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A Pregnant Physical Therapist’s Top Tips for Your Healthy Pregnancy

Navigating the pregnancy literature on proper posture, exercise and sleeping alignment can be overwhelming and the guidelines presented are often not a “one size fits all”. Afterall, everyone’s pregnancy is unique. Below you will find some quick and easy tips that I utilized and found helpful throughout my pregnancy that kept me fit, aligned and pain free throughout my work day as a physical therapist at EMH.

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PelviCorFit™ by EMH Physical Therapy Grand Opening

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Have you been working out for years, but neglecting a crucial muscle group??

At EMH Physical Therapy we recently launched our brand new PelviCoreFit™ program designed to whip your pelvic floor muscles into shape. Proper firing of pelvic floor muscles is not only essential for pelvic health but is also a key factor in overall core strength and fitness.

Visualize this:

screen-shot-2016-09-20-at-2-03-35-pm

The pelvic floor muscles form a sling that transmit forces from the ground up and from your head down. If pelvic floor muscles are weak and unaccustomed to firing during exercise, you could be promoting a faulty movement pattern in the chain. Neglecting the Pelvic floor muscles can potentially lead to more serious conditions such as chronic hip, back or pelvic pain, urinary or fecal incontinence, GI and bowel disorders, and erectile or sexual dysfunction. At EMH Physical Therapy we will help you identify and strengthen the pelvic muscles during your general workouts to help prevent future dysfunction!

Additionally, did you know that the pelvic floor muscles play a fundamental role in breathing through connections to the diaphragm?  Think about doing cardio, executing a heavy lift, or performing a Vinyasa flow with a sub optimal breathing pattern. Strengthening the pelvic floor muscles can improve breathing which will help to optimize your workout efficiency.

Come try out our discounted  PelviCoreFit™ program, learn about proper activation of the pelvic floor muscles and bring your workouts to the next level!

We offer 2 options:

“PelviCorFit™ #1” – One fifty minute session with a DPT + Fitness Guru that includes 15 minute pelvic floor/core education followed by a 30 minute PelviCorFit™ workout, then Q&A. Regular price is $200. New Client price is $50

“PelviCorFit™ Pack” – Three (3) fifty minute sessions with your DPT + Fitness Guru. The first session is similar to the description above. The 2 follow up sessions include 45 minute PelviCorFit™ workouts plus instruction on how to implement pelvic floor awareness into your fitness program. Regular price is $500 for 3 sessions. New Client price is $130

To register call 212-288-2242

or

email info@emhphysicaltherapy.com

For more information click here

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How to Foam Roll Most Major Muscle Groups in 5-10 Minutes

Don’t you wish you could get a deep tissue massage every day? If you said “yes!” then I highly recommend you make a small investment in your own foam roller.

I foam roll every time I go to the gym because it’s the easiest way to self-release all of the major muscle groups. Foam rollers act on the fascia, or connective tissue, that lies above all muscles and organs of your body. When you use a foam roller, you’re making the fascia mobile, which ensures all structures underneath will function without restrictions.

When ordering remember: darker colors usually mean a firmer roller. If you are a beginner try white or a light color. If you want a deeper, firmer tissue massage go with dark grey or black.

Check out my quick video that hits most major muscle groups in just a few minutes. Happy rolling!

The TOP 5 Exercises to Reduce Pelvic Pain

Written by Kirsten Hober, PT, DPT

If you are experiencing pelvic, abdominal, hip, and pelvic floor dysfunction these 5 exercises can help your body relax, allowing more oxygen to flow to loosen tight muscles and fascia that may be causing your pain.

 

1.) Diaphragmatic breathing

Deep breathing is an excellent way to calm the nervous system and relax.  In particular, diaphragmatic breathing is a specific pattern of breathing closely related to the functioning of the pelvic floor and enables relaxation of those muscles.

The diaphragm is a dome-shaped muscle that lies below the rib cage. As the diaphragm contracts, it expands downwards and resulting pressure pulls air into the lungs. This downward pressure and expansion of the muscle also results in descending movement upon our internal organs. As this happens, the pelvic floor muscles receive a gentle stretch and expansion as well, facilitating a relaxation of those muscles. This pelvic floor expansion can be felt upon inhale with a diaphragmatic breath.

