There is one question that we get asked by neary EVERY postpartum mom…
Which exercises are best for me to strengthen my core and abdominal muscles after I had a baby?
The simple answer is it depends. I know that this is not the answer you want to hear, but it really does depend. There is no one size fits all exercise that is going to get your abdominals back after having a baby. It depends on many factors:
- what you were doing pre-pregnancy
- What you were doing during your pregnancy
- how your abdominal muscles are working currently
- how everything coordinates together
I’m not going be giving you specific exercises, but instead I’m want to give you some things that you should be watching out for when you are exercising to make sure that things are working correctly. I, as a physical therapist, hate hearing people say that they should never do something. Our human body is amazing and there are definitely things and ways that we can modify so that people can be doing the things that they want be doing.
Here are my tips for the things that you should be watching out for so that you know that you’re potentially protecting and properly engaging through the abdominal muscles.
- If you are trying to decide if an exercise is appropriate for strengthening your postpartum core is you want to make sure first that you can breathe while you doing it. You should not have to hold your breath to complete and exercise. There are certain exercises when we doing very high level lifting, heavy lifting when breath holding can be a good strategy that needs to happen. However, for the vast majority of us especially when we’re just getting back to exercise, if you cannot properly engage your core muscles and breathe while performing the exercise then it’s probably not appropriate. And that goes for whether the exercise is specific to strengthening your core muscles or not.
- The other thing to think about if you are trying to make sure if a core exercise is appropriate is can you maintain a deep abdominal activation. At the start of a core strengthening exercise you should be able to gently draw in your abdominal muscles on an exhale and maintain this muscle activation throughout the exercise. If during the exercise, your feel your abdominal muscles push forward/bulge out or maybe if your laying down, you feel your back arch off the ground then that’s the sign that your not using the abdominal muscles the right way anymore.
So, if you can’t keep breathing or maintain a deep abdominal muscle activation while doing the core exercise, then it’s not probably not an appropriate exercise for you yet. That doesn’t mean never, it just mean right now.
What can you do if you are in a situation where there is an exercise that you want to be doing but you’ve notice now that you’re doing it holding your breath and you’re belly pushes out every time you do it? This is the time to partner with a pelvic health physical therapist to evaluate what is going on in your abdominal wall that you may be not recruiting correctly. They can show you how to perform the activities correctly so that you can get back to doing the exercise that you want you be doing.
It’s my goal as a physical therapist to try and get you as active as you want to be, doing what you want to be doing, and working with you to achieve the goals that you want to achieve. Sometimes, we all just need a little help along the ways.
Pelvic physical therapy is something that is unfamiliar to many people. I would say for about every 10 new patients that come to see us here Legacy Physical Therapy, about 7 or 8 of them start out their evaluation by saying that they have never heard of Pelvic Physical Therapy and they are not sure how we can help them.
We are passionate about helping women & men of all ages enjoy active, healthy lifestyles, by restoring confidence and dignity in pelvic, bladder, bowel, and sexual function, without relying on medications or surgery. We provide conservative treatment options for many conditions that people may be unaware that they even can do anything about.
Conditions Pelvic Physical Therapy Can Help
- Bladder Issues:
- Leakage, Urgency, Frequency, Painful Urination, Urinary Retention
- Bowel Issues:
- Constipation, Fecal Leakage
- Pain Conditions:
- Back Pain, Pelvic Pain, Tailbone Pain, Sacroiliac Joint Pain, Vaginal Pain, Rectal Pain, Vulvar Pain, Abdominal Pain, Penile Pain, Painful Sex
- Pelvic Prolapse Issue:
- Cystocele, Rectocele, Uterine Prolapse, Vaginal Vault Prolapse
- Pregnancy/Postpartum Related Issues:
- Low Back Pain, Sciatica, Diastasis Recti, Clogged Milk Duct, Episiotomy or C-section Scar Tissue Adhesions
Many people are surprised to learn that all of the above conditions can be helped by pelvic physical therapy. One of the things that we commonly see happen is that a patient will be referred to us by their urologist for bladder issues. Then once we get talking with them, we find out that they also have some back pain or hip pain issues that despite treatment aren’t going away. We teach the patient how all everything can be related.
