Having trouble losing the “Mom Belly” Post Baby?

Why diastasis recti may be your problem and how you may be making it worse…



If you’re doing a million crunches to get your abs back post baby but can’t seem to lose that last little “pooch,” STOP!! You may be experiencing a very common postpartum complaint: diastasis recti.


What is diastasis recti?
It’s a separation of your rectus abdominis (6-pack muscles). As your belly expands during pregnancy, the connective tissue between the right and left sides of the muscle (called the linea alba) stretches to accommodate your growing baby. This separation may persist postpartum and in some women does not naturally reduce. This gap leaves your abdominals less functional, weaker and allows the other soft tissues to hang out. This causes that little belly that most new moms learn to hate.

Do I have diastasis recti?
Lay on your back with your knees bent and feet flat on the floor. Place 2 fingers at your belly button. Now lift your head like you’re trying to look at your belly while keeping your abs relaxed. Do you feel a gap along the midline of your abs at your belly botton, how about above or below the belly button? If you can fit more than 2 fingers in this “gap” you have a moderate-severe case of diastasis recti.test

What can I do about it?
Don’t freak out! You can learn a simple exercise to “brace” your abdominals that will begin to close this gap. Begin on your back with knees bent, feet flat and try to engage your deep abdominals by inhaling and bringing the navel to the spine as you exhale. See the exercise program below (“Other Resources” at the bottom of this blog) for a beginner plan geared towards closing the gap of your diastasis recti. If your goal is to get back to running, yoga, barre classes, spin classes etc., it’s recommended that you attend a few (anywhere from 2-12) PT sessions in order to strengthen your abdominals and avoid stressors that you’re not ready for. For example, planks and crunches are too challenging for abdominals weakened by diastasis recti and can worsen the separation if done improperly or too soon.

Bracing Steps (standing & lying down)





Other Resources:


Home exercise program for beginners: View at www.my-exercise-code.com using code: TGQQAGV

http://mumafit.com.au/  A site created by an aussie mom of 3, Maternal Wellbeing Specialist, and International Holistic Life and Wellness Coach. She also has a very popular app that has quick and easy exercise programs for during and after pregnancy.


What is Fibromyalgia and How Can PT Help?

treatment room EMH Physical TherapyFibromyalgia is a chronic syndrome that is composed of a group of symptoms.

The symptoms associated with fibromyalgia are varied and may include:

  • Musculoskeletal pain that is widespread
  • Fatigue
  • Sleep deprivation and sleep disorders
  • Loss of memory and cognitive difficulties
  • Mood disorders such as anxiety and depression
  • Tingling in hands or feet
  • Tension headaches
  • IBS
  • Joint pain and morning stiffness
  • Dysmenorrhea and urinary problems
  • Restless leg syndrome
  • Jaw pain
  • Nausea

The cause of fibromyalgia is still largely unknown; however it has been linked to injuries, illnesses, repetitive injuries, infection, surgery, trauma or stressful events, and possibly genetic factors.

If you suffer from fibromyalgia, there are some things you can do to help control fibromyalgia symptoms, which include:

  • Gradual and regular exercise performed in moderation
  • Relaxation techniques to reduce stress levels
  • Get adequate amounts of sleep
  • Limit caffeine intake
  • Eat healthfully

Chronic pain found in fibromyalgia may be initiated by trigger points, and after this pain is generated, the central nervous system amplifies the pain and results in hypersensitivity. This means that pain symptoms from specific causes are increased exponentially and even some sensations that should not be painful are interpreted as painful. So in order to decrease symptoms of pain, it is important to treat the causes to allow the nervous system to unwind from tension. Trigger points, tender areas in the body, and musculoskeletal imbalances are treated by physical therapists to help manage fibromyalgia pain and improve quality of life.

For further information on fibromyalgia:

National Fibromyalgia Association: http://www.fmaware.org/

American Chronic Pain Association: https://theacpa.org/

P-A-I-N is a 4 letter word, but so is T-E-A-M

IMG_4839Why a team approach of seeing MD and Physical Therapy under one roof is ideal for treating chronic pain.

If you have chronic pelvic, urologic,  sexual pain/dysfunction and can answer “Yes” to this statement:

“I’ve been to a number of medical practitioners about my pelvic condition and still don’t have a definitive treatment plan”, you’re not alone!