Diagram of how human breathe

Exercise

To begin, lie on your back in a comfortable position with one hand over your chest and one hand over your abdomen just below the rib cage. Breathing in through your nose, let the air fill your belly and feel the expansion of your abdomen as your hand rises. Meanwhile the hand that is placed over your chest should remain still and you should not feel any chest expansion upon the inhale. As you exhale, feel the abdomen drop back down towards your spine. Continue to breathe, feeling your belly rise and fall with each inhale and exhale. Performing this exercise for 5-10 minutes per day will help allow the pelvic floor muscles to relax.

Once you have become comfortable with diaphragmatic breathing while lying on your back, you may also try the same techniques for this breathing pattern in sitting, and even standing.

Incorporating diaphragmatic breathing into the following four pelvic floor exercises will increase your awareness and ability to fully relax these muscles.

Diaphragmatic breathing exercise diagram

 

2.) Deep Squat

Bringing your legs wider than your hips, squat down towards the ground until a stretch is felt through your legs and you reach the deepest comfortable position.  You may choose to hold onto a stable surface for support, or you can bring your arms inside your legs as a counterbalance. Hold this pose for 30 seconds as you breathe deeply into the belly using the diaphragmatic breathing. Try to feel the expansion of the pelvic floor muscles in this open position. Repeat 5 times throughout the course of the day.

Deep squat pelvic floor exercise holding on to something sturdyDeep squat balancing pelvic floor exercise

 

3.) Happy Baby

 

Lie on your back on a comfortable surface. Bend your knees and lift your legs off the ground, gripping the outside of your feet or your ankles with your hands as you separate your legs wider than your torso. Remain in this posture for 30 seconds and breathe deeply using diaphragmatic breathing to expand the belly. As you inhale feel the expansion of the pelvic floor muscles. Repeat 3-5 times throughout the day.

Happy baby yoga pose

4.) Child’s Pose

 

Begin by kneeling on the ground on a comfortable surface. Separate your knees so that they are open wider than your torso. Bend forward at the hips and bring your forehead to rest on the ground or a pillow. You can either reach your arms forward in front of your head or back to rest by your hips. Bring your hips back so that they are resting by your heels. Relax into this position, letting your body fall towards the ground, releasing all tension in your body. Once you feel relaxed fully, focus on diaphragmatic breathing. Allow your belly to expand into the space between your knees as you inhale. Feel your pelvic floor muscles relax and melt towards your hips and feet as you inhale. Remain in this position for 30 seconds to 1 minute. Repeat 3-5 times per day.

Child's pose in yoga with arms frontYoga pose child's pose with arms back

5.) Legs Up Wall

Sit down with your hip 5-6 inches from a wall. Lie down and swing your legs up onto the wall so that your heels are resting supported against the wall and your legs are relaxed. You may choose to let your legs fall out to the sides so that you feel a stretch through the inner thighs or you can allow your legs to remain closer together. Once you have found a comfortable position, focus on diaphragmatic breathing. Allow your inhale to increase the expansion of your pelvic floor muscles as your belly expands. Breathe deeply in this position for 3-5 minutes.

Inverted wall stretch exercise

 

Watch Kirsten demonstrate these exercises below.

Strong Abs during Pregnancy and for New Mom’s

The staff Doctors of Physical Therapy at EMH specialize in pre and postpartum physical therapy for a healthy pregnancy and a fast recovery after delivery. Preventing Diastasis Recti is one aspect of our expertise.
Please forward to all your pregnant/new mom friends and family!

Diastasis Recti Abdominis (DRA) can occur in up to 66% of pregnant women due to hormones that allow ligaments and joints to relax, the increasing baby size in utero, improper weight lifting (ie heavy food bags, other children, furniture etc), a history of prior C-section or abdominal surgery and repetitive poor mechanics during daily activities and lack of regular exercise.

Men can also develop DRA due to faulty weight lifting mechanics, obesity and chronic medical conditions that result in frequent coughing such as bronchitis.

What is a DRA?

