Breathing Difficulties After Baby?

August 29, 2013 in Abdominals, Post Partum

Diaphragm and Organ Restrictions after Childbirth Leads to Breathing Difficulties

Ever wonder what happens to all your abdominal organs when the baby grows so big in your belly?   Did you have problems taking a deep breath during your pregnancy?  What about afterwards?

It’s very common for woman to experience mid back pains after delivery or have difficulty taking a deep breath.   As your baby takes up space in your belly, your stomach, liver and small intestines all get jammed upwards and laterally. See photo below.  It also compresses your diaphragm upward into your chest and your ribcage widens out to the sides.  Sometimes things have a hard time getting back to their original places after birth.  This is really true if your baby found it fun to use your stomach or liver as its punching bag!pregnant belly w_ organs

Working with so many post partum woman I’ve seen time and time again where one organ, more commonly the liver, gets jammed upwards and remains this way for months to even years after birth.  I also find the thoracic spine and diaphragm to be restricted in mobility after having a baby.

If you find it difficult to take a deep breath after delivery or you have pain in the bra line area you may have some restricted organs or diaphragm in your midsection.

Jane came to see me after delivering twins two years ago.  She complained of not being able to take a deep breath since delivery.  One of the babies laid sideways across her upper belly near her ribs during her pregnancy.  I found her liver and stomach to be jammed up into her chest and her diaphragm and mid thoracic spine restricted in the middle.  With just one session her organs and her diaphragm released and were back in their normal place, and the mobility of her thoracic spine was freed.   She told me she was surprised she wasn’t hyperventilating because she had been taking so many deep breaths since our session together.

Getting your organs back in their proper place and getting the thoracic spine moving again is helpful to regain that sense of having your body back after pregnancy.  Doing some abdominal contractions, pulling your belly button back to the spine til it can’t go anymore, while also focusing on bringing your lower ribcage together in front can help with the flaring ribs and to mobilize your diaphragm.   Initially, some woman report having mid back pains when doing these contractions but over time that pain goes away as things gain more mobility and find their way back to their normal position.  If your organs are really stuck upwards you may need some help from a practitioner who does visceral manipulation and or a chiropractor to help make an adjustment in your thoracic spine.

THERE IS HELP OUT THERE FOR YOU!

Just know that whatever ailment you may be experiencing in your body after birth, there is help for you.  Keep searching til you find the right practitioner who knows how to help you.  Many healthcare professionals don’t have experience working with the post partum body.  Keep searching til you find one who does.

It saddens me how many women are left to feel crazy, “it all must be up in your head” after childbirth when their body doesn’t feel the same anymore.  There is help and it can feel the same again.  Don’t give up!

 

 

Exercise after Childbirth-Proceed with Caution! Part 3

May 31, 2013 in Abdominals, Childbirth, Diastasis Recti, Exercise, Post Partum, Pregnancy

Exercise After Childbirth-Part 3

So we’ve discussed the issues of low back pain and pelvic organ prolapse in two previous posts.  There is one other issue you need to be aware of that doing the wrong kinds of exercises can keep from healing and that is diastasis recti.

Diastasis Recti

A diastasis recti is a separation of the rectus abdominus muscle, otherwise known as the six-pack muscle. The rectus abdmonius muscle runs from the sternum down to the pubic bone and has two muscle fibers separated by a connective tissue called the linea alba. During pregnancy, as the uterus expands the two muscle bellies separate and the linea alba gets stretched thin. It is very important to allow this connective tissue to heal so the muscle bellies can come back together. Any activity that causes the abdomen to move forward forcefully causes this connective tissue to stretch out thus preventing it from healing.

Also any twisting motion causes the rectus muscle bellies to separate making the diastasis larger. You need to avoid all twisting motions and any forward forceful movements so you can let your rectus muscle to come back together and heal. Sit ups or crunches, especially with twisting are the worst thing you could be doing right after having a baby as the transverse muscle is so weak it can’t keep the lower abdomen from jutting out.  Many moms are doing sit up wondering why they aren’t getting their bellies smaller.  Sit-ups are working the wrong muscle and doing more damage than good in the post partum period.  It’s the transverse muscle that needs to be strengthened.

