4 Reasons New Moms Need Physical Therapy

April 23, 2013 in Bladder issues, Pelvic Floor, Post Partum, Prolapse, Women's Health Issues

4 Reasons New Moms Need Physical Therapy: This week’s featured guest blogger is Ginger Garner, PT, MPT, ATC, PYT.  Visit Ginger at  www.gingergarner.com and www.professionalyogatherapy.org

 

Pregnancy and childbirth exact an enormous toll on a woman’s body. It is transforming and beautiful, but when a mother does not get the physical and emotional support she needs, the effects can be devastating.

I am a new mother, three times over. Each time after I have given birth, I have benefited enormously from physical therapy afterwards. I could not stand strong, fit, and wholly healed without it.  massage

I am also a physical therapist, myself, and feel that every woman should know her rights to receive physical therapy as a new mother. One of the many fields of specialization in physical therapy is women’s health. I bet you didn’t know that. That’s okay. Most doctors don’t either.

A physical therapist (PT) in women’s health is dedicated to helping women get their bodies back after birth. They can treat a myriad of issues, including pelvic and back pain, incontinence, and other ailments. The American Physical Therapy Association’s 2010-11 report titled Today’s Physical Therapist: A Comprehensive Review of a 21st-Century Health Care Profession, states “physical therapists are committed to facilitating each individual’s achievement of goals for function, health, and wellness.” The core values of a physical therapist are “altruism, accountability, integrity, clinical excellence, social responsibility, and compassion.”

The sad fact, though, is that most new mothers will never get the therapy they desperately need after giving birth.

But I am passionate about turning the tide. All too often, women in general, not just new mothers, do not receive the health care they need. Read my article which reviews the shocking statistics about the crisis in women’s health care today in the US.

A Prime Example of Falling Through the (Medical) Cracks

I have had patients and friends who have suffered from pelvic pain, sexual dysfunction, painful scarring, chronic incontinence, and lower back pain for so long that it has severely altered their quality and enjoyment of life.

A friend recently came to me asking for advice for another girlfriend. Let’s say her name is Teresa. Teresa had just undergone major abdominal surgery (think C-section) and was having awful abdominal pains and even headaches.

Knowing that the two are related, based on her surgery type and plan of care, I immediately asked if the surgeon had referred her to physical therapy. Of course the answer was no. Her plan of care did not include any post-operative physical therapy. In fact, when I asked Teresa directly, she said her doctor (a woman, mind you) had never even mentioned needing physical therapy.

I was upset by what I felt was an oversight by the physician to refer Teresa to therapy, but mostly I felt a surge of urgency to help her. This woman needed therapy immediately, yesterday, even. She was floundering, depressed, in pain, and alone at home six weeks after major surgery on her reproductive organs due to a cancer scare. She had no idea how to get better (she had been a marathoner) now that she had this huge scar (larger than that of a C-section) across her abdomen. Even coughing caused pain, and the related headaches and back pain were terrifying.

But, it was not the doctor’s fault. Not really.

Doctors are educated very little, if at all, about PT services in medical school. A good friend with an MD sister said this when asked if she had learned about PT in medical school: “sure, we had education about what PT’s do in medical school. It was a single lecture, on one day, it was optional, and it covered all allied health care services.”

Physical therapists spend a similar amount of time in earning their degree in physical therapy (7-8 years) as doctors do in medical training. There really is no way a single optional lecture in medical school can prepare physicians to know what PT’s do and how to refer for physical therapy.

The Take Home Message

Be your own advocate in health care. Before going into surgery or giving birth, educate yourself about what to expect and what you will need for your body to heal fully.

The biggest mistake a mother can make in seeking maternity care is assuming her doctor knows best. The doctor may not even know PT’s treat women’s health issues, much less how to refer to PT for prenatal or postpartum rehabilitation.

There is good news though. Here are the tools you need to get physical therapy after giving birth:

First, BEFORE you give birth, ask your doctor is he/she refers to physical therapy after giving birth. If you already have low back or pelvic pain during pregnancy, then you should get a referral for physical therapy now. Do not wait until after giving birth.