DRA is defined as the separation and thinning of the rectus abdominus muscles (see diagram in green) and stretching of the linea alba (see diagram in blue). The linea alba runs from the xiphoid process (base of sternum) to the symphysis pubis (center of pelvic bone). Both the rectus abdominus muscle and linea alba are the main support for the front of the abdomen, keeping the visceral organs in place and functioning well. They also maintain pelvis stability during walking, lifting, bending and squatting.

What are the symptoms of DRA?

Symptoms may include:

  • Noticeable small or large bulge in the center abdomen
  • Sharp or burning abdominal pain during bending, lifting, standing and walking
  • Lower back pain
  • Feeling like the intestines or stomach may fall out
  • Poor posture
  • Longer term problems of prolonged DRA may include Stress Urinary Incontinence, Fecal Incontinence and Pelvic Organ Prolapse.

How To Measure for a DRA?

The best way to measure is a finger width measurement. Lie on your back, knees bent, head resting on floor/pillow. Place tips of 4 fingers across the body at naval or just above/below the naval per your comfort. Now raise your head and shoulders slightly upward. If your fingers descend inbetween the parallel rectus abdominus muscles on either side of your naval, measure how many fingers move downward. If there is a true split of the linea alba, your finger will fall into a space that feels squishy (your intestines live here!). A positive DRA is one where there more than 2 fingertips (1 inch or 2.5cm width) that lower. We have measured women with 3 to 4 inches ( 8cm) wide and have helped them narrow back to 1 inch (2.5cm) wide.

 

What to Do if you have a DRA?

Best to first consult a pelvic physical therapist for a tailored postural, stabilization and home exercise program targeting the Tranversus Abdominus (deepest and lowest muscle of our abdomen), the pelvic floor muscles and the multifidi muscles (lower back stabilizers). Here are some tips to help you immediately:

  • Avoid positions that may further separate the recti muscles, like doing sit ups, crunches, strong stretches of the abdomen, quick trunk rotation movements
  • Stand and sit symmetrically (not to weight bear more on one side vs the other)
  • During standing, gently unlock your knees and gently pull your stomach inward while breathing normally
  • Self bracing of your stomach with your hands pushing the rectus together when sneezing, coughing or laughing
  • Wear a pelvic and abdominal support product to help maintain erect trunk posture and decrease pain until your muscles are aligned and strong

 

 

Pelvic PT highly rated in new IC Guidelines

The American Urological Association (AUA) released a new update to their 2011 Guideline on the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). The original guidelines included research studies up through 2009. This new revision includes research studies through 2013. Read the amended guidelines here!

“Although the science relevant to IC/BPS is continually improving and evolving, it is still a challenging and complicated condition to diagnose and treat,” said Philip Hanno, MD, who chaired the multi-disciplinary Panel that developed and updated the Guideline. “…this Guideline is fully aligned to the latest science and provides physicians with a relevant blueprint to treating patients.”

Developed as a treatment guide and planning tool, the 2011 guidelines introduced a six step treatment plan. Newly diagnosed patients generally begin with strategies outlined in Step One and then, if those strategies do not bring symptom relief, are advised to try Step Two treatments and so forth. The treatments are classified within the steps based upon their risk of adverse events and/or if the treatment is reversible. Surgery, for example, would never be used as a first line intervention because it is irreversible and could cause very serious complications. Rather, surgery is listed as a Step Six treatment and would only be considered after the patient has tried and failed the therapies listed in Step One Through Step Five.

Two Key Changes

Comprehensive Physical Therapy Encouraged

In Step Two, Pelvic Physical Therapy was suggested for patients who present with pelvic floor tenderness with the highest review possible, Grade A. It states:

Appropriate manual physical therapy techniques (e.g., maneuvers that resolve pelvic, abdominal and/or hip muscular trigger points, lengthen muscle contractures, and release painful scars and other connective tissue restrictions), if appropriately-trained clinicians are available, should be offered to patients who present with pelvic floor tenderness. Pelvic floor strengthening exercises (e.g., Kegel exercises) should be avoided. Standard (Evidence Strength Grade A).

Botox Therapy Rating Improved!