I’ve written a another post on how to prevent diastasis recti in pregnancy and I also teach a class and offer a video on healing Diastasis Recti you can check out here.

What is the best way to strengthen the abdominal muscles?

Pulling your belly button all the way back toward your spine and holding it there, WITHOUT HOLDING YOUR BREATH, and then trying to do little pulses to take it back even farther.   When the muscle is weak you will notice movement with your pulses at end range of your abdominal contraction.   You want to get the muscle stronger to when you go to pulse there is actually no movement that occurs.   That will help shorten your lengthened abdominal muscles.  Start off just doing 10 pulses and work you way up to doing as many as you can at one time with 100 being your goal.  Doing this several times throughout the day will help you lose the pooch that so many women have after pregnancy.

 

Exercise after Childbirth-Proceed with Caution! Part 1

May 29, 2013 in Abdominals, Childbirth, Diastasis Recti, Exercise, Post Partum, Pregnancy

Exercise After Childbirth- Part 1

Most new moms are ready to shed those extra pounds and jump right back into their pre-pregnancy workouts right after giving birth. With all the changes that have happened to your body over the last 9 months doing what you did before getting pregnant might not be the smartest and safest thing for your body. Certain exercises can cause long-term problems for your body. Knowing what exercises are safe to do and which are harmful is very important after having your baby.

3 Issues you want to Avoid when Resuming Exercise After Delivery

There are 3 major issues you might encounter if you are not careful with exercising immediately after giving birth. You are at risk for low back strain, prolapsing of your pelvic organs (falling out of your vagina) and diastasis recti- a separation of your rectus abdominus muscle, known as the six-pack muscle.

Each issue is so important that we’ll talk about them in a separate post so you have clear understanding on how to avoid developing these problems that are no fun to experience.

Low Back Strain/Pain

Our core muscles in our body are made up of 3 muscles, the transverse abdominus, the pelvic floor and the multifidus muscles in the back. Two of these muscles have been completely stretched to the max from childbirth and pregnancy and are very weak, the tranverse abdominus muscle and your pelvic floor muscles. The transverse abdominus muscle runs from your spine in the back around to the front and attaches into the rectus abdominus or the six-pack muscle. It acts like a corset supporting your spine. Remember how stretched out this muscle was with your pregnant belly? If you don’t do any strengthening of this muscle and just let it be it will shrink back but may not be as short as it was prior to pregnancy, thus giving you a little pooch in your belly.

So your pregnancy loosened the corset around your back and pelvis and you don’t have the support you had prior to pregnancy.

Jumping right back into doing the same exercises as you did before pregnancy can cause a strain on your back as your abdominal  and pelvic floor muscles don’t have the strength to stabilize the spine like it did before.

So your first order of exercise should be to re-strengthen your transverse abdominus muscle and your pelvic floor muscles.  Performing a kegel, or pelvic floor contraction is important in the post partum period.  Normal strength of the pelvic floor muscles is the ability of the muscles to maintain a good contraction for 10 seconds.  Click here to learn more about restrengthening your pelvic floor after childbirth.

While this is a great idea and may be a little easier for a mom who had a c-section than a vaginal birth, trauma to the pelvic floor tissues can prevent any strengthening from happening.  Helping to heal the vaginal tissues that got so strained during the birth process can help improve your muscles ability to contract.   Click here to read more on how to do that.

Working on restrengthening your abdominal muscles is also a must after childbirth.  The abdominal muscles act as a corset to support our spine.  Without this support our spine is at increased risk for injury.   The abdominal muscles get extremely lengthened during pregnancy and sometimes can separate creating a diastasis recti.  If you have any separation, this alone can cause low back pain as the muscles are ineffective in supporting the spine.   You need to heal this first and part of healing a diastasis is restrengthening your abdominal muscles correctly.   Doing crunches will only make things worse!