Aren’t You Just Going to Teach Me to Kegel?
One of the things that we get asked all the time is, “I’m already doing Kegel exercises. It doesn’t help, why would coming to pelvic physical therapy help?” For those of you who don’t know a Kegel exercise is simply a contraction of the pelvic floor muscles like you are trying to hold back gas or pee. Muscle function is not simply about contraction. We need to make sure that we have a variety of different movements with the muscles. Muscles need to be able to contract, relax, stretch, and coordinate with other muscles.
As pelvic physical therapists, our job is to figure out how your pelvic floor muscles are working and coordinating with other muscles. We really take the whole body approach to looking at how things are coordinating together. It is never simply just about Kegel exercises. Those may be a part of your treatment plan, but it may not be. For some people, the problem is that they are doing pelvic floor muscle contractions or Kegel exercises incorrectly and that is actually causing more of the problem. For other people their pelvic floor muscles may be too tense or tight and trying to squeeze them more isn’t going to improve their symptoms. Instead, we need to actually teach them to relax and let go.
Pelvic PT Can Help Before or After Surgery
Another thing we hear commonly when we talk with patients on the phone is that I’m planning them to having the surgery so why would I need to see pelvic physical therapy. Our simple answer to that is if you’re planning on having shoulder surgery, neck surgery, back surgery, or knee surgery; 9 times out of 10, you’re going see a physical therapist either before or after the surgery to help make sure that you rehabilitate the muscles and that everything is working well together. Similarly, working with the pelvic physical therapist after you’ve had surgery for a bladder sling, prolapse repair, hysterectomy, or giving birth can promote return to optimal muscle function allowing you to have better, longer lasting surgical outcomes.
Pelvic PT Helps During Pregnancy & Postpartum
Females who have given birth are at a greater risk for pelvic dysfunction. Here at Legacy Physical Therapy, we feel strongly that every women should see a pelvic physical therapist for at least for 1 visit postpartum to identify any musculoskeletal issues that may be preventing her from improving her core and pelvic function postpartum. This should happened before she starts out with any type of exercise regimen, especially a high level one, to make sure that the pelvic and abdominal muscles are functioning the way that they should be. The therapist will also review movement patterns to make so she doesn’t develop any bad habits that will potentially lead to problems down the road such as bladder leakage or pelvic prolapse.
Pelvic physical therapists also work with women during their pregnancy. We help make sure that the pregnancy progresses as comfortably as possible and that you are able to be as active as you want to be. Pregnancy is a time that can be very stressful on the abdominals and pelvic floor because of the changes in your body. Working with the pelvic physical therapist to help you maximize pelvic and abdominal support and control can really make a big difference for a comfortable pregnancy.
You May Need Need to Advocate for Yourself
So now that you have learn a little more about what pelvic physical therapy is, you may be wondering why you haven’t heard of it before or why your doctor has not told you about it despite you mentioning some of the symptoms. Unfortunately, many doctors are unaware that pelvic physical therapy is an option out there to help their patients. Even the ones who do refer to pelvic physical therapy already may not be aware of all of the different thing that we can be doing to help patients. Because of this, you may have to be an advocate for yourself if you feel like you need to see a pelvic physical therapist. Don’t be afraid to ask your doctor for a referral to pelvic physical therapy.
If you feel like you’re dealing with any of these issues that we’ve been talking about, you may have to be the one to advocate for pelvic PT. You as a consumer, have the right to go wherever you want to go for your treatment. You do not have to necessary to go only to a place that is in your doctor’s office. You can seek healthcare from a pelvic physical therapist with whom you feel comfortable.
So, that is the brief introduction to pelvic physical therapy. If anything you have read about seems like something you are dealing with, give us a call at 636-225-3649. We are happy to chat with you about what you are experiencing to see if pelvic physical therapy would be a good option for you.
This holiday season we hope that you will help us give the gift of pelvic health. All too often at Legacy Physical Therapy we hear our patients say things like…
- “I have never heard of pelvic physical therapy.”