Just like the saying  “No man is an island”, no single practitioner can provide the breadth of treatment to help patients heal from chronic pelvic pain/dysfunction without working together in a TEAM of health care providers.

” Pelvic Help for Pelvic Pain”  is a 2 week intensive, non surgical program in NYC designed and provided by EMH Physical Therapy and Dr. Robert Echenberg MD.

The program is based on a Bio-psycho-social model of care which is evidence-based on neuroscience and pain processing disorders that are triggered by both functional and structural pain generators.

During the 2 weeks, you’ll receive a thorough education about pain and how pain can be retrained, receive a variety of treatments that includes medicines, trigger point injections, manual therapies, biofeedback and instruction in a tailored home exercise/management program.

It makes sense to address pain from all angles at the same time and this team approach with such open communication between MD, PT’s and other disciplines such as acupuncture and talk therapy is unprecedented and unmatched today. If you think you’ve tried everything else, try one more thing because it works!

Patients who attended our 2 week “Pelvic Help for Pelvic Pain”  program report a sense of well being, get pain relief, learn many self help tools and feel empowered that they can continue to heal.

The following is an interview of an international 32 year old female patient with 20 years of pelvic pain who traveled to NYC to attend our program:

Q: What was the best part of the intensive 2 week “Pelvic Help for Pelvic Pain” program?

A: The best part was the global approach to my health condition by MD and DPT. Working together,  which is rare in my country, gave me a broader view of my pain and of my power to overcome it.

The compassionate way Dr. Echenberg and the EMH PTs treated me was very supportive. As chronic pain is very stressful, the caring treatments and the kindness of these health professionals were very important and one of the best parts.

Q: How did you feel at the end of the 2 weeks?

A: I felt very well educated about my pain and about my role in my treatment. I was trained by PT to be able to continue my exercise program in South America and I felt I wasn´t alone with my pain, because they told me that they´ll continue support me even with the distance. The symptoms didn´t disappear, of course, because it´s a chronic pain but I felt better and well prepared to deal with it.

We have openings in our program!

Call (212) 288-2242 to schedule your appointment.

For more information about Dr. Echenberg go to his website, http://www.instituteforwomeninpain.com/For more information about EMH physical therapy, go to their website, http://www.emhphysicaltherapy.com.

The Mythical Hymen

This week, we’d like you to laugh as you learn about a myths surrounding an a structure of female anatomy and function: The Hymen.

What is it?

The hymen is an elastic piece of tissue  that lines the inside of vaginal opening. It has an opening that can be of any size- it can be thin or thick.

It should have an opening – otherwise menstrual blood cannot come out and an opening would need to be created.
Only 2% of women may need this procedure.

The Hymen & Virginity

You often hear about the hymen breaking with first intercourse.  It can happen, but if a woman is relaxed during intercourse and has good lubrication and she or her partner has stretched the hymen with fingers, then it likely won’t break (remember it’s elastic) So, you can’t tell if someone is a virgin if they have a hymen.

Here’s the video:

Prolapse: My Organs are Dropping- What Now?

Pelvic Organ ProlapseWhat is it?

Pelvic organ prolapse is a common condition that occurs most often in women following childbirth or menopause. The muscles inside the pelvis become weakened and lack the endurance or strength to support the body’s internal organs. This can result in a descent of the bladder, uterus, rectum, or even the vagina itself into the vaginal canal. The degree to which the pelvic structures descend can vary greatly. Some women with pelvic organ prolapse may have no signs at all and be completely unaware of their condition, while other women may have a larger grade of loss of support to their pelvic organs and develop more significant symptoms.

How might you know if you have a prolapse?

Some symptoms of pelvic organ prolapse include:

  • Sensation of a bulge/protrusion- feeling like something is coming out of the vaginal canal
  • Pressure and/or heaviness in the vagina
  • Urinary leakage, frequency, or urgency
  • Weak urinary stream, hesitancy with urination, incomplete bladder emptying
  • Painful sexual intercourse
  • Feeling of incomplete bowel emptying
  • Fecal incontinence or leakage
  • Low backache
  • Vaginal bleeding or discharge

What are the risk factors for pelvic organ prolapse?

