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 2

May 30, 2013 in Childbirth, Exercise, Pelvis, Post Partum, Prolapse, Women's Health Issues

Exercise After Childbirth-Part 2

So many women are jumping right back into doing the same exact exercise program they did before getting pregnant and their body is just not ready for it.  There are 3 main issues you may experience if you aren’t careful in the post partum period.  We’ve already talked about low back pain and why you can develop this problem in a previous post.  Click here to review.

Prolapsing of Pelvic Organs

Another issue you can experience if you are not careful is prolapsing of your pelvis organs.  Prolapse is when your pelvic organs, your bladder, uterus or rectum, are falling down or out of your vagina.  It can feel like pressure in your vaginal area or like a tampon is falling half way out.

I had one client come to see me who was only 7 weeks post partum.  She had a stage 3 bladder prolapse.  That is where the bladder was sitting at the opening of the vagina.  I asked about her delivery and she said it went smoothly, she didn’t push more than an ½ hour and everything felt fine afterwards.

When I asked about what exercises she was doing she reported she was running and doing pilates 100’s.  Those are the two worse exercises you can do that early on in the post partum period.  She developed her bladder prolapse from the exercises she was doing after having her baby.

What happened to her bladder?

The pelvic floor muscles have been stretched and are weak from childbirth. They run from the pubic bone in front and attach to the tailbone in back.  One of the main roles of the pelvic floor muscles is to offer a hammock like support to our pelvic organs, which are also held in place by ligaments. So if your pelvic floor muscles aren’t strong enough to help support your organs, the ligaments have to take on extra work to keep them in place.  If excessive strain keeps getting placed on the organs the ligamentous suport can fail, causing prolapse.   Whenever we cough, sneeze, laugh or exercise and our abdomen goes forward forcefully, downward pressure gets applied to the bladder and uterus and pushes them down, thus stretching out those supportive ligaments. Any jumping, running, high impact exercises, and/or crunches or pilates 100’s, can create the same downward forces.

When we do these activities without first strengthening our pelvic floor muscles and our abdominal muscles we are at risk of prolapsing our pelvic organs.  To learn more about restrengthening your pelvic floor  and your abdominal muscles read these articles.

Once your organs fall down it takes a LOT of effort to correct the situation.  Most doctors will only recommend surgery; but there are other options.  You can work on strengthening your structural support around the organs and see if that can help with the prolapse.  This can cover another 5-6 blogposts, but I just want you to know that it is possible to manage this prolapse without surgery.

Stay tuned for the third issue you can develop if you are not careful with exercising after childbirth and then how you can strengthen your body safely!

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.

To Kegel or Not to Kegel, That is the question!

March 15, 2013 in Bladder issues, Exercise, Pelvic Floor, Post Partum, Prolapse

If you were to ask any woman what is the number one exercise to do for a healthy pelvis and the answer would be “a kegel,” or pelvic floor contraction.   Healthcare Practitioners all tell you to do a Kegel if you are peeing in your pants when you laugh, cough, jump or sneeze or if your bladder is falling out.  It’s the number one “go to” exercise that women are told to do with any problem in the pelvis.   Contrary to popular belief the Kegel may not be all that it’s cracked up to be and is not always what I recommend.

The Problem with Kegel Exercises

We are well aware of the state of the muscles we see on the outside of our body.  You can look at your biceps, your “Popeye” arm muscle that helps bend your arm, and see if it’s got good tone in it or not.  A muscle used through normal daily activity stays rather healthy and strong.  If you were to immobilize a joint the muscles influencing that joint quickly fade away to mush.

The problem with our pelvic floor muscles is we can’t see them and probably have no idea what state they are in.   Are they truly weak or do they have too much tone in them?    Just like the knots in your shoulders cause your shoulders to raise up to our ears, the pelvic floor muscles can have too much tone in them causing them to contract and not be able to relax.  So many women are walking around with TOO MUCH tone in their pelvic floor muscles and yet the number one suggestions practitioners make with any problem in the pelvic floor area is “DO KEGELS!”   If the muscles don’t know how to relax and have too much tone in them, doing Kegels is only going to make the problem worse.

Think of the pelvic floor muscles as an elevator.  Normal resting tension is at the ground floor.  A full contraction starts at ground floor and reaches 5th floor, maximum contraction ability.  If you are holding tension in your pelvic floor muscles and they hang out at 3rd or 4th floor all the time there is not much contractile ability  for the muscles to get you to 5th floor.  The contraction feels very weak and doesn’t move very far.  It’s not that the muscle is weak per se, it’s that it’s already contracted and can’t find the ground floor.    It’s really relaxation ability that is needed for these muscles.  They need to find ground floor again.  Doing more kegels is like banging your head against the wall!  You are not going to get very far.