- “How come none of my doctor’s told me this was an option?
- “Why am I just hearing about women’s health physical therapy now?”
- “Every woman who has had a baby should see a women’s health physical therapist.”
- “Why isn’t pelvic physical therapy recommended to all pregnant or postpartum women?”
Our goal is to spread the word about pelvic health. We want women and men suffering with bladder issues, bowel dysfunction, sexual problems, pelvic pain, pelvic floor dysfunction, and core weakness to know that they are not alone and there are options for treatment. We hope that we can count on you for your help.
Ways to Spread the Word about Pelvic Health and
Legacy Physical Therapy
- Provide a testimonial for our website
- In 2018, we would like to update our website with new patient stories in our testimonial section. You can greatly help us by writing, even anonymously, about your experience with our group. Email Us Here!
- If you are like me, you might need a little help to get your creative writing juices flowing. Here are a few questions to get you started:
- What kind of impact has it made on your life coming to Legacy Physical Therapy?
- What was the reason that you came to Legacy Physical Therapy?
- What goals have you accomplished at Legacy Physical Therapy?
- What would your advice be to others who are thinking about coming to Legacy Physical Therapy?
- Write a review on Google or Yelp
- Get social with us and review us on Facebook
- Legacy Physical Therapy has a Facebook page where we love to share helpful pelvic health information. ‘Like’ our page and share our pelvic health information with your social circle. While you are there, leave us a review.
- Tell your doctor about your success with physical therapy!
- Your doctor would love to know that you are feeling better and achieving your goals. Please let them know about your success at your next appointment or by sending an email.
- Give us feedback!
- All feedback helps us improve our delivery of care, so please let us know if there’s something we are doing well or if there is something we can do better.
Happy holidays and cheers to a healthy New Year!!!
From the staff at Legacy Physical Therapy
Brooke, Jamie, Rosie and Abbie
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
Awhile back we asked you to support a bill to take on the insurance company’s crazy high co-pays. SB 159 passed the Senate 34-0 and the House of Representatives 136-22, but it still needs the Governor’s signature.
That is why WE NEED YOUR HELP AGAIN!
Governor Nixon must sign or veto S.B. 159 by July 14th and your call/email could be the one that makes it happen!
Contact the Governor today! It is as simple as clicking on the link below to email the governor directly and emailing the statement below (copy and paste). It took me all of 30 seconds to do, soPLEASE take 30 seconds out of your day to email him today.
The e-mail link to contact the Governor is http://governor.mo.gov/contact/
Let Governor Nixon KNOW:
“I support the fair co-pay bill, Senate Bill 159 (S.B. 159) to ensure Physical Therapy copays are fair– the same as my doctor visit copays. Please sign this Bill.”
The address to mail a letter is:
The Honorable Jeremiah Nixon
Governor of the State of Missouri
216 Missouri State Capitol Building
Jefferson City, MO 65101
Let’s make sure Governor Nixon knows Missouri cares about being able to afford and access physical therapy care!
Call, write or email and help make this fair copay bill a reality.
Brooke Kalisiak PT, DPT, WCS
So this past Sunday, I along with 3 other teammates participated in the Go! St. Louis Marathon Relay. Each one of us runs roughly 6-7 miles of the 26.2 mile course and then passes the timing chip along to the next teammate. For those of you who know me, you know that I do not and have not ever considered myself a runner. Because of this, I found my mind wondering quite often while I was struggling through my 6 miles. I recorded these musing after the race and thought others might find them interesting. Hope you enjoy.
At 5:40 in the morning: Why did I sign up to run the first leg of this race?
At the start of the race: It’s really beautiful day for a race. Six miles won’t be too bad. Surely I can run as fast as most of these people.
First mile: This isn’t too bad. I can probably run my whole 6 miles and be okay.
Second mile: Why did I think running 6 miles today was a good idea? I have never really enjoyed running, what made me think I would start now.
If you have to stop and stretch it 2 miles it’s probably not going be a good race for you.
Just had the people who are going to win this race pass me as I’m still in my second mile.
I can’t believe the majority of these people are going to be running 13 or 26 miles today!