While women who have been pregnant or given birth vaginally are the most at risk, especially in cases where the mother has given birth to a large baby or experienced prolonged pushing during labor, there are many other causes of pelvic organ prolapse.  Some are work or lifestyle related, such as heavy and frequent lifting.  Others stem from other medical symptoms such as chronic coughing, chronic constipation and/or straining with bowel movements, connective tissue disorders, prior pelvic surgery, or obesity.  Pelvic organ prolapse may also occur as a result of a genetic predisposition or from increasing age.

How can physical therapy help?

A healthy pelvic floor is vital in preventing pelvic organ prolapse, inhibiting further descent of organs that have already begun to fall, decreasing symptoms of pelvic organ prolapse, and as an effective conservative measure to avoid or delay surgery. A study performed by the American College of Obstetricians and Gynecologists in 2007ⁱ found that women with prolapse were found to have defects in the pelvic floor muscles, specifically the levator ani, and were found to produce less power in closing of the vagina with muscular contractions. Pelvic floor physical therapy will directly assess the strength and endurance of pelvic floor and core muscles, look for trigger points within the muscles themselves, help restore shortened muscles of the pelvic floor to their optimal length, and improve awareness of control of pelvic floor muscles with daily activities.

Pelvic floor physical therapy treatment of pelvic organ prolapse includes:

  • strengthening the pelvic floor and core muscles
  • biofeedback to help with improved awareness in using the muscles correctly and effectively
  • education in how to protect from further descent of pelvic organs
  • education in activities to avoid or modify

Women with symptoms of prolapse or who are at risk for pelvic organ prolapse should seek a consultation with a licensed pelvic floor physical therapist to have the best results in long-term pelvic health, function, prevention and management of pelvic organ prolapse.

How Can I Get Started?

Here is one exercise to begin:

Exercise for to help prolapsed organsLie flat on the back with feet propped up and supported on a wall. Place a pillow beneath the pelvis so that the hips are slightly elevated. This will put your pelvic floor in a gravity-reduced position to improve the ease of contractions and encourage an upward movement of the pelvic organs. Next try a pelvic floor contraction by exhaling and drawing the pelvic floor in and upward.  Hold this contraction for 5 seconds and then fully release, allowing the muscles to rest for 5-10 seconds. Repeat 10-20 times.





For more information, please go to: http://www.pelvicorganprolapsesupport.org

ⁱDeLancey JOL, Morgan DM, Fenner DE, et al. Comparison of Levator Ani Muscle Defects and Function in Women With and Without Pelvic Organ Prolapse. Obstetrics & Gynecology. 2007; 109: 295-302.

Endometriosis: ladies, let’s talk about it!

I fight like a girl graphicIt’s rare these days that a high profile celeb talks about anything that isn’t skin deep or filtered on Instagram. That’s why I give props to Lena Dunham (of HBO Girl’s fame) for writing an open and honest letter to her fans citing her endometriosis as the reason she will be missing from the press tour for the new season of her hit HBO show. That got me thinking, what other celebs have endometriosis? Are they just like us? Whoopi Goldberg, Hillary Clinton, Dolly Parton, Emma Bunton of the spice girls, Julianne Hough, and possibly Marilyn Monroe have all been linked to the diagnosis. That’s not surprising as 1 in 10 women have endometriosis, with more than 170 million women worldwide having already been diagnosed often after several years of debilitating pain.

1 in 10 women have endometriosis

So what exactly is endometriosis? Simply put, the tissue that lines the uterus (called endometrial tissue) somehow spreads to areas that it shouldn’t be causing pain and possible infertility. Endometrial tissue has been found in the adjacent areas of the body: vagina, cervix, rectum, abdomen, ovaries, bladder, and even the lungs or brain. Symptoms can include pelvic pain, painful intercourse, severe abdominal cramping, heavy periods that leave the woman incapable of leaving her bed, constipation or diarrhea, infertility or difficulty conceiving, and chronic low back pain.

What causes this terrible, invisible disease? Nobody really knows. Theories include: genetics, stress, hormone imbalance, toxins or environmental factors, a defect during embryonic development, or immune system defect. Think the symptoms sound familiar? How do we diagnose a case of endometriosis? The only way to confirm diagnosis is to “take a look” with a laparoscopic surgery which in itself introduces new injury and potential scar tissue to an already vulnerable area. At least the theory that a hysterectomy would “cure” endometriosis has been thrown out in recent years as that pesky endometrial tissue has estrogen of its own, and can re-grow in absence of a uterus. So basically our bodies can attack us from the inside at any moment without anything to be done about it?!