In my class and video, How to Lose the Pooch for Good, I present a 4 step healing process to bring your abdominal muscles back together and also how to restrengthen your abdominal muscles safely to get rid of your “pooch” for good!

Also your pelvis has just gone through an amazing transformation getting your baby out and may have some challenges getting back to it’s normal position.  This can create low back pain as well.  Opening up to allow your baby out creates an instability that takes time to solidify again.  This usually takes around 3-4 months.  I recommend you wait until then to resume any high impact aerobic activities.  Focus in on just doing your abdominal restrengthening and your kegels and walking for the first 3 months.  Then once your core is stronger then you can introduce more high impact type of activities.

But with everything you do, you must listen to your body.  If it doesn’t feel right, don’t do it!  You only have one body, so you need to learn to take care of it, honor it and do what feels right.

Abdominal Hernia’s-Diastasis Recti in Post Partum Women

April 22, 2013 in Abdominals, Diastasis Recti, Post Partum, Pregnancy

Diastasis Recti- Abdominal Muscle Separation

Do you know what one of the most commonly untreated issues women face after delivering a baby?  It hardly ever gets diagnosed and if it does the medical community doesn’t think there is any solution other than surgery.

Diastasis Recti

I’m talking about Diastasis Recti.  This is the separation of the rectus abdominus muscle, which is the “six-pack” muscle in our abdomen.  The rectus abdominus muscle has two sets of muscle fibers that run up and down from the sternum, or chest plate, down to the pubic bone. They are connected by a connective tissue called the linea alba. These muscle bellies can become separated and the connective tissue between them stretched thin with pregnancy.   The muscle bellies get forced out to the side to make room for the expanding uterus.  Also, activities with a forward forceful movements as in coughing, sneezing, laughing, or doing sit ups incorrectly can create a diastasis or make an already existing one worse.

Abdominal Muscles

The abdominal muscles are one of the most important muscles in our body. They are responsible for all of the support and movements in our trunk and consist of three layers. The most superficial layer, the Rectus abdominus, otherwise known as the “Six-pack” muscle, helps us to bend forward or sit up from laying down. The middle layer includes the Internal and External Obliques which helps us to twist and the deepest and most important layer, the Transverse abdominus, helps to compress the abdomen in and is part of our core muscles to stabilze the spine and pelvis.

How do you know if you have Diastasis Recti?

The separation of the Recti muscles is called a Diastasis Recti. You will know if you have one if you are laying down on your back and you place your fingers pointing down toward your spine in your belly button. When you lift your head any fingers that fill the space between the two muscle fibers of the rectus abdminus let’s you know you have a separation.  One to two fingers separation is considered normal.  However you also need to check the depth of your connective tissue.  That linea alba needs to be very superficial.  If you sink down past your fingertip the connective tissue still needs to heal.

Also another key sign you have a

Doming of linea alba in Rectus abdominus with diastasis recti

Doming of linea alba in Rectus abdominus with diastasis recti

separation is when you lift your head do you have any doming in the midline of your abdomen?

There are certain things we do like getting in and out of bed, doing abdominal crunches, and playing golf and tennis that can make this separation worse and keep it from healing.

At Intuitive Hands PT we offer training and education to teach you a 4 step program to help you heal a Diastasis Recti and also to help you lose the “pooch” from pregnancy. By learning how to use your body and strengthen your transverse abdominus muscle correctly you can loose your “pooch” and bring the rectus abdominus muscle bellies back together again.

Anyone with a diastasis can be helped no matter how long your muscles have been separated.   If you are currently pregnant, reading this previous post on how to avoid developing onein the first place can help save you ton of effort in the post partum period.

The Importance of Massaging your C-section scar

April 18, 2013 in Abdominals, Post Partum

Much of the recovery process after a c-section birth feels out of your control. Really, other than “taking it easy,” patients are given little information on how they can help avoid painful issues down the road. However, despite getting very little press from physicians or other resources, there is one simple activity that can aid in both your recovery and long term prognosis — massaging your surgical scar.