Botox A was reclassified from Step Five to Step Four. New research emerged which showed that using BotoxA at a lower dosage, (from 200u to 100u) substantially reduced the risk of a troublesome complication, the need for self-catheterization. If a Botox treatment silences the nerves which control urination, a patient may be forced to self- catheterize until the effect wears off, often for months. One criteria for the use of Botox is the ability of a patient to self-catheterize if necessary. If a patient is unable to do so, this therapy is not recommended. The guidelines state:

Intradetrusor botulinum toxin A (BTX-A) may be administered if other treatments have not provided adequate symptom control and quality of life or if the clinician and patient agree that symptoms require this approach. Patients must be willing to accept the possibility that post-treatment intermittent self- catheterization may be necessary. Option (Evidence Strength- C)

Learn more about IC Treatments, including all treatment options in the AUA Guidelines here!

Pelvic Pain App developed by Evelyn Hecht, PT

evelyn-and-joe-300x178

 

 

“She inspires us to not accept the status quo, to strive for wonderful things and not just acceptable things. There’s a lot of good nuggets of wisdom and interesting ways of looking at the profession. Some Apps are fun but the best are more about life”-  Dr Joe Simon

 

I felt this quote was the best to describe my thoughts about this interview. Dr Evelyn Hecht has been treating patients with Pelvic Floor Dysfunction (PFD) longer than there has been a doctorate program at my alma mater. But innovation is not the key to riches. Evelyn saw a need in the marketplace and decided unlike many in our industry not to wait for someone else to do it .

Lately i have consulted with more and more physicians and surgeons on their legacy or exit strategy. Evelyn is no where near the end , matter of fact , she is on the cusp of a new road in healthcare. Apps are a highway of free traffic from possible clients from around the world. Evelyn has just made it easier for the vast population to accept her as the expert in the field.

Pelvic floor therapy is a growth factor for practices across the country. This new specialization is growing with a medical network from physicians, physios & psychologists.

INTRODUCING, PELVIC TRACK a new app to help PATIENTS and practitioners to work together. The challenges associated with communication with the therapist dealing with pelvic floor therapy. Again , it was not looking for a better mousetrap but to create one that doesn’t exist from the need of her patients and her therapists.

The motivation for our new grad and younger (not age but career wise)  listeners. Evelyn has made strides and conquered the niche market. Marketing pelvic floor therapy through facebook, through her blog and now through her App is something i would ask all my listeners to take a deeper look at.

I hope you find the takeaways that I did.

For more info or to read the article directly click  HERE

To purchase or for more info on Pelvic Track App click HERE

Pregnancy achieved following manual pelvic physical therapy for Mechanical Infertility

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Sumer Samhoury, MSPT

Manual Physical Therapy can help some women with Mechanical Infertility achieve  pregnancy.   To understand what Mechanical Infertility is and how manual pelvic physical therapy helps, let’s first review the steps to becoming pregnant.

Mechanics of pregnancy

To achieve pregnancy, the process of ovulation and fertilization within healthy, mobile, and supported reproductive organs (ovaries, fallopian tube and uterus) without presence of adhesions & scar tissue has to occur. The steps to pregnancy are

 

  • The woman’s body releases an egg from one of her ovaries (ovulation)
  • The egg is grasped by the “fingers” of the fimbria, located at the ends of the fallopian tubes.
  • The egg travels through the open, non blocked fallopian tube toward the uterus (womb)
  • The man’s sperm joins with the egg (fertilization)
  • The fertilized egg attaches to the inside of the uterus (implantation)

Mechanical Infertility

Mechanical Infertility (MI) is defined as the inability to become pregnant due to intra pelvic and abdominal adhesions on/around or within the reproductive organs. MI affects approximately 2.5 million ( 40%) of the 6 million infertile women in the United States who have not conceived after 1 year of unprotected sexual intercourse.

Adhesions around the ovary can prevent the release of the egg (ovum) from the ovary. Adhesions can squeeze the fallopian tube (s)like a used tube of toothpaste, so the egg cannot travel to the uterus to hook up with the sperm.    Adhesions can pull the uterus out of a centered, midline position which makes implantation of the fertilized egg difficult. Adhesions within the uterus could increase uterine spasms which can result in miscarriage.

What are Adhesions?