Look how much that lady rotates her torso. I bet her back hurts. I should give her my card.
Miles 3: Seriously I’m only halfway to my destination!
I didn’t think holy Hill was until mile six, but this sure feels like a holy hill!
I appreciate running through Anheuser-Busch but not sure I like the smell of hops to motivate me while running.
She really pronates her foot. I bet that she’s going to get plantar fasciitis.
He really wiggles his hip side to side I wonder he has IT band issues.
I walk faster than some of these people run, maybe I should just try walking this thing.
Mile 4: I get to see the person who most likely going to finish last and it reinvigorate me to keep running because I’m sure as hell going to beat him.
Really wish the first leg wasn’t so much of an out and back run. It is no fun seeing how far I have to go back.
Mile 5: Look how much that lady adducts and medially rotates her femur. I bet that her knee really hurts.
I wonder where we can go get breakfast after the race because that sounds like a really good idea right now.
Mile 6: I am very happy for the shade and the crosswind provided by the buildings in downtown St. Louis it’s going to be hot today.
I am very happy that I am just about finished running especially when I hear them start announcing to get to the left for relay station!!
Yes, I see Megan, I am almost done running!!!
Living on a Prayer makes a great motivational song when you’re almost finished running!!
So there it is. The mad ramblings of a physical therapist while running! Hope you enjoyed! By the way, big thanks to my teammates: Megan, Sara, and Angela for putting up with me!!
Dear friend and patient of Legacy Physical Therapy,
Please consider the following important issues impacting private practice physical therapy clinics such as ours. After reading this I hope that you will take action and contact your state senator and representative on our behalf so that we can continue to provide you with the top-notch care you have come to expect from Legacy Physical Therapy
Health Insurance Companies set up financial contracts with all healthcare providers in order to establish operating and reimbursement standards. These contracts are solely based on the bargaining power of the healthcare provider and the needs of the insurance company. These contracts have no relation to the quality of service provided by the hospital or clinic.
Over the last 20 years, large hospital systems have been given more favorable contracts than private practice clinics, especially in the field of physical therapy. Based purely on the size of the organization, insurance companies would be more willing to listen to the needs of the healthcare provider. More often than not, the needs of large hospital systems were taken into consideration because of the number of providers and services the system provided.
Conversely, the needs of private practice clinics and their owners are rarely taken into consideration when contracting reimbursement rates and patient co-pays. Without the benefit of having hundreds of providers and a multitude of services, private practice clinic owners are unable to negotiate for the basic needs just to maintain operations. Requests for reviews and appeals to the insurance companies routinely fall on deaf ears. Health Insurance companies are impeding Fair Trade Competition by deliberately paying large hospital systems more than private practice clinics for the same services.
Thus, we are taking our fight to the state legislature. We are fighting for fair pay and fair patient co pay amounts. The insurance industry routinely discriminates against small businesses by paying hospitals as much as 100% more than they reimburse for the same services we provide. I’m asking that you please contact your state senator and representative and respectfully request their support by co-sponsoring the bills that are at the bottom of this post. If you do not know your state representative or senator you may look them up at www.house.mo.gov and www.senate.mo.gov in the “Legislature Look-up” but a 4 digit zip code extension is needed. Your 4 digit zip code extension can be found at zip4.usps.com/zip4. For quick reference for Kirkwood patients:
Rep Dwight Scharnhorst (district 093) represents the Kirkwood area – 573-751-4392
Senator Eric Schmitt (distircit 015) represents the Kirkwood area – (573) 751-2853
Thank you for your help!