The other problem with Kegel’s is not many women know how to do them correctly.   They just don’t know how to engage the muscles to get them to contract.   To read more about the correct way to kegel click here.  In my practice it’s very common for women to NOT be able to fully contract their pelvic floor muscles.   We carry so much tension in our pelvic floor muscles that they can’t fully relax all the way to be able to contract fully.

What about after childbirth?

The pelvic floor muscles get stretched to their max, are lengthened after having a baby and need help finding the ground floor again.   So you think that strengthening for most moms after childbirth is critical.  Well it is in most, but not all moms.

It is interesting to note that in some women, just months after having a baby when you’d expect to find lengthened weakness in their pelvic floor that they are actually hanging out at 4th floor.  This may be due to trauma in the muscles or an unconscious holding pattern.  If you tear during childbirth then scar tissue can cause increased tone in the muscles and help hold the muscles at 3rd or 4th floor.  Getting those muscles to relax is key.

So how do you know what state your pelvic floor is in?

You’ve got to check yourself!  Yes that means inserting your finger inside your vagina and feeling your muscles engage and relax.  How do you do this?

Checking for Pelvic Floor Strength:

  • Sit semi-reclined so back is nice and supported
  • Bend knees up and separated slightly
  • Insert your index finger or thumb into your vaginal opening
  • Think of the opening as a clock and check your muscle contraction ability in 4 quadrants:  at 1:00, 5:00, 7:00 and 11:00.
  • See if the left side contracts the same at the right side:  1:00 and 11:00 should be the same as is 5 and 7:00.
  • Checking out the relaxation ability of the muscles is just as important as the contraction ability.

Addressing tone in the pelvic floor muscles

  • Gentle massage of the tissues may help it respond more and be able to contract more fully.  If you are postpartum your pelvic bones may be out of place and may need some adjustments to get back to normal positioning after childbirth.
  • Also learning how to relax the pelvic floor muscles is key.  Feel the tension in your muscles when you check internally.  Both sides should be able to bounce and move up and down with pressure.  If one side moves and the other doesn’t then you need to work on the side that doesn’t move.  Adding gentle pressure and encouraging the tissues to relax is key. Focusing in on that muscle and breathing into it can help it relax.
  •  See a Women’s Health Physical Therapist if you need help in discerning what your pelvic floor muscles are doing or need help in getting them to relax.

While it is important to have good contraction ability of your pelvic floor I believe there is a much better way to keep your pelvis healthy and strong that doesn’t involve Kegelling!   Stay tuned as I’ll share with you what that is all about.  Until then check out your pelvic floor muscles and see what shape yours are in.

 

Check out other great blog posts:

Sarah Cody at birth play love gives a run down of the importance of eating organics:

http://birthplaylove.com/organic-food

Sarah Bauer at Press Pause Photography works up a list of birth and baby services in Northern Colorado:

http://wp.me/p2HgfA-9B

How to do Kegel Exercises Correctly

March 4, 2013 in Exercise, Pelvic Floor, Pelvis

Doing Kegel’s Correctly

Do you know how to do a Kegel correctly?  Most women don’t!  Yet kegel exercises are all the rage.  They are the most popular piece of advice given to women for any condition in the pelvic region.  Yet many women don’t know how to engage their pelvic floor muscles correctly.    Let me explain the correct way to contract these muscles.

pelvic floor musclesTo figure out what needs to be contracted let’s find the boney landmarks that house the pelvic floor muscles.  Sit on a hard chair and roll your pelvis forward so you become aware of your pubic bone coming into contact with the chair.  Then roll your pelvis backwards so your tailbone feels the contact of the chair.  Then move your weight over to one side so you feel your sit bone in contact with the chair and then repeat to the other side.  You have just contacted all four boney landmarks to where your pelvic floor muscles attach.  To contract your pelvic floor muscles think about pulling your pelvic floor muscles up and inside your pelvis while bringing all four of those boney landmarks together.   Imagine a purse string being pulled tight to gather all the material to close the purse.

If you are doing a kegel correctly you should not have any muscles on the outside of your body visibly contracting.  Nobody should know you are doing a kegel.  If your pelvic floor muscles are weak or you don’t know how to activate them correctly, your butt, leg and abdominal muscles kick in to try and help out.

In order to make sure you are doing the exercise correctly there are two positions you can get into that guarantee you are contracting only your pelvic floor muscles.  One position is sitting in a chair with your knees spread wide open and leaning forward with your trunk. Your arms can rest on your legs.  As you contract your pelvic floor muscles your legs should remain still.

