Caring for yourself in the 4th Trimester

The term 4^th Trimester has been widely used to explain a newborn infant’s transition into the world. While this is extremely important and should be a large part of your focus after giving birth to your little one, it is also wise to not forget about yourself. I’d like to take some time to discuss how mothers should take care of themselves during this 4^th Trimester. New research states it can take 18 months for a woman’s body to heal post-partum and this 4^th Trimester can be the foundation for a complete recovery.

Most importantly, surround yourself with a supportive team with YOU being the main focus. Let them care for you, cook and clean for you while you rest. Make things as easy on yourself as you can.

Lie down as much as possible. This is important as you heal and your uterus shrinks back down. This added pressure can cause the vaginal wall collapse (prolapse) so take this weight off by lying horizontally or even prop your tush up on pillows.

This is the perfect time to start doing kegels. Due to swelling and the recent trauma, you might not be able to feel your pelvic floor muscles contracting. One trick is to sit in a chair and feel your perineum (the area between the anus and the scrotum or vulva) lift from the chair. Another trick is to lie on your back with pillows under tush and let gravity help you contract and lift those muscles. If you have incontinence, see a pelvic floor therapist.

Lastly, protect and assist your Rectus Abdominis muscle (6-pack muscle) by using tape and avoiding “sit ups”. Diastasis Recti has been getting a lot more attention lately but it still can be misunderstood or even overlooked by your doctor. All pregnant women who carry to term will have a separation of the rectus abdominis muscle along with stretching of the linea alba. Use the log roll technique to get in and out of bed by rolling on your side to get on or off you back to avoid opening a diastasis more. Also, I have found that taping can help assist with the closure of the Rectus Abdominis as well. A therapist can place this on you and teach you how to do independently as well. I would be careful with the popular corsets or girdle shapers out there as they increase abdominal pressure and place additional force on your pelvic floor worsening prolapsed.

In summary, use this 4^th Trimester to take care of yourself and listen to your body. If you think you are not healing properly make an appointment with your doctor, see a pelvic floor therapist; be your own advocