Helping Women Heal Their Body After Birth

July 10, 2013 in Pelvic Floor, Pelvis, Post Partum

Being a Women’s Health Physical Therapist has given me the privilege of working with a lot of post partum women.  I have a profound respect for the body’s ability to birth a baby.   It is a natural event that the body is designed to perform.

While birth is a natural function of the body, it is not designed to handle the effects of prolonged pushing or a baby that comes out in a less than ideal way.   These conditions place excessive strain on the pelvis and vaginal tissues and create issues.  Issues that a woman doesn’t have to just deal with for the rest of her life, but can get help with and fully recover.  That is, when she gets help.   Often times women are left to just deal with theses issues on their own and learn to just live with them.   Many are convinced or made to believe it’s just a natural side effect of childbirth.   But it doesn’t have to be this way!

A large majority of issues such as painful intercourse, incontinence, a pressure or falling out feeling in the vaginal area from organ prolapse, or just your body not feeling the same anymore, can all be helped by working with a women’s health physical therapist.

Helping Women Get the Help they Need!

Birthing professionals need to understand the effects a birth can have on a woman’s body and help them get the support they need to help their pelvis come back to it’s normal alignment and get their vaginal tissues released.    This idea that birth is a natural function and we just spring right back to our pre-pregnancy state doesn’t always happen for all birthing women.   The birthing professional needs to listen to the post partum woman and help them to understand that what they are experiencing in their body is an effect of birth and there is help.

Also understanding that when a birthing woman gets to a point in her labor where she feels like she doesn’t want to go on, it’s too much, or “just get this baby out of me now!” are all signs where the body can register the event as traumatic.  When trauma occurs the tissues get stuck in the position she is in during the traumatic moment.  The woman may not vocally say these words, it may just be a fleeting thought but those tissues respond accordingly.    After the birth is over when you are reviewing the birth with the new mama, asking her if she got to that point of wanting things to stop or be done could give you an idea if any trauma effects may have occurred.

Releasing Trauma in the Bodymassage

When we experience any traumatic event our body has three different options to protect itself.  We can either choose to fight the event, try and flight from it or we just freeze.  During labor, fighting and running away are not an option.  The body’s only choice is to freeze, so the tissues get stuck in whatever position they are in at the time.

Usually this occurs during the pushing phase.   When women are pushing their ischiums, or sit bones, are splayed out to the side, their sacrum is nutated, where the tailbone is farther away from the pubic bone, and their tissues are bearing down.   A traumatic response can keep these tissues in this position well after the birth is over.

By listening to the tissues on an energetic level, one can feel what they still want to do.   Helping a new mom tune into the effected area and realize that the birth is over can bring the tissues into a more neutral state.

When I assess post partum women’s tissues on an energetic level, many of them present with their bladder and uterine tissues still bearing down as if they are continuing to push a baby out.    By just placing my index finger on the urethra and bladder and just listening to what that tissue wants to do, most of the time my finger gets pushed out of the vagina.

The great thing is, it’s easy to fix this problem.  By having the woman bring her attention to the tissues I’m touching  she can help them to realize the birth is over, that the tissues can stay up and inside.  The tissues retract back up and in like a turtle pulling its head back into its shell.

Bringing the ischiums back into midline also helps to relax the pelvic floor tissues.  Since the pelvic floor muscles attach to the sides of the ischiums, when they are splayed out and stuck there, the pelvic floor muscles can have too much stretch on them not allowing them to relax and contract fully.  Sometimes one ischium gets more pressure than the other, creating an imbalance in the pelvis, especially when sitting.  To learn more about pelvic trauma in birth, read this blog.

The vaginal tissues may need help releasing the effects of the baby turning it’s head to come out.  Many times I can still feel the twisting effect on the pelvic floor tissues from this part of the birth.  Soft tissue mobilization of the vaginal tissues can help restore normal function and contraction ability of the pelvic floor muscles.  Read more here.  Without this type of work regaining strength in the pelvic floor muscles can be like beating your head against a wall.  The muscles need to be released in order to work properly.   But in order to free up these tissues, any trauma that may be present in the tissues needs to be released first.

I had one mom I worked with who had seen another women’s health physical therapist for 12 sessions and she reported that after every internal session of massage with this PT, her pelvic floor area would ache and hurt afterwards.  This is a sign that there is trauma in the tissues.  When a tissue with tension in it doesn’t want to let go or release, there is trauma that needs to be addressed first.  Also when a tissue reacts by hurting worse after a session, the body is trying to tell you it does not like that approach, something else needs to happen first.  By listening to the tissues and sensing them you can tell when they are willing or unwilling to release.  There is a different quality to the tissues when trauma is present.

