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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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Chronic Pain and sexuality: How Eva Margot Kant, LCSW-R helps people navigate these issues

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(Image courtesy of Eva Margo Kant, LCSW-R)

The National Institute of Health (NIH) defines chronic pain as pain lasting more than 3 months and it affects more than 100 million Americans today.  As a pelvic floor physical therapist, I help patients with both acute and chronic pain, more specifically pelvic pain, on a daily basis. Due to the private nature of pelvic floor issues, sexual dysfunction, or bowel and bladder complaints it can be difficult for patients to feel comfortable talking about their symptoms.

The famous quote, “no man is an island,” rings true for healthcare providers who treat chronic pain as multiple specialists working together is more effective than one. I recently met with Eva Margot Kant, LCSW-R  with 12+ years of experience helping people deepen their self-esteem, navigate life’s transitions, and address fears and questions about chronic illness/pain which includes topics of sexuality and sensuality. Eva taught me some great perspectives on how she helps people heal their emotional/sexual wounds and how they can be a source of chronic pain.

Eva runs workshops about sex and disability, sex and aging and trains medical students how to talk about sex with their patients. Her goal is to help people “unpack their feelings” that are attached to physical pain and anxiety. Anxiety increases the output of the limbic system, the emotional flight or fight, and memory areas of our brain which results in pain.

Eva believes that “understanding how the body works is the key to understanding you”.  Her job is to help people understand what their sexuality is to them and to own how they view and understand it.  Eva believes that “the body always remembers.” She likened the reflexive blink of an eye that’s about to be poked to the feeling a woman with sexual pain feels if her partner demonstrates affection. The woman may fear that any show of affection may lead to sex which is painful for her, so she avoids this.

Eva’s goal is to help patients learn if some physical reflexive tightening may be due to thoughts involving shame, guilt, or embarrassment.  She helps clients decide when to disclose to a new partner about their chronic condition. She stressed the importance of self-care with their partner and to feel emotionally safe. People who have chronic pain/illness may go thru life as if they are “holding their breath.” Often times Eva finds that partners want to help, they just don’t know how. Demystifying chronic pain/illness allows partners to be supportive and an active participant in healing.

Eva’s upcoming book and course work, called “The Holy Trilogy of Sex (c),” guides patients and their partners in sensuality, sexuality, and intimacy; none of which are possible without communication, sensation, and connection. She encourages partners to engage in body mapping: offering each other a “menu” of intimate ideas that can promote togetherness without causing more pain.

As a Pelvic Physical Therapist, I invite my patient’s partner to a session to observe, learn, and understand what my patient is experiencing and teach the partner ways they can help. I work on the physical aspect of pain with my manual, movement and exercise therapies while Eva addresses on the mental and emotional aspects of chronic pain which leads to a more efficient outcome.

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EMH Team; Jennifer Jurewicz, Tova Laufer & Charissa Morrisroe with Eva Margot Kant, LCSW-R

If you have chronic pelvic pain consider receiving both physical and talk therapy to get your life back on track.  Consider visiting us at EMH Physical Therapy and Eva Margot Kant, LCSW-R if you are in the NYC area. Your pelvic floor with thank you!

Resources:
http://evamkantlcsw.com/
http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm

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“Cupping”: not just for Olympians

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Were you watching the Olympics this summer wondering about those red circles on Michael Phelps’ shoulders? Those marks, called “sha,” are from an ancient Chinese healing technique known as “cupping.

Cupping has been around for over 5,000 years. It’s practitioners stated it released toxins and helped correct imbalances in the flow of energy.

There were two cupping types: dry and wet. Dry cupping is performed when a glass bulb with a smooth rounded lip is suctioned onto the skin via heat. Either a cotton ball is lit on fire and used to generate heat inside the cup, or alcohol is rubbed around the rim and lit on fire before being placed on the skin.

The heat inside the bulb generates a vacuum like effect, producing a negative pressure on the connective tissue or fascia under the skin pulling the skin upwards (1).

The resulting  “sha” are painless broken skin blood vessels which heal in 3-7 days.

Wet cupping was administered in the same way, except the skin is slit prior to application to allow blood to escape (2).

This method is rarely used today.

Myofascial Decompression – cupping in the 21st century

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The modern application of cupping by physical therapists is known as “myofascial decompression.”

The purpose of myofascial decompression is to:
  • reduce adhesions, scar tissue of skin and connective tissues
  • restore normal mobility
  • improve efficiency of movement.

Instead of glass bulbs, hard plastic cups are used and instead of heat generating a vacuum, a hand pump suctions the skin. This allows for a more precise application of pressure.

The application of cupping is done with the “cup” device left in place for 5 – 10 minutes or slowly moved back and forth over the restricted area.

How can we – non super-human species – benefit?

While more studies are needed the literature thus far shows some positive effects from myofascial decompression (3), including decreased neck (4) and low back pain (5).

Empirically, we at EMH Physical Therapy observe that the cupping technique combined with functional movements reduces pain and releases tight tissues quicker for patients with painful cesarean scars, plantar fasciitis, scoliosis and other conditions.

Keep in mind that cupping is an adjunct treatment, used alongside other types of manual therapy, therapeutic exercise and neuromuscular re-education at the discretion of your physical therapist.

