PT & Rehab: Physical Therapy and Pregnancy

The Newsletter About Your Health And Caring For Your Body

Physical Therapy During and After Pregnancy Keeps YOUR BODY HEALTHY!

FEBRUARY 2018 The Therapy Bulletin The Newsletter About Your Health And Caring For Your Body A Painful Truth About Pregnancy

Over the last 40 years, the average age of women having their first child has risen from 21.4 to 25 years of age. Due to the fact that many women are juggling both the demands of pursuing higher education and the competitive nature of today’s workforce, more women are having their first child after the age of thirty-five. As a result, many women becoming pregnant are less physically active in their daily lives. “This decreased activity leaves an alarming number of women under-prepared for the strenuous journey of carrying and delivering a baby” shares Madhu Rishi PT, DPT, owner of Physical Therapy & Rehab Specialists. During pregnancy, the most common areas where women experience pain are the pelvic girdle, lumbar region, and hips, says Sandi Gallagher, PT, of Oregon Health & Science University in Portland. She chairs the Certificate of Achievement in Pregnancy/Postpartum (CAPP-OB) Committee for APTA’s Section on Women’s Health. “In pregnancy, women are more predisposed to these conditions because of the ligamentous laxity that results from hormonal changes, and because a woman’s center of gravity and body mass are changing,” Gallagher explains. “So, any muscle weakness or joint instability that she had coming into the pregnancy increases her difficulty meeting the increased demands of her body’s changes.” Some people believe that back and pelvic pain during pregnancy will get better once the baby is born. However, that is not the case for all women. The literature is pretty clear that if women are having pelvic girdle pain early on in their pregnancy that isn’t treated, often it can become quite severe in the last trimester. Thirty percent of women who have untreated pelvic girdle pain during pregnancy later become chronic pelvic pain patients. Other common problems experienced during pregnancy include Diastasis Recti, which is the separation of the rectus abdominis muscle from the mid-line; above, at, or below the umbilicus. A separation of 2 cm and more is considered significant. The diastasis may appear during the second trimester and result in low back pain. After childbirth, women should have a follow up with a physical therapist in order to put back on a proper exercise and stretching

program. Some women notice changes after childbirth, that might have not been present during pregnancy. Again, these discomforts can be treated and include scarring, C-Section, episiotomy, or perineal tear, Pelvic floor weakness, Prolapse and Urinary or fecal incontinence. Most physical “ailments” experienced during pregnancy can be treated with physical therapy explains Amanda Srader PT, DPT a women’s’ health physical therapist at PTRS. “A physical therapist can help by starting an exercise program that is focused on balance and support. The best advice is to call a women’s health physical therapist to get individualized attention and guidance. We can help identify your problems and get you on the right track to overcoming your pain. As PTs, we are musculoskeletal experts. Part of our job is to teach our patients how to reengage their body and to move again in a way that makes sense with what is happening during pregnancy. At Physical Therapy & Rehab Specialists we encourage that kind of creativity of movement. We help you get stronger.”


Often during pregnancy, women experience discomfort, pain, and even urinary incontinence. Frequently, physicians who treat them— whether general practitioners or obstetricians—give similar advice: “It’s because you’re pregnant. It will go away after you give birth.” But that’s not what research shows, states Valerie Bobb, PT, DPT, ATC, director of the women’s health program at the Baylor Institute for Rehabilitation in Dallas, Texas. “Research has shown that for 80% of women, if pain or urinary incontinence hasn’t resolved itself 3 months postpartum, it’s not going to,” she says. A study published in BJOG: An International Journal of Obstetrics and Gynecology found, for example, that among women who reported having urinary incontinence at 3 months, 76.4% reported having it at 12 years. Common post-pregnancy conditions that can be related to problems with the pelvic floor can last beyond the first six months or strike later in some women include: • Urinary Difficulties Women with urinary incontinence leak urine when they sneeze, cough, or run. Some women feel a frequent or sudden, compelling urge to pee, even when their bladder isn’t full. Others are unable to start the flow of urine at will or empty their bladder completely when urinating. • Anal Incontinence Many postpartum women have trouble controlling gas or bowel movements. • Perineal Pain This is common in postpartum women, especially those who tore during childbirth or are recovering from an episiotomy. (The perineum is the area of skin between the vagina and the anus.) A tight pelvic floor causes some new moms to experience persistent perineal pain, even after their wound heals. • Pelvic Pain Some women have pain during sex for many months or even years after childbirth. And some have chronic pain, itching, or burning in their vulva – the tissue surrounding the opening of the vagina. This can make it hard to tolerate wearing tight clothing and even underwear. Others have pain during bowel movements. These symptoms are often caused by tight pelvic floor muscles, which can lead to inflamed tissue and nerve endings.

• Pelvic organ prolapse When pregnancy and childbirth weaken the pelvic floor muscles, one or more of the organs they support – the uterus, bladder, and bowel – can slip out of place. Rehabilitating these muscles can help prevent or improve this condition. Do Kegels help? “It depends on what’s causing your symptoms. Kegels are exercises you can do to support your pelvic floor muscles. Your doctor may have recommended doing Kegels and may help some women, particularly those with weak pelvic floor muscles. But many women are not taught to do Kegels correctly. And if your problem is caused by chronic tightness in the pelvic floor muscles, practicing contracting but not releasing them can actually make the muscles tighter and the symptoms worse” explains Madhu Rishi PT, DPT. “Instead, these muscles need to be retrained so you can tighten and then relax them when you need to.” At Physical Therapy & Rehab Specialists are here to help you throughout your pregnancy and after. You can live a normal life free from pelvic floor dysfunction.

No Doctor Referral Necessary Whether you want to come in for a check-up, suffered a recent injury or you want to improve your health, a doctor referral is not needed. In the state of Michigan you have direct access to physical therapy!

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Improve your health naturally

See our physical therapists for: • Recent injury • Nagging aches and pains • Back and neck pain • Joint pain and movement problems • Walking or balance difficulties

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CHILD’S POSE Try this movement if you are experiencing back pain. Exercise Essential

Kneel on the floor, buttocks resting on heels if possible. Stretch arms forward as far as you can. Let head and trunk hang heavy to the floor.

Do What’s Good For The Heart!

1. Aim for lucky number seven. Young and middle-age adults who slept 7 hours a night have less calcium in their arteries (an early sign of heart disease) than those who sleep 5 hours or less or those who sleep 9 hours or more. 2. Keep the pressure off. Get your blood pressure checked every 3-5 years if you’re 18-39. If you’re 40 or older, or if you have high blood pressure, check it every year. 3. Move more. To keep it simple, you can aim for 30 minutes a day, 5 days a week of moderate exercise. Even if you exercise for 30 minutes a day, being sedentary for the other 23 1/2 hours is really bad for your heart. 4. Slash saturated fats. To help your heart’s arteries, cut down on saturated fats, which are mainly found in meat and full-fat dairy products. Choose leaner cuts and reduced-fat options. 5. Find out if you have diabetes. Millions of people don’t know that they have this condition. That’s risky because over time, high blood sugar damages arteries and makes heart disease more likely. 6. Think beyond the scale. Ask your doctor if your weight is OK. If you have some pounds to lose, you’ll probably want to change your eating habits and be more active. 7. Ditch the cigarettes, real and electronic. Smoking and secondhand smoke are bad for your heart. If you smoke, quit, and don’t spend time around others who smoke as well. E-cigarettes are popular, but they’re not completely problem-free. They don’t contain the harmful chemicals in cigarette smoke but, they still do contain nicotine, so your goal should be to quit completely, not just switch to a less toxic version. 8. Clean up. Your heart works best when it runs on clean fuel. That means lots of whole, plant-based foods (like fruits, vegetables, nuts, and seeds) and fewer refined or processed foods (like white bread, pasta, crackers, and cookies).

Healthy Recipe


INGREDIENTS • 1 head leaf lettuce • 3 pears • 5 ounces Roquefort cheese • 1 avocado • 1/2 cup thinly sliced green onions • 1/4 cup white sugar • 1/2 cup pecans

• 1/3 cup olive oil • 3 tablespoons red wine vinegar • 1 1/2 teaspoons white sugar • 1 1/2 teaspoons prepared mustard • 1 clove garlic, chopped • 1/2 teaspoon salt • Fresh ground black pepper to taste

INSTRUCTIONS In a skillet over medium heat, stir 1/4 cup of sugar together with the pecans. Continue stirring gently until sugar has melted and caramelized the pecans. Carefully transfer nuts onto waxed paper. Allow to cool, and break into pieces. For the dressing, blend oil, vinegar, 1 1/2 teaspoons sugar, mustard, chopped garlic, salt, and pepper. In a large serving bowl, layer lettuce, pears, blue cheese, avocado, and green onions. Pour dressing over salad, sprinkle with pecans, and serve.

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