Working with trauma in the tissues can be challenging, depending on the amount of trauma one has experienced.  A lot of times with birth, just the act of bringing a woman’s awareness to the tissues, helping her breathe down into the affected area can help them to release.  Also helping her go back to remembering herself before the moment of trauma and reconnecting to herself then can help release the tension and trauma in the tissues.  This work needs to be extremely gentle and respectful.  Forcing any tissues in the vaginal area is very counterproductive.

Helping new moms recover from the effects of birth needs to be a bigger priority in our country.   In France, women get 8 physical therapy visits after giving birth.  Getting moms the support and help they need to heal from the effects of trauma from birth and get their body and tissues back into their proper place should be available for every woman who has had a baby.    I wish I could see every post partum woman just once to get her on the path to reclaiming her body and healing after birth.

 

 

Is Sacroiliac Joint Dysfunction Causing Your Low Back Pain?

June 18, 2013 in Pelvis

Low back pain is a common complaint with people across all ages and stages of life.  Because there are so many structures in the low back that can be causing your pain, it’s important to know from where the source of your pain is coming.  One area that may be contributing to your back pain is your sacroiliac joint (SIJ).  Your sacrum sits at the base of your spine and the two broad elephant ear shaped bones, called your ilium,  connect to it on either side.  This is what makes up your sacroiliac joint.  In some people you can see little dimples right where this joint is located in their low back.

 

The sacroiliac joint is comprised of two very incongruent joint surfaces pressed together through a joint coupling that is held in place by broad ligaments and muscles.  It’s when these incongruent surfaces get out of their normal position that pain can arise.  Problems occur when either the ilium gets displaced, or the sacrum, or both.IMG_1644small

 

Through jarring motions such as stepping into a hole unexpectedly, jamming on the brakes in a car accident or falling onto your buttocks, the sacroiliac joint can get displaced.  Also the repetitive jarring of running can sometime cause the ilium to get displaced upwards and cause pain.

 

The thing about this joint is that when the sacrum is not in it’s proper place there is no amount of stretching or exercise that you can do to get it back into place.  An outside passive force is needed to help the sacrum find it’s happy home in the sacroiliac joint.  On the other hand there are muscles, mainly the hamstrings and hip flexors, which influence the ilial bones that can be stretched and used to help the ilial bones find their way back into place.  Usually it’s a combination of both that brings about the greatest relief of your pain.

 

So how do you know if your low back pain is coming from your sacroiliac joint?

 

Between 10-26% of all low back pain is attributed to the SIJ.  In pregnancy, SIJ dysfunction is even more common.  Up to 80% of all low back pain in pregnancy is SIJ related. (1)

 

SIJ dysfunction typically causes unilateral low back pain, just slightly off center.  It can also radiate into the buttocks, groin or down the leg.  The pain can be sharp and stabbing with motions or a dull achiness all the time.

 

There are certain motions that stress the SIJ that when painful implicate dysfunction in the joint.  Painful motions such as standing putting your pants or socks on one leg/foot at a time or any weight bearing on one leg, is a very common sign of dysfunction in the SIJ.   Usually it’s when the weight is being bared on the side in dysfunction that it is more painful, but not always the case.    Also standing up from sitting, getting in and out of a car or climbing stairs can all strain the SIJ.   If these motions are painful, then it’s most like that the SIJ is in dysfunction.

 

If you are experiencing any low back pain, seeking professional care, by seeing an orthopedic doctor, a physical therapist or a chiropractor, can help you determine the cause of your pain.   Dysfunction in your SIJ can be helped through either physical therapy or chiropractic care.  Learning how to keep your hamstrings and hip flexors flexible and your core strong can be beneficial.
To learn more about two other areas that may need to be addressed if you are not getting relief from traditional treatment, check out my other blog on the Sacroiliac joint.

 

 

 

1.  http://www.oadortho.com/centers/documents/Dr.MathewSACROILIACJOINTDYSFUNCTION.pdf

 

 

 

 

Sacroiliac Joint Dysfunction- Part 2

June 13, 2013 in Pelvic Floor, Pelvis

Sacroiliac Joint Dysfunction- Part 2

If your low back pain is caused by your sacroiliac joint dysfunction and isn’t responding to traditional treatment there are two areas that you need to check out.

In the first part of this post we talked about how lower abdominal scar tissue may be inhibiting your sacrum.  Lack of mobility in the sacrum can cause dysfunction in the sacroiliac joint.

pelvic floor musclesAnother area you should have checked out is your pelvic floor muscles.  Since your pelvic floor muscles are attached to the sacrum, if there is increased tone in them, they can restrict sacral mobility as well.   When a muscles has increased tone, it has limited flexibility.  The sacrum needs to be able to move forwards and backwards as you bend and straighten.  If it gets anchored by tightness in the pelvic floor muscles it’s not going to be able to move as it should and can cause dysfunction in the sacroiliac joint.