An adhesion is a sheet or band of scar tissue that binds two parts of tissue or organs together.   Normally, with no scar tissue present, organs are slippery and they glide against each other. Adhesions can look like thin sheets similar to  plastic food wrap or they can be thick fibrous bands,  like ropes.  These bands of scar tissue can wrap around your internal reproductive organs squeezing them too tight or pull the organs out of their normal centered alignment which prevents their  optimal  function during pregnancy.

Cause of Adhesions

Adhesions naturally develop when the body’s healing/repair mechanisms respond to any tissue disturbance, such as surgery, infection, trauma, or radiation.  Our body naturally cleans a damaged area, which is followed up by the laying down of collagen fibers to replace the damaged tissue.  The replaced new collagen is haphazard, fibers get bunched up  and cross-links form. As healing time continues, cross links may grow into microadhesions, then adhesions and may eventually thicken into scars  When a woman has pelvic or abdominal surgery,  such as a C-section or other gynecological surgeries,  the only visible scar is on the outside where the incisions may have been made, but  tissue also heals on the inside,  resulting in internal scarring.

The formation of internal pelvic adhesions is known to accompany any inflammatory process, whether it be internal trauma and bleeding (ruptured ovarian cysts or ruptured appendix), Endometriosis, or sexually transmitted infections such as Chlamydia, Gonorrhea, pelvic inflammatory disease (PID).  Pelvic spasms, bowel obstructions and chronic abdominal/pelvic pain can also lead to adhesions.

The most common cause of adhesions within the uterus is due to previous uterine surgeries such as D&Cs either for abortions, miscarriages, or excessive bleeding. In addition, adhesions may be related to child birth when there are uterine infections or bleeding associated from childbirth, or if a Cesarean Section is performed.

What is Manual Pelvic Physical Therapy?

Manual pelvic physical therapy is a gentle hands on approach, no surgery, no drugs, to improve motion, decrease restriction and improve organ function. Manual therapy techniques for Mechanical Infertility can include:

  1. Myofascial Release to decrease restricted muscles and fascia (the web-like covering that surrounds all organs, muscles and nerves of the body)
  2. Visceral Mobilization to improve organ mobility and function
  3. Pelvic lymphatic drainage to reduce pelvic congestion

Myofascial Release is a safe and effective hands-on technique that applies gentle sustaining pressure to the restricted connective tissue to eliminate pain and restore motion. The slow sustained, gentle pressure allows fascia to elongate.

Visceral mobilization technique is a gentle hands on technique to release tight ligaments and connective tissue which surrounds and supports the internal organs. Just as a therapist would mobilize the shoulder for someone who has lost motion  tight  ligaments that support the organs also need to be treated.

The lymphatic system helps our body detoxify, drain stagnant fluids, regenerate tissues, filter out toxins and maintains a healthy immune system. Pelvic lymph drainage helps to re-circulate body fluids, stimulates the immune system and promotes relaxation and balance in the autonomic nervous system.

Pregnancy Achieved

In 2012, Doctor Mary Ellen Kramp, DPT published her infertility case study in the Journal of American Osteopathic Association demonstrating that 6 out of 10 women diagnosed with mechanical infertility conceived and delivered their healthy babies at full term following  manual pelvic physical therapy. These women were found to have mechanical infertility due to lymphatic congestion, sacral dysfunction and restrictions in uterine mobility and were treated with a group of manual therapies Dr Kramp described as above and  termed  “The Infertility Protocol”.

At EMH Physical Therapy, we received training to treat Mechanical Infertility and can offer this service to women to  help them achieve pregnancy.

 

Diastasis Recti Abdominis (DRA) or “Split Seams” can be treated by Pelvic Physical Therapy

Diastasis Recti Abdominis (DRA) can occur in up to 66% of pregnant women due to hormones that allow ligaments and joints to relax, the increasing baby size in utero, improper weight lifting (ie heavy food bags, other children, furniture etc), a history of prior C-section or  abdominal surgery and repetitive poor mechanics during daily activities and lack of regular exercise.

Men can also develop DRA due to faulty weight lifting mechanics, obesity and chronic medical conditions that result in frequent coughing such as bronchitis.

What is a DRA?