But wait, there’s hope! Although more research needs to be done about potential treatments and cures, there are a lot of options out there. The gold standard of diagnosis and treatment is a laparoscopy, but the tissue may grow back. Birth control or hormone therapy may help with menstrual pain and avoid a monthly relapse.

Pelvic floor PT can also help in reducing abdominal restrictions and decrease abdominal pain and cramping in addition to strengthening the core and pelvic floor muscles. Decreasing the restrictions caused by the endometrial tissue can free up the nerve endings in the abdomen decreasing pain signals sent by the entrapped nerves. Chronic pain additionally causes increased muscle tension due to our body’s protective contraction of muscles in the area that hurts. Manual techniques by a physical therapist can also help reduce this muscle tension, leading to father relief of chronic pain and faulty postures. Other forms of exercise can also be helpful including biking and walking.

Many women anecdotally report their endometriosis was “cured” after giving birth, but this is not always the case. Some have had success with acupuncture, massage, or working with a dietician to hit the disease from every angle.

The moral of the story is: DON’T GIVE UP! You’re not alone, there is help out there. The more people talk about endometriosis the less “imaginary” and “invisible” it will be. Here are some additional resources to check out for more information about endometriosis and treatment options:

The Endometriosis Foundation of America:    http://www.endofound.org/endometriosis

U.S. endo March (kind of like the Susan G Komen breast cancer walk) Happening March 19, 2016 in San Francisco!  http://www.endomarch.org/

The endometriosis association: http://www.endometriosisassn.org/endo.html

Coccyx Pain: A Huge Pain in the Butt!

Pieter Brueghel the Younger, c. 1616

The term coccydynia was coined in 1659, but coccyx pain, or pain in the tailbone, has likely been afflicting man since the beginning of time. After all, humans have been falling on their behinds for thousands of years.

While there can be many causes of coccyx pain, this post focuses on traumatic injury localized to the coccyx bone.


What is a coccyx?

The coccyx is a small triangular bone that forms the very tip of the spinal column. Though it’s a remnant of the tail, it serves as a crucial attachment site for various tendons, muscles and ligaments that contribute to the pelvic floor. It also is a weight bearing structure for sitting.


A traumatic injury, such as a fall or a difficult vaginal delivery may cause a shift or fracture of your tail bone which can lead to a change in pelvic floor muscle length and give rise to a cascade dysfunction. In addition to tenderness at the tip of the tailbone, injury to this structure can cause pelvic floor muscle spasm or muscle weakness. If left untreated, symptoms can progress, manifesting  as pelvic pain,  difficulty with  urination and defecation, or even urinary and/or fecal incontinence.


Symptoms of true coccydynia include:

  • sitting pain at the tail bone or sitting intolerance
  • pain with moving from a seated position to a standing position (pain usually resolves while standing)
  • pain in both glutes (butt cheeks) and/or both hamstrings


What to expect for evaluation of coccyx at EMH Physical Therapy:


First, the therapist will perform a posture analysis to determine spinal and pelvic alignment. The therapist will observe the pelvis and palpate (feel) the coccyx externally to determine if it is shifted, rotated, curved or extended.


She will then assess the muscles that attach to the coccyx externally to determine if they are painful and tight, or weak and overstretched.


An internal exam will then be performed in order to reach the anterior surface of the coccyx and the full length of the pelvic floor muscles to confirm the diagnosis.


An internal sensor may be used to get objective information with regard to exactly how the pelvic floor muscles are firing.


Based on the results of the evaluation, the therapist will treat your tailbone pain by mobilizing the coccyx, releasing the tight muscles and strengthening the weak ones in order to restore normal alignment and function.


Lastly, the therapist will design an individualized home exercise program to reinforce the techniques used during the physical therapy session that will address both the local coccyx pain and the global, full body strength and alignment.


For best results, research shows that it is best to seek physical therapy treatment within the first six months post injury. So hang up your “donuts”, “butt cushions” and heating pads, and treat yourself in 2016 by making an appointment at EMH physical therapy to kick coccyx pain’s butt!