I’ve had many clients come to see me with low back pain.   In assessing their pelvis there was limited mobility in one side of their sacroiliac joints.  When I assessed their pelvic floor muscles, doing an internal exam, I found increased tone on the same time as the sacroiliac joint dysfunction.

There is a way for you to assess your own pelvic floor muscles.  Get into a comfortable position leaning up against the headboard of your bed with your knees slightly bent out to the side.   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).  Insert one of your thumbs into your vagina. Using your left thumb press into the tissues from 9 to 6 o’clock  and 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.  A knot in the tissue will feel hard and have less mobility than the other side.  The problem with doing this yourself is you have limited reach with your fingers.  Your thumbs only reach so far and the muscles that could be a problem may be beyond your reach.   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 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.

Doing this self message can help rebalance your pelvic floor muscles and free up your sacrum so your sacroiliac joint can move as it needs to.  Getting mobility back into your sacroiliac joint can end your low back pain.    If you are not able to get the tissues to soften on your own I encourage you to find a women’s health physical therapist in your area to help you out.  Go to www.MoveForwardPT.com and search under women’s health PT’s to find one near you.    Internal vaginal work can do a lot of good for not only low back pain but for painful intercourse as well.

 

 

 

Sacroiliac Joint Dysfunction- Part 1

June 12, 2013 in Pelvis

Sacroiliac Joint Dysfunction Part 1- Scar tissue

 

Low back pain is a very common complaint with most people.  There are many different structures in the low back area that can be causing the pain.   The sacroiliac joint is one of the most common areas that can be in dysfunction creating low back pain.

Looking at the back of the pelvis showing the sacroiliac joints

Looking at the back of the pelvis showing the sacroiliac joints

While common treatments such as joint mobilizations, manipulations, stabilization exercises and stretches can be helpful for most cases, if your pain remains, you might want to look into to two other areas that may be causing your pain.

Do you have any scar tissue in your lower abdomen?

Scar tissue forms very haphazardly to help heal a wounded area, connecting to any tissues around the injured area.   Until it learns how the tissues need to move,  it limits the surrounding tissues mobility.   In the lower abdomen movement alone is not enough to help release the restrictive nature of scar tissue.  Manual mobilization of this scar tissue is important to help free up the organs and surrounding tissues in this area.

Scar tissue in your lower abdomen can cause sacroiliac joint dysfunction.  Appendectomy scars, laparoscopic surgeries, cesarean sections and even seatbelt injuries from car accidents can create scar tissue in the lower abdomen.  Since your organs are connected to your spine and pelvic bones, if scar tissue is restricting the organs mobility the body will protect the organs first.   Whatever the organ is attached to will be pulled out of alignment.

With cesarean scarring the uterus can get anchored by scar tissue and pull on the sacrum because of it’s connection with the uterosacral ligaments  . It is very common to have one side of your surgical scar more limited in mobility than the other side.  Typically it’s the more restricted side of a scar that causes the sacrum on that side to get stuck and lack mobility.  Restricting the sacral mobility can cause SIJ dysfunction.   The junction between the small and large intestines, called the ilieocecal valve, sits right in front of the right SIJ and the sigmoid colon sits in front of the left SIJ.  Any restriction in these two organ areas can cause dysfunction in the sacroiliac joint.  Mobilization of the fascia around these organs can free up the connection to the sacroiliac joint.

I had a friend who came to see me as she had developed low back pain getting ready for a camping trip.  She was bent over and couldn’t stand straight without pain.  Not touching her back and just working on her 8 year old c-section scar alleviated her pain and she was able to go camping the next day.  Two years later getting ready for another camping trip this same friend developed low back pain again and was considering not going on her trip.  She had knee surgery earlier that year and had been hobbling around and I thought her pelvis was out of position causing her pain.  Working just on her pelvis and low back in one session did nothing for her back pain.  Seeing her the next day and just working again on her c-section scar completely relieved her low back pain and she was able to go camping.  She is now able to massage her own scar and keep her back happy.

You can learn to massage your own c-section or any type of scarring in the abdomen by watching my FREE How to Massage your C-section Scar video.

It also doesn’t matter how long the scar tissue has been present as you can loosen it up at any point in time, even years down the road!  Most of the women I see in my PT practice that have had c-sections may not have any problems until 10-15 years down the road.   There are two other issues that c-section scarring can cause, read here to learn more.

Scar tissue in your lower abdomen, no matter what the cause, needs to be released to help free up and restore mobility to your sacroiliac joint so you can be pain free.

Stay tuned for part 2 of this post to learn of another area that is often not addressed in treating SIJ dysfunction.

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!

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.

 

 

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