When Should You Begin Massaging Your  C-Section Scar?

Once you get the okay from your doctor that your scar is well healed, usually at your six-week check up, you will want to begin massaging your surgical scar. If you are having pain before then, you can do gentle massaging around the scar area while it is healing, but not on top of the scar tissue. Loosening up the surrounding tissues can help ease your pain.   After you have clearance, however, don’t delay working directly on the scar to garner maximum benefits! Also note, whether it has been months or even years since your c-section, it isn’t too late to achieve improvements. Trust me, this is worth your time to learn more.

Why Should You Massage Your Surgical Scar?

When scar tissue forms it lays its fibers down very haphazardly in all different directions. It also may adhere to tissues you don’t want it to, mainly the fascia and organs. The fascia is a band of connective tissues covering or binding together parts of the body, such as muscles or organs.

In the abdomen it can cause adhesions. Adhesions are bands of scar tissue that bind together body parts that are normally unconnected. Any tissue it comes into contact with may stick to it. With c-sections it’s very common to have an adhesion on your colon, ovary or between your bladder and uterus. Think of these fibers as a tangled mess of yarn that has bounced around your room, wrapped around everything but where it should be! Scar tissue needs to be shown how to lie down properly.

The “training method?” Massage your surgical scar!

What Happens If I Don’t Massage My Scar?

Many women were never told to massage their surgical incision. “Healing” instructions are often limited to the outer appearance — to avoid redness, watch for signs of infection, etc. Years down the road these same women may endure numerous medical concerns. Without having a more in-depth physical exam, they may not even associate it with their previous c-section.

The most common issue is lower back and pelvic pain. The scar tissue adheres to all the tissues directly in front of the sacrum. The sacrum is the triangular bone located at the base of your spine that joins to a hip bone on each side and forms part of the pelvis. The sacrum needs to be able to bend forward and backwards with all of our movements.

There is fascia that runs from the pubic bone around the bladder, uterus and colon and attaches back to the sacrum. There is also an uterosacral ligament, (another major ligament of the uterus), that can get tight from scar tissue that inhibits the sacrum from moving as freely as it needs to when we bend, twist and walk. This restricted tissue mobility causes limited sacral mobility and is what leads to low back pain. In layman’s terms: Ouch!

C-section scarring can cause frequency of urination. Unbelievably, this symptom can delay until 10 to 15 years after your surgery!  You will find yourself feeling like you have to pee every 15-20 minutes, even though you just urinated. Relatively young women may be horrified at this loss of bladder control and stressed by their need to either stay within a fast dash to the toilet or wear Depends™.

So what’s happening? The scar tissue from your surgical incision in the lower abdomen is inhibiting the bladder from expanding fully. Once the bladder tries to expand and it hits the scar tissue it sends a signal up to the brain telling it you need to empty your bladder. The more scar tissue you have, the less the bladder can expand, and the more you will have to go, go, go!

Don’t give up hope! This isn’t like that extensive exercise routine that you can’t seem to become motivated to do. A few minutes of effort on your part of good scar tissue release work will have you back to urinating normally, which is every two to three hours.

Two of the most painful difficulties scar tissue creates are pelvic pain and pain with intercourse. Adhesion on the organs in the pelvis generates tremendous pain. Our organs are very sensitive structures. When their mobility is limited, pain is inevitable. With intercourse the uterus needs to move superiorly out of the way. If scar tissue inhibits this motion, deep thrusting during intercourse can be downright agonizing. This often leads to almost complete avoidance which is likely to cause a strain on the best of relationships for both parties involved.

While massaging your c-section scar may not prevent all instances of these issues, it is shown to lessen the risks and/or impact of these matters for your future health in both long and short term! In other words, what are you waiting for?

What if I don’t like touching my scar?