DRA is defined as the separation and thinning of the rectus abdominus muscles (see diagram in green) and stretching of the linea alba (see diagram in blue).  The linea alba runs from the xiphoid process (base of sternum)  to the symphysis pubis (center of pelvic bone).  Both the rectus abdominus muscle and linea alba are the main support for the front of the abdomen, keeping the visceral organs in place and functioning well.  They are also maintain pelvis stability during walking, lifting, bending and squatting.

What are the symptoms of DRA?

Symptoms may include:

Noticeable small or large bulge in the center abdomen

Sharp or burning abdominal pain during bending, lifting, standing and walking

Lower back pain

Feeling like the intestines or stomach may fall out

Poor posture

Longer term problems of prolonged DRA may include Stress Urinary Incontinence, Fecal Incontinence and Pelvic Organ Prolapse.

 

How To Measure for a DRA?

The best way to measure is a finger width measurement.  Lie on your back, knees bent,head resting on floor/pillow. Place tips of 4 fingers across the body at naval or just above/below the naval per your comfort.  Now raise your head and shoulders slightly upward. If your fingers descend inbetween the  parallel rectus abdominus muscles on either side of your naval, measure how many fingers move downward.  If there is a true split of the linea alba, your finger will fall into a space that feels squishy (your intestines live here!).  A positive DRA is one where there more than 2 fingertips (1 inch or 2.5cm width)  that lower.  We have measured women with 3 to 4 inches ( 8cm) wide and have helped them narrow back to 2.5cm width

 

What to Do if you have a DRA?

Best to first consult a pelvic physical therapist for a tailored postural, stabilization and home exercise program targeting the Tranversus Abdominus (deepest and lowest muscle of our abdomen), the pelvic floor muscles and the multifidi muscles (lower back stabilizers).

Here are some tips that you can do immediately:

Avoid positions that may further separate the recti muscles, like doing sit ups, crunches and quick trunk rotation movements.  Avoid being on “all fours”  or on hands and knees for too long during exercise classes.  Assuming the yoga, “cow position” where your belly drops down as your head and hips arch upwards,  puts too much pressure on the already stretched linea alba.  Plus, the yoga position of  “Up dog” and extensive backward bends are not recommended.

Stand and sit symmetrically in good posture  (don’t stand on one leg or sit with crossed legs leaning on one hip for too long)

When you are standing, gently unlock your knees and pull  your stomach inward while breathing normally to give abdominal  support and prevent “hanging out” on your ligaments

When you sneeze, cough or laugh you you can self bracing of your stomach with your hands pushing each side of the rectus abdominal muscles towards the midline, or hold a pillow against your stomach for bracing

Wear a pelvic and/or  abdominal support product to help support the growing baby in uteruo , maintain erect trunk posture and decrease pain until your muscles are stronger by doing core exercises.

By keeping your core toned during pregnancy and taking the steps to prevent further widening of your recti muscles, you can prevent extensive DRA.

 

 

Pelvic physical therapy is an effective non invasive treatment for Pelvic Organ Prolapse vs “high risk” transvaginal mesh surgery

The FDA recently deemed use of transvaginal mesh surgery to be “high risk” to repair pelvic organ prolapse.  See news link below:

http://www.philly.com/philly/health/womenshealth/HealthDay687309_20140429_FDA_Moves_Female_Incontinence_Device_to__High_Risk__Status.html

Pelvic physical therapy is a more effective and non invasive option.

In a 2014 study of 800 women with pelvic floor dysfunction (which includes pelvic organ prolapse) by University of Missouri, researchers found that ” incontinence, constipation, and/or pain improve by 80% with pelvic physical therapy”. Research shows that pelvic physical therapy plus a prescribed home exercise program works better than just engaging in one option.

Pelvic physical therapy teaches patients with pelvic organ prolapse how to build up the “floor” or muscular base of the pelvis. The pelvic floor muscles provide the main support for all pelvic organs. Kegels alone are not the only treatment option. If there is tension in the pelvic floor muscles, they need to to be released via manual therapies or risk further dysfunction. Sitting posture and good voiding habits are addressed, exercises are prescribed and body awareness improved.

EMH Physical Therapy has been providing successful pelvic physical therapy for 18 years in NYC. We have helped thousands of women return to better function. Call us today to get your prescription for pelvic health.