References

1. Kravetz, R.E., 2004. Cupping glass. The American Journal of Gastroenterology 99, 1418.
2. Xue, C.C., O’Brien, K.A., 2003. Modalities of Chinese medicine. In: Leung, P.-C., Xue, C.C., Cheng, Y.-C. (Eds.), A Comprehensive Guide to Chinese Medicine. World Scientific, Singapore, pp. 19–46.
3. Cao H, Han M, Li X, Dong S, Shang Y, Wang Q, et al. Clinical research evidence of cupping therapy in China: a systematic literature review. BMC Complementary & Alternative Medicine 2010;10:70.
4. R. Lauche, H. Cramer, K. -E. Choi et al., “The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain—a randomised controlled pilot study,” BMC Complementary and Alternative Medicine, vol. 11, article 63, 2011.
5. Y. D. Kwon and H. J. Cho, “Systematic review of cupping including bloodletting therapy for musculoskeletal diseases in Korea,” Korean Journal of Oriental Physiology & Pathology, vol. 21, pp. 789–793, 2007.

 

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Having trouble losing the “Mom Belly” Post Baby?

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

checkyoself

 

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)

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Other Resources:

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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.

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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!

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

 

 

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.

 

 

Women’s Pelvic Health

Women's Pelvic Health

 

 

Check out this link ( link) to see Evelyn’s interview on physical therapy for women’s pelvic health in the Los Angeles Times. The app, Pelvic Track, is now available on the Apple store.

 

 

Painfree sexual intercourse during Menopause: Helpful tips by a Pelvic Floor PT

Physical therapists have helped women in menopause return to painfree, satisfying sexual intercourse. These women could experience pain with intercourse, even after rehydrating their vaginal tissues under the guidance of their GYN, due to pelvic floor muscle tension.   The pelvic floor is a group of muscles located at the bottom of the pelvis  surrounding the vaginal canal.  Intercourse requires that the muscles be flexible to be able to receive the penis and strong enough to contract to provide more intense orgasms.    All healthy muscles have a normal length during rest.  Unhealthy muscles have knots/fascial restrictions so they are stuck in tight position during rest.  So with a tight pelvic floor, the penis cannot enter and women can experience pain.

How to gain a healthy pelvic floor?  Treatment by a physical therapist trained in pelvic floor dysfunctions is optimum as we provide you with tailored manual expertise and guidance to heal.  Here are some helpful tips:

1)      STRETCH HIP/GLUTEAL MUSCLES Stretch the large muscles of your hip, and buttock region as they can actively refer pain into the pelvis and cause the pelvic floor muscles to overwork or be strained.  By actively stretching the hip flexors, hip external rotators, inner thigh (adductors), groin and hamstrings,  the pelvic floor is released and can function optimally.  Hold each static stretch for 30 seconds, done twice,  2x’s times a day.

2)      VISUALIZE A RELAXED PELVIC FLOOR   Chronically tight pelvic floor muscles need many reminders to relax throughout the day.   Every time you look at the watch or your mobile phone, ask yourself, “Where is my pelvic floor?”   Think about the area softening, melting, widening. Use any visualization that is calming to you, send a healing color to your pelvis to bring awareness and “let go”.

3)      BREATHE  Diaphagramatic breathing helps to relax the abdominal and pelvic regions.   Lie on your back, pillow under your knees. Place your hands on your stomach, bent elbows resting by your sides.  Inhale slowly through your nose for a count of 5 seconds.  During your inhalation, allow your stomach expand into your hands. Visualize your pelvic floor muscles widening as well.   With each inhalation,  imagine or visualize the pelvic floor muscles expanding in all directions, front, back , left , right.  Slowly exhale for 5 seconds. Repeat 5 times. Do once in morning and at night.

4)      NEUTRAL PELVIS Set up your computer/reading/art work space to fit your body versus your body having to adjust to the environment.  The chair should be at a comfortable height so your feet are supported either on the floor or a raised footrest.  “Good posture” is when a neutral spine in maintained.  When sitting, your weight should be on center of your pelvic bowl, your lower back resting against a lumbar cushion. The lumbar cushion gently pushes your lower back forward to maintain it’s natural curve.  You should not slump back to sit on your coccyx bone, nor too far forward on your pubic bone and no sitting on one side/hip for hours at a time.      Here is where a PT can really help you gain knowledge and best position of your body.

5)      SELF STRETCHING INTRAVAGINALLY  This is a technique where you can stretch the intravaginal tissues by inserting a clean left thumb intravaginally up to the level of the first thumb joint. Gently press or sweep your thumb along the right vaginal walls providing a deep stretch.  Do a few sweeps from the midline towards bottom of the right vaginal wall.  You can hold a few areas that feel tight or uncomfortable.   Then insert the right thumb intravaginally and sweep or apply pressure points along the left side of the vaginal wall.  Repeat a few times each side. Do once a day.

6)      DILATORS Dilators are also used to help women prepare for intercourse and to apply pressure to tight spots within the vaginal walls to stretch. Your PT can guide you on how to use them.

7)      PELVIC FLOOR STRENGTH   Once your pelvic floor muscles are lengthened, a basic pelvic floor strengthening program can begin. Your physical therapist can teach you how to best recruit these muscles without co contraction of the hip adductors, hip extensors, and breath holding.  A basic pelvic floor strength exercise can be done by holding a contraction for 10 full seconds, resting/relaxing for 20 seconds. Repeat this 10x’s.   Then do 10 quick contractions and quick relaxations, repeated 10x’s to stimulate the fast twitch fibers of the pelvic floor which are innervated during orgasm

8)      SQUAT Squatting exercise helps to lengthen the pelvic floor and increases the strength of your hip and buttocks muscles.  When performing either a quarter, half or full squat in good alignment, this provides great balance of the pelvis and pelvic floor muscle function.

9)      AN ORGASM A DAY… Yes, an orgasm a day keeps all the pelvic muscles happy and healthy