When asked why you need it (physical therapy), you can give them these four reasons:   click here to read more

 

 

 


GingerGarnerpicGinger Garner PT, MPT, ATC, PYT

Ms. Garner is an educator, integrative physical therapist, and founder of Professional Yoga Therapy Studies, an organization that creates inter-disciplinary curricula and educational competencies for using yoga in medicine and rehabilitation.  Ms. Garner received her Master of Physical Therapy from the University of North Carolina at Chapel Hill, where she completed studies in the School of Medicine and School of Public Health.  Ms. Garner began working in the field of integrative therapies in 1995, after becoming licensed in sports medicine.  Her clinical specialties include public health education, orthopaedics, and pain management, with a focus on maternal health.

Ms. Garner has been writing, teaching, and lecturing for hospitals and medical practices throughout the US since 2000, and in 2012 she joined the Caring Economics Coalition and the work of Dr. Riane Eisler, who she credits as one of her greatest mentors.  Ms. Garner now consults pro bono with medical schools at several domestic and international universities in order to develop integrative medicine curriculum in medical therapeutic yoga.  She is currently an instructor with Medbridge Education and consultant at the University of Mississippi Medical Center, Misericordia University’s Doctoral Physical Therapy program, and the University of Saskatchawan School of Medicine.  These evidence-based programs are a first of their kind in North America.

Ms. Garner considers her most important work to be in maternal health care advocacy and health care policy,  where through her multi-media platforms she works to increase awareness of, and eliminate barriers to, receiving holistic and integrative health care.   Ginger is a mother of three children, and lives with her husband and rowdy sons on a small island off the east coast of the US.  Ginger can be contacted at www.gingergarner.com and www.professionalyogatherapy.org.

Caring for your pelvic floor after childbirth

April 6, 2013 in Pelvic Floor, Post Partum

 Whether you had a vaginal birth or a c-section your pelvic floor tissues need some care after childbirth.  

No matter which way your baby came out during your birth, your pelvic floor tissues need some help readjusting back to their normal state of being.  Fascial tension patterns can be created from pulling your baby out of your belly during a c-section or having your baby pass through your vaginal canal.  These fascial tension patterns can inhibit your pelvic floor muscles from being able to contract fully and can create trigger point or tender spots in your pelvic floor tissues.  Problems in these tissues can produce issues such as painful intercourse, sacroiliac joint dysfunction or low back pains and/or incontinence or prolapse issues down the road.

One of the best ways to treat these issues is with pelvic floor massage.  By massaging and releasing your vaginal and pelvic floor tissues you can eliminate the fascial tension patterns that can be inhibiting your muscles functions allowing for a much happier state in your vaginal area.

I highly recommend learning to massage your pelvic floor area yourself and becoming familiar with the tissues of your pelvic floor.

PELVIC FLOOR/VAGINAL MASSAGE

pelvic floor sketch bnwsmall

Get into a comfortable position leaning up against the headboard of your bed with your knees slightly bent out to the side.   The bathtub, on the toilet  or in the shower are other places you can try massaging your pelvic floor.

If you were to think of your vaginal opening as a clock face (with the clock facing out between your legs) your pelvic floor muscles run from 3 o’clock ( on the left side) to 9 o’clock (on your right side).  I find using my thumbs allows for greater ease and access to working with the tissues, but you could also try your index finger.  Insert the tip of your thumb into your vagina and place it at 6 o’clock.  You are on the perineal body the area between your vaginal and anal opening.  If you tore during childbirth this area may feel restricted to downward pressure.  Try pushing down on the perineal body and see if it can move easily.  If it can’t, apply pressure and hold until you feel the tissues release.  With the tip of your thumb right at the opening move it side to side and see if you feel any tenderness or restrictions.  If so massage these tissues until they release and have good mobility without pain.  You may want to try to insert two fingers, index and middle fingers work great or two thumbs,  just into your opening and work to try spreading the tissues out to the side, kind of like ironing the tissues flat.  This is the motion of expansion that needs to happen for intercourse.