For many women, especially if your surgery wasn’t planned, there most likely is trauma associated with your  c-section experience.  When anything occurs to us that is outside of our control and/or  too overwhelming to deal with, there is a tendency for us to disconnect from ourselves.  This disconnect is a natural part of a trauma response.  Being unable to touch or even look at your scar are indicators that you are dealing with trauma in your body.  I highly recommend seeking professional help, someone trained in trauma release work, to assist you in letting go of your trauma so you can reconnect to and take care of yourself.

How does massaging Your Scar Tissue Work?

When you massage your scar you help the scar tissues learn where to lie down and relieve it from growing in unwanted places like on the fascia and surrounding organs. Massage can facilitate increased blood flow, which is beneficial for healing the area. Massage aids in smoothing out thick scars and can help stop the scar from growing larger during the initial phase of healing.

A scar heals in two phases. The first phase, immature, the scar has just initially formed and healed together. During this phase the scar can be itchy, painful or sensitive as the nerve endings within the tissue heal. While the scar will look red initially, it eventually will fade to normal flesh color with maturation. You can get the most effect with exercise, massage and heat application during this phase.

The second phase is a mature scar. With c-sections, scar tissue can form for up to two years. When scar tissue is no longer being produced then the scar is considered mature. At this point, massaging is still beneficial but requires a more disciplined and vigorous approach. Remember, it is never too late to gain some benefit from massaging your surgical scar!

What is the Best Way to Massage Your Surgical Scar?

As soon as the scar is no longer open and considered well healed you can begin gentle massaging. While the scar is in its immature phase you will want to take a mild approach when massaging. Initially the scar may be really tender, red and painful. In this stage it may be best to work around the scar, focusing on the tissues immediately above and below it. As the scar becomes less sensitive you can follow this procedure with your fingers on top of the scar.

Place your fingertips so the pads of your fingers lay just above your scar line. You will want to think of the abdomen as having three layers, though there are many more but we are simplifying things here.

The first layer is the superficial skin. You lightly put your fingers on the skin and see how mobile the skin is in moving up and down and side to side. Think about placing your fingers on a keyboard and you’re checking to see if all the keys move equally in all directions.

Work in the direction of resistance. You may feel it moves down more than it does up so you will want to work more in the upward direction to regain movement in that area. Does it move easier to one side than the other? If so, work more in the direction of resistance, taking the skin till you feel a gentle stretching in the tissue. Hold it there until you feel a release or the tissues melting.

To recap, the movements you want to do are up, down, side to side and also little circles. Start by working the tissues around the scar and, in time, progress to doing it on top of the scar as your pain and tenderness allows. Eventually you will want to be able to roll the scar between your fingertips.

The second layer just below the skin is the muscular layer. Allow your fingers to melt deeper into your abdomen where you feel the abdominal muscles. Check to see how this layer of the tissues moves. Does one side move less than the other side?

I usually find one end of the scar is more restricted than the other side. My theory, which I haven’t proven yet, is the more restricted side is the side the surgeon stood on during the operation. Does that hold true for you?

Repeat the same movements as with the skin — up, down, side to side, and circles. Once again, you want to do it all around the scar and even on top of the scar as pain/tenderness allows.

Feel free to work the entire lower abdomen. Adhesions can form way over on the colon located near your hipbones.

Once more, if you feel an area or direction that doesn’t move very well, encourage in that direction. Gently take the tissues to where they don’t want to go and carefully hold them there. You may feel a slight burning sensation, which is normal for stretching tissues. Hold the tissue at their end range of motion until you feel a softening or melting of the tissues. That is scar tissue releasing. It feels like butter melting under your fingertips.

If you work respectfully with your tissues, not forcing but encouraging the tissue to have more freedom of movement, you can attain that release or melting feeling. Avoid forcing, as the tissue may fight back and never release.

The third layer is the deepest layer working down at the organ level.  Right below your scar line lies the small intestines where it rests on top of the uterus and bladder. The bladder sits right behind the pubic bone; the uterus behind and a little up from there.

