Take Action TODAY!!!
Use e-mail and social media to flood Congress with messages on December 2, 30 days ahead of the expiration of the therapy cap exceptions process.
Ask your legislators to permanently fix the therapy cap or at the very least extend the exceptions process by December 31, 2013.
Download the APTA Action app (members and nonmembers). Search “APTA Action” in the Apple or Google Play app stores to download the app, then select the “Action Center” button to e-mail your legislators.
Urge at least one friend or family member to use the Patient Action Center to send a prewritten e-mail to their legislators.
We at Legacy Physical Therapy know how beneficial physical therapy can be for our patients. We do not want the therapy cap to limit patient’s ability to receive quality care here. Please take a minute to contact your legislator today!!
Legacy Physical Therapy is excited to announce that we are now offering health coaching services. Legacy’s owner, Brooke Kalisiak has had personal success with the Take Shape for Life program. Read her personal story below:
“When I had my son 7 years ago I put on 70 pounds and never really lost the baby weight. With the long hours of work involved in the opening and running Legacy Physical Therapy, my health got put on a back burner. Finding out that my best friend was getting married in Clearwater Beach, Florida in February 2014 was the motivation I needed to get healthy. On July 1, 2013 I started the Take Shape for Life program. I am still a work in progress, but as of October 1, 2013 I have lost 34 pounds. See my Before/During photos below. I have more energy, am sleeping better, and generally just feel better. I am passionate about the success I have had with the program and have therefore decided to pay it forward and assist other people in achieving optimal health.”
Result may vary. Typical weight loss is 2-5#/week in the 1st 2 weeks and 1-2#/week thereafter.
Legacy Physical Therapy’s Health Coaches help you understand your unique health risks and create a unique and individualized plan to optimize your health. The health revolution at Legacy Physical Therapy uses proven strategies and simple lifestyle changes that make your health and wellness wishes a reality. With the help of your FREE health coach you can:
- Lose 2-5 pounds per week for the first 2 weeks and 1 to 2 pounds per week thereafter.
- Learn how to keep it off with this physician recommended plan.
Contact one of our health coaches today at 636-225-3649 to develop a health improvement plan that works!
Vaginal pain is a condition that millions of women will deal with at some point in their lives. Unfortunately many women will never seek treatment or if they do they will be told that there is nothing wrong or nothing can be done. An article in The New York Times urges women to be persistent in seeking treatment, because there are things that can be done.
One of the treatment options recommended is pelvic physical therapy. Check out our website for more information on how physical therapy can help.