If you move your thumb in past the first knuckle you will be on your rectum. Don’t push here as if may feel uncomfortable.  Slide off the rectum to the side at either 5 or 7 o’clock depending on which thumb you are using. Using your left thumb press into the tissues from 9 to 6 o’clock.  Use your right thumb to check the tissues from 6 to 3 o’clock and see if both sides spring and move equally.  Normal tissue has a nice bounce to it, like pushing down on a trampoline.  A knot in the tissue will feel hard and have less mobility.  When you encounter a hard area allow your thumb to sink into the tissue, you are not pushing your thumb in.  Just allow it to sink into the tissue until it can’t sink in any further and just hold it there.  As you hold it there, you are waiting for it to release or “melt” under your finger.  You can try placing your other hand either on your pubic bone, your tailbone or on the same side ischium (your sit bone).  Visualize a connection between your two hands and see if the placement of your other hand helps the tissue under your thumb relax.  Your goal is to get the harder side tissue to feel the same as the other side.  You can also try to massage the pelvic floor muscles between your thumb on the inside and your fingers on the outside.  Sometime offering compression between your thumb and fingers can help the tissues to relax.

You want to feel softness in the tissues, without any pain or tenderness, and ease in movement as you push on the tissues.  As you continue to work with these tissues the tenderness and pain should subside and the mobility should increase.  If you find things aren’t getting better, the tissues that need the most help might be beyond your reach.  I encourage you to seek help from a women’s health physical therapist.    A trained practitioner should be able to help you release post birth tension patterns in your vaginal area.  For the long term health of your pelvis it really is a must!

To find a local women’s health physical therapist in your area go to www.moveforwardpt.com.

To learn about other issues you can heal after childbirth check out my What Moms Wished They Knew About their Bodies After Birth Video.  It’s full of great ways to reclaim your body and get it back to it’s pre-pregnancy state.   This is not an exercise video but educational instead.  There are certain things you need to know to best help your body heal after childbirth.

 

 

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.

 

 

Post Partum Care of Your Body

February 26, 2013 in Childbirth, Pelvic Floor, Pelvis, Post Partum

POST PARTUM CARE

Congratulations on the arrival of your baby!  Now that your baby’s here, now WHAT do you do with your body!?!?

Whether you had a caesarian section or a vaginal birth your body has just completed the most strenuous feat.  After the adrenaline and fatigue wear off you may be wondering what has happened to your body?  Things may not feel normal in your abdomen or your pelvis.    That is where Intuitive Hands Physical Therapy can help!

C-Section Recovery

Remember you have just had major surgery!  You need to be protective of your abdomen and not lift anything heavier than your baby.  It’s very important to watch the way you get up and down from laying, always remembering to roll over to your side first.  Your activities should be limited the first 6 weeks until you get the all clear from your MD that your incision is well healed.

SCAR MASSAGE

Once you get that clearance it is VERY IMPORTANT to massage your scar.   You want to move the scar up, down, side to side and rub it between your fingers.  There are many layers you want to work through so start off superficially and work till you can move the tissues deep down in the abdomen.   It may be very tender initially but do what you can to keep the scar tissue from adhering to other tissues.  It’s been my experience that 10-15 years down the road women come to me with frequency of urination.  They have scar tissue from their c-sections that is inhibiting the bladder from expanding.  A session or two of scar tissue release work gets them back to normal voiding frequencies.  You can avoid this by massaging your scar early on.

VAGINAL BIRTHS

The pelvis is amazing in its ability to open up to pass a baby through its canal.  Sometimes during labor the mechanics of the pelvis opening doesn’t work properly and you can experience a difficult delivery and have lots of back labor or pelvic pains.  If the delivery was traumatic in any way the pelvis can have a hard time going back into its normal position, thus creating pain for you.  At Intuitive Hands Physical Therapy we specialize in helping the pelvis find its natural home and help you get out of pain after delivery.

THE PELVIC FLOOR

It is quite common to experience a tear to the pelvic floor during childbirth.  Depending on the degree of tear, from 1st to 4th degree, you can develop scar tissue that can inhibit the pelvic floor.  Scar tissue is not as flexible as our normal tissue so intercourse can be somewhat painful the first couple of times after childbirth.   If intercourse continues to be painful please see a women’s health physical therapist to have them work on your pelvic floor and release any scar tissue that may be present.

Scar tissue can also inhibit the pelvic floor muscles from contracting as strongly as they could thus leaving you with weakness that could contribute to stress incontinence.   Just like our shoulders get knots in them, our pelvic floor does the same.  These knots can be caused by scar tissue and can prevent the muscles from contracting fully.  A session of soft tissue mobilization, using just a gloved finger can help work out those knots and free up the scar tissue so the muscles can work more normally.  You can really tell a difference in a “Kegel” contraction after your muscles have been fully released.