To reach this level you need to be lying down with your knees bent up to allow the lower abdominal tissues to slacken. This lets your fingers dive deeper into the tissues and abdominal cavity. Not only do you want to do this massaging at your scar level but also lower near the pubic bone, you want to sink below the muscles and see if you can move these deeper tissues side to side and up.

This deeper level needs to be released to ensure you don’t develop low back pain or frequency of urination in years to come. Make sure one side feels as mobile as the other side. If it does not, focus your attention to increase mobility in the area of most resistance until you can’t move it any further. Gently hold this position until you feel the tissues melting and releasing under your fingers. Continue to recheck the tissues mobility and see if it matches from side to side.

I have not heard of anyone causing problems or damage by massaging their own scar tissue, as pain usually stops you from doing too much.  It’s very hard to inflict pain on yourself, unless you are sadistic!  If you are doing any “damage,” pain will be created.   Pain is a signal to stop!  When you work respectfully with the tissues they respond by relaxing and releasing.  A pulling or burning sensation may be experienced and that is ok, try to hold that feeling til it lessens or gives way.   If you are too aggressive, pain will prevent you from getting those desired results.

How Long Do I Need to Continue Scar Massaging?

Initially, massage regularly until your tissues are freely moving in all directions within all three layers. Once you’ve achieved that mobility you will want to check in with the area every so often, whether it’s every other week to once a month for the first year or two after your surgery. If you find the tissues getting tight again return to a more regular massaging routine.

Whether your c-section scar is new, several months, or years old, performing this massage can help you avoid problems down the road.  It’s never too late!  It may sound like a lot of work but spending just five minutes a day can do great things in releasing scar tissue and increasing mobility in your lower abdomen. If you have difficulties doing this or notice your tissues don’t seem to be responding to your efforts, then you should seek out a Women’s Health physical therapist for treatment.

Lynn Schulte-Leech is a physical therapist with over 20 years of experience. She specializes in Women’s Health and Visceral Manipulation.

 

 

Caring for your Belly During Pregnancy-Preventing Diastasis Recti- Part 3

March 29, 2013 in Abdominals, Childbirth, Diastasis Recti, Pregnancy

Part 3- Preventing Diastasis Recti in Pregnancy

This is the final post in a three part series on how to minimize and protect your abdominal muscles from developing diastasis recti.

In the other two posts we talked about how rib thrusting and forward, forceful movements of your belly can contribute to development of diastasis recti.  See these posts here to review, part 1 and part 2.

There is one other motion that we do at least two times a day, more if you are getting up to empty your squished bladder in the middle of the night, that causes the greatest strain on our abdominal muscles.  That is the way we get up and down from laying down.  What most of us tend to do is just lay straight back down and jack knife straight on up to sit up from laying down.  This motion puts the greatest amount of strain on your abdominal muscles.  If you continually get up and down this way, your abdominal muscles will separate.

There is a better way to lay down and get up without straining your abdominal muscles.

LAYING DOWN CORRECTLY

Let’s start with laying down.  Sitting on the side of the bed you want to pull your belly button back to your spine and then lay down on your side while your legs come up onto the bed.  Next, and the most important step, is placing your head down on the pillow while on your side.  Then contract your belly again as you roll over onto your back.

To get back up, the most important step is the keep your head down on the pillow while you roll over.  If you lift your head you are essentially doing a crunch and your belly will pooch out or dome if there is any separation.

During this entire motion it is important to contract your abdominal muscles by pulling your belly backward toward your spine.  Remember your head is the most important step and should be the last thing down in lying down and the last part up in getting up.

This takes practice to remember how to do it correctly and to make it a habit.  You will want to continue to lie down and get up in this fashion well after you baby is born.  This can help heal any separation you may have in your abdominal muscles after your baby is born.

There are other steps you need to learn to heal a diastasis recti, if you have one.  You can learn how to do so by watching my How to Lose the Pooch For Good and Heal Diastasis Recti.  Check it out!

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