An even better position is child’s pose.  In this position you are kneeling on the floor, sitting back so that your butt is resting on your heels and your body is draped over your thighs with you arms either out in front of you or by your sides.  There is no way you can contract anything but the pelvic floor muscles in this position.  If you don’t feel anything happening between your sit bones then your pelvic floor muscles are either too weak or just not contracting.

Another way to figure out if you are contracting your pelvic floor muscles correctly is to try and stop the flow of urine.  If you can stop the flow or are able to deflect it a bit then those are your pelvic floor muscles you are using to make that happen.  As you try this pay attention to what is happening in those muscles to get a feel for that contraction.

Warning!  It is important that you do not test your muscles by stopping the flow of urine all the time.  Testing your contraction ability about once a month is preferred.  If you stop the flow of urine too often your bladder gets confused and doesn’t know if it should start or stop the flow.  The nervous system that controls the bladder is very sensitive and you don’t want to be messing it up by testing your muscles too frequently.   Remember testing about once a month should be tops!

NORMAL STRENGTH OF THE PELVIC FLOOR

A strong pelvic floor muscle should be able to hold a contraction for 10 seconds.   See how long you can hold your contraction before the muscles fade away from weakness.  You can work on trying to hold the contraction for 10 seconds by just reengaging the muscle for the duration of those 10 seconds and then relaxing.  Just do 3 sets of these 10-second holds and then you could be done, for the hour.  Doing that every hour will hopefully improve your strength.  If it doesn’t get stronger or you have difficulty even engaging the muscles, stay tuned for my next post on the problems with kegel’s.

 

 

What is this thing called our Core?

January 18, 2013 in Abdominals, Diastasis Recti, Exercise, Post Partum

What is this thing called our Core?

Our body is an amazing machine.  What keeps it strong and allows us to move and do all sorts of activities is having strong core muscles.  Core strengthening is all a buzz these days and rightfully so because without good strength in our core muscles our performance can be diminished and can lead to back pains and problems.

So what is our Core?

Our core is made up of 3 groups of muscles, the abdominal, the pelvic floor and the multifidi muscles of the back.  While the other two are important I’m going to focus in on the abdominals and how certain things can really put us in danger of weakening these muscles.

The abdominal muscles 

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

Do you ever see a bulge in your abdomen when you go to sit up from lying?  

If you do, then you have a Diastasis Recti.  That is a separation of the six pack abdominal muscle known as the Rectus abdominus.  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 separated by a connective tissue called the linea alba. These muscle bellies can become separated and the connective tissue between them stretched thin with pregnancy, increased pressures in your abdomen or by just having a big belly.   The muscle bellies get forced out to the side with the increased pressures.  Also, activities with forward forceful movements as in coughing, sneezing, laughing, or doing sit ups incorrectly can create a diastasis or make an already existing one worse.

So how do you know if you have a separation of the recti muscles, or a diastasis recti? 

You will know if you have one if you are lying down on your back and you place your fingers perpendicular to the rectus muscles, pointing down toward your spine in your belly button. You need to be pushing down into the tissue and not just have your fingers resting on the belly.  When you lift your head any fingers that fill the space between the two muscle fibers of the rectus abdominus let’s you know you have a separation. One to two fingers width separation is considered normal.  However you also need to address the connective tissue and see how deep you can poke down before you feel the connective tissue. Normal is very shallow.  Anything past your first knuckle needs some attention.  You want to assess this in three places, at the belly button, 2 inches above and then 2 inched below.  It is normal to have different measurements in all three areas.

Also another key sign you have a separation is when you lift your head does anything pop forward in the midline around your belly button?  That bulge is actually your colon protruding out.  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.

Do you still have a “pooch” from being pregnant?

It doesn’t matter how old your baby is, our stomachs can still be stretched out from carrying the baby.  The transverse muscle runs like a corset from our spine around the front and inserts in the rectus sheath in front.  If you haven’t restrengthened this muscle it will continue to stay stretched out.  Granted, after the baby left your womb the transverse muscle did come back in somewhat but not to where it was prior to pregnancy.  There are some exercises you need to learn to help restrengthen this transverse muscle and we can show you how.  Regular sit-ups, Pilates and yoga do not address this muscle like it needs to be to help you lose your “pooch” for good.

At Intuitive Hands Physical Therapy we teach classes in the Boulder/Denver area and also have a video you can purchase that addresses all the issues with your abdomen.  You can lose inches and have a flatter belly by learning how to do two simple abdominal exercises that you can do anytime and anywhere.  There is a 4 step program that helps heal your diastasis recti so you can keep your organs in place and protect your back from injury.  We can also teach this class online via Skype.  For more information and to register for a class or purchase the video, click here.

 

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