 

EVERY MOM SHOULD HAVE A BODYWORK SESSION AFTER CHILDBIRTH

Your body has just completed the most arduous task!  Think about what your body has been through in the last 10 months.  The baby grew so big, your belly was huge and what do you think happened to your organs?  The baby pushed them way up into your chest and somehow they find their way back down but in the meantime they can create some mid back pains as you try to care for your wee one.

Your pelvis can get out of whack from opening so wide to allow the baby through and could use help finding its place back home again.

If you had a c-section the doctors might have taken all your small and large intestines out and go through them all to make sure there’s no kink in them before sewing you back up.   I’ve had several women come to me complaining of things just not feeling quite right in the pelvis and abdomen after the surgery, and they were right.

One session can help you feel back to normal again.  We can check to make sure your organs are happy and in their rightful places, make sure your abdominal tissues can move freely, and check to make sure your pelvis and pelvic floor are working right and all the pieces are in their proper place.

So any aches and pains you may have post partum can be addressed in a treatment session with Lynn.

Contact her today for your post partum session for your ticket back to feeling normal in your body again!

 

Hi Lynn – I wanted to tell you that last night was the first night since my last pregnancy that I slept a solid 8 hours without having to get up to pee.  Unbelievable!  And all day I have felt so different too – I can’t really describe it.  It’s like what you said, I haven’t really thought about my bladder every 10 minutes like before because it wasn’t bothering me! Again, I thought I was bordering on a compulsive disorder with how much this issue defined my life.  

So I just want to say thank you, thank you, thank you from the bottom of my heart  – if I can write a testimonial for you or share my story please just let me know.  Now I know that no amount of kegels, core conditioning, etc. was going to help this problem go away – I am just so relieved that I found you and I avoided a costly surgery because of it. 

~A. S.

Is Sex Painful?

February 26, 2013 in Pelvic Floor, Post Partum, Women's Sex Issues

Do you have pain with sex?

You may be shocked to be asked this question but this problem is more common than you think, especially after having a baby.  Women usually just don’t talk about it because when they ask their OB/GYN they are told everything looks ok in there.

What women need to understand is that most doctors don’t understand the muscles and connective tissue problems of the pelvic floor area.  Their expertise is in the organs functioning.  While everything may look “normal” most doctors do not check the ability of the tissues to move and expand and this may be where your problem lies.

Do you realize there are three distinct specialty areas in the small, little vagina?  You have to see an urologist for any bladder issues, a gynecologist for your uterus and if you have issues with your bowel you need to see a proctologist.  Unfortunately vary few of these specialists fully understand how the connective tissue or fascia, and the pelvic floor muscles contribute to pain and problems in this area.  This is where a woman’s health physical therapist can help you.  They are trained to work specifically with the muscles and connective tissues of your pelvic floor.

Pain with Intercourse

Typically there are two types of pain with intercourse, pain with insertion and/or pain with deep thrusting.

Insertion Pain

Pain with insertion may be caused from tightness in the pelvic floor tissues.  Just like our shoulders can get a “knot” in them, the pelvic floor muscles can also develop increased tension that can cause low back pain along with painful intercourse.  Any tearing during childbirth creates scar tissue which can also inhibit the movement and stretching of the pelvic floor tissues to allow for penetration.   A couple of sessions of physical therapy can help to free up or relax the pelvic floor tissues to allow for more enjoyment during intercourse.

Deep Thrusting Pain

Deep thrusting pain may be contributed to the lack of motion of the cervix and uterus.  If the uterus isn’t able to move from adhesions or scarring from a c-section every time the penis hits the organ it will create pain.  All the organs in our pelvis need to have free mobility or deep thrusting may be painful.  A physical therapist trained in visceral manipulation and scar tissue release work should be able to help you free up your pelvic organs so deep penetration pain is no longer a concern.

 

Lynn Schulte-Leech is a physical therapist with more than 20 years of experience.  She specializes in Women’s health and Visceral Manipulation.  If you’d like to talk to her about your issue or set up an appointment please call her at 303-845-0604 or email her at intuitivehandspt@comcast.net.

Visit Us On FacebookVisit Us On YoutubeVisit Us On Google PlusVisit Us On PinterestVisit Us On Linkedin