Brooke Kalisiak and the staff of Legacy Physical Therapy
After finding out your specific State Senator and Representative, please email, send a letter in the mail, or call to ask for their support on the following bills that are active in the 2012 Missouri Legislative Session (January thru Mid May):
Senate Bill 644, Sponsored by Senator Kurt Schaefer: Requires health carriers to reimburse a physical therapist in the same amounts as paid to a licensed physical therapist for rendering the same services regardless of the setting or venue. (Equal Pay for Equal Services Bill)
Senate Bill 687, Sponsored by Senator Eric Schmitt: Limits the copayment, coinsurance, or deductible imposed by a health insurer for physical therapy services by a licensed physical therapist to that for services provided by a primary care physician or osteopath. (Fair Co Pay Bill)
House Bill 1355, Sponsored by Rep. Donna Lichtenegger: Requires health carriers to reimburse a physical therapist in the same amounts as paid to a licensed physical therapist for rendering the same services regardless of the setting or venue. (Equal Pay for Equal Services Bill)
House Bill 1134, Sponsored by Rep. Dwight Scharnhorst: Limits the copayment, coinsurance, or deductible imposed by a health insurer for physical therapy services by a licensed physical therapist to that for services provided by a primary care physician or osteopath. (Fair Co Pay Bill)
So a friend of mine who knows that I am a pelvic physical therapist, sent me this picture this morning.
Although I did get a chuckle out of the quote, it is just another example of how women tend to think that it is a normal thing to leak urine when they laugh. I am here to tell you that it is NOT normal, it is NOT something you should just live with, and there are conservative treatment options out there.
Urine leakage when you laugh is a type of stress incontinence, which typically is a result of weakness of the pelvic floor muscles. An individualized program to strengthen the pelvic floor muscles may be all you need to be leakage free. Pelvic floor physical therapy is a safe and effective treatment option for stress incontinence.
If you leak when you laugh and are sick of being told “it is normal, just live with it,” then give Legacy Physical Therapy a call to set up your first appointment today. 636-225-3649.
The 12th annual National Women’s Health Week kicked off on Mother’s Day, May 8, and will be celebrated until May 14, 2011. The theme is “It’s Your Time.” This weeklong health observance empowers women across the country to make their health a top priority and take simple steps for a longer, healthier, and happier life.
National Women’s Health Week brings together communities, businesses, government, health organizations, and other groups in an effort to promote women’s health. The theme for 2011 is “It’s Your Time.” National Women’s Health Week empowers women to make their health a top priority. It also encourages them to take steps to improve their physical and mental health and lower their risks of certain diseases. Those steps include:
* Getting at least 2 hours and 30 minutes of moderate physical activity, 1 hour and 15 minutes of vigorous physical activity, or a combination of both, each week
* Eating a nutritious diet
* Visiting a health care professional to receive regular checkups and preventive screenings
* Avoiding risky behaviors, such as smoking and not wearing a seatbelt
* Paying attention to mental health, including getting enough sleep and managing stress
In celebration of Women’s Health Week, Brooke Kalisiak, owner of Legacy Physical Therapy, has just signed up to run her first Half Marathon. She will be participating in the first ever Rock ‘n’ Roll Marathon event in St. Louis on October 23rd. Those of you who know Brooke may know that she trained for the Chicago Half Marathon last year, but was unable to run it secondary to getting ill the night before. She is ready to get back to training and try again!
Running is always easier with someone else there to run with you. If you are at all interested in training for a half marathon, why not sign up for the first Rock ‘n’ Roll Half Marathon in St. Louis. Let us know if you sign up and we can try to get a running group together. Happy running all!!
I have been wanting to get classes together for my pregnant and postpartum clients for awhile now. The childbearing years bring about so many changes in women’s bodies that can set them up for problems down the road. There are so many preventative things that women can do to avoid these problems.
I am excited to say that I will teaching 2 different classes geared towards pregnant and postpartum women in the St. Louis area. On the 3rd and 4th Wednesday of the month from 6:30 to 7:30 pm I will be teaching at the Town & Country Cottonbabies.
Mommy and Me
This class is intended for moms in their last trimester or new moms. In the class you will learn how to regain muscle strength in key areas, “back, bellies, and bottoms,” how to get tone back in the abdominal muscle, and how to minimize back pain. We will teach ways to incorporate your baby into your work-out and how to protect your body from common overuse injuries that new moms encounter.
In this class participants will learn musculoskeletal changes during pregnancy, understand reasons for back pain during pregnancy, learn techniques to minimize pain, and get self help ideas for comfort. This is great class for expecting moms and their partners.
Space is limited. Please register for this class by calling the CottonBabies Store at 636-220-7720