Intimacy Postpartum Doesn’t Have to Hurt

post baby sexIn complete irony the same activity that gave you your little bundle of joy can be painful, daunting, and scary postpartum. I’ve reached the age where the majority of my friends have one or more babies and our group text is rife with complaints about the post baby “bounce back”. If 100% of my girlfriends have complained of pain or aversion to sex post baby I assumed that most women have some concerns about it.

Why Postpartum Pain during Intimacy Occurs

Well, there’s the obvious:  you just pushed a human out of a place that is normally a whole heck of a lot smaller than a baby. If you had a C-section, your doctor had to surgically create an opening to deliver your baby.  If you had an episiotomy or perineal tearing, residual scar tissue can restrict your abdomen and pelvis making intercourse feel painful. In addition, your life just got a whole lot more complicated. You’re now the caretaker for a little miracle and your mind may be on your fragile new baby instead of getting it on with your hubby. Thoughts and distractions can be a powerful libido killer. Lastly, your body is just not the same as it was pre-baby hormone wise. While breastfeeding, your estrogen plummets, and the hormone level in the vagina may be lowered while your whole body focuses on making enough milk for your baby.

post baby massageHow to Overcome Postpartum Pain during Intimacy

  • Firstly, if you had a c-section or episiotomy, self-massage of the vaginal area can be a helpful tool for breaking up scar tissue that may be causing pain. Tips: be gentle with yourself! Don’t rub over the scar but simply hold pressure on the area of discomfort for 5 seconds and then try to move the skin around the incision. Don’t be shy! You can even have your partner gently massage where the perineal or episotomy scar is located if you’re working on an episiotomy scar.
  • Next , when attempting intercourse, use lubrication. Low estrogen levels lead to a lower libido, which means less arousal and less lubrication in the vaginal tissue, and even thinner, more brittle tissue. If you’re into the natural stuff even coconut oil will do. Otherwise try any over the counter kind you like. Your MD may even prescribe a topical cream with some estrogen to help the vaginal tissue bounce back.
  • So you’re lubed up and ready to go…what next? Try different sexual positions, such as being on top of your partner, so you are better to control the depth and speed of penetration. Remember: everyone heals differently. There’s no rush, and you need to communicate with your partner what feels good and what doesn’t.
  • Last tip: don’t forget that you can still get pregnant during postpartum healing.

If you feel like working through the suggestions in this blog on your own is too daunting or you feel like you need professional help, let your MD or physical therapist know. At EMH physical therapy we can help. We specialize in women’s health including any issues that occur post-partum. You deserve to feel like “you” again, so you can be the best mom for that new baby!

Leaking is More Common Than You Think

Hmmm…. How to put this delicatelyWoman jogging on a track

Do you often find yourself leaking urine while exercising?  Squat… leak a little, overhead press… leak a little more, jump… forget about it, pants are soaked!

If this describes YOU, know that you are not alone. You likely fall into the 25% of women between the ages of 18-44, or the 44% of seniors, or the 33% of female athletes who experience varying levels of incontinence. These astounding statistics represent only those who have come forward to report symptoms. If you are skeptical, just take a look at YouTube (search “girl peeing while lifting weights”). You will find solidarity; everything from women admitting to leaking during exercise, to videos of complete loss of bladder control while executing a heavy lift. Today, there are even T-shirts glorifying urinary leakage during workouts in order to empower women and banish feelings of shame.

It is wonderful that women are finally coming forward to bring this previously taboo topic out into the open.  Just last week, Kate Winslet explained that she no longer jumps on trampolines for this very reason.  Leaking when exercising, sneezing, or coughing is so normal that Winslet’s admission was received with more “it’s nice to know she’s normal” reactions than surprised ones.  Yet, shockingly, statistics show that women will wait, on average, 6.5 years before reporting incontinence, because as normal is it may be, women rarely speak of it, even to their medical providers.  It’s no wonder urinary (and fecal) leakage has generated a $28 Billion dollar industry in the US alone.

If you are leaking while exercising, it is likely that your pelvic floor muscles are just not firing properly in order to withstand the load. We call this Stress Urinary Incontinence (SUI) which describes urinary leakage that occurs particularly with physical activity or exertion. While this issue is extremely common, it is not something you want to leave untreated. Whether you are losing a few drops or outright “peeing your pants”, help is out there, in some cases, right around the corner.

First you must understand that the pelvic floor muscles are just that: muscles. Therefore, you can strengthen them like any other muscle. We spend hours in the gym attempting to perfect every muscle in the body, but somehow forget the pelvic floor, a keystone to our overall health and fitness.

The tricky part is that you can’t easily see these muscles. As a matter of fact, you may not even be able to feel them. That is where Pelvic floor rehabilitation comes to the rescue. At EMH, we teach you how to identify, isolate and strengthen the pelvic floor muscles to restore normal function. We then help you integrate pelvic floor techniques back into your exercise routine so that you can squat, overhead press, and jump “leak free”.

So at your next holiday party, just think to yourself — 1 in 4 of the women in this room are currently peeing in their pants. Luckily, you don’t have to be one of them.

When Kegels Do More Harm Than Good

Sit forward, slight inward curving back to prevent a short pelvic floor

Strength Training for healthy muscle is generally good – it thickens the muscle tissue (hypertrophy), increases motor neurons activity for better awareness and reaction time, and improves muscle tone.  Kegels, a specific exercise for the pelvic floor, may help in reversing incontinence, preventing prolapse, increasing sexual pleasure, and stabilizing our core, but they don’t do the full job by itself and can be harmful.   As a pelvic physical therapist treating men and women with pelvic floor dysfunction and pain for 18+ years, I’ve found that the regular performance of Kegel exercises, especially if self-taught, may aggravate or even lead to dysfunction and pain.

How can Kegels do Harm?

Most people who experience leaking, urgency, prolapse, sexual dysfunction and pain in pelvis/groin/hip have short, or “non-relaxing” pelvic floor muscles. A short pelvic floor means just that – instead of returning to a lengthened state at rest, the muscle stays chronically short. Performing repetitive Kegel exercises to these already shortened muscles can further shorten and weaken those muscles leading to pain.  At EMH Physical Therapy, we advocate learning how to relax and lengthen the pelvic floor while recruiting other external muscles to work more effectively for best outcome.

What is the function of the Pelvic Floor?

The pelvic floor muscles attach from the pubic bone in front of the pelvis to the coccyx bone in back. During pelvic floor contraction, the muscle gently pulls the coccyx slightly forward.  The pelvic floor squeezes the urethra shut when not at the bathroom (no leaking), relaxes during urination (no hesitation) and bowel movement (no constipation), and works with the deep lower abdominal and lower back muscles to stabilize our body in preparation for movement (preventing back/hip pain).

A chronically short pelvic floor keeps the coccyx tucked forward, cannot fully relax during urination and bowel movements and because it is weak, can lead to leaking.   Research shows that pregnancy is not the main cause of pelvic floor issues, as teenaged girls, women athletes who have not been pregnant and men suffer from pelvic floor issues.

How does the Pelvic Floor become Short and How to Reverse this Habit?

Think about how you position and use your body during your day.

At the office: are you placing weight backward on the single small coccyx bone (not good) or on your two larger ischial tuberosities (good)?

Is your lower back rounded or flat (not good) or have an inward curve (good)?

At home: Avoid slouching on couches – use back pillows and support your feet.

Here are some Tips to Reverse a Short Pelvic Floor

  • Sit with your spine against the back of your chair, placing a roll or pillow in the lower back.
  • Stand up regularly.
  • Keep your gluteal muscles toned with regular squats, bridging or hip extensor exercises. Gluteal activation helps to lengthen the pelvic floor to prevent chronic shortening
  • Keep your hamstrings and inner thigh muscles flexible. STRETCH or foam roll these muscles. Tight hamstrings and adductors directly refers tension into the pelvic floor.
  • Check your pelvic floor tension throughout the day- gently squeeze this muscle first and then completely release. Feel this release for a few seconds and see if you can relax a bit further.
  • Take a deep slow inhale – allow your abdomen to expand and think of the pelvic floor widening as you inhale. Exhale as you keep the pelvic floor open.
  • Yoga positions such as Childs Pose, Happy Baby and Pigeon Pose help to open the pelvic floor and hips as you slowly breathe.  Maintain each position for 30 seconds.
  • Consult with a pelvic physical therapist for tailored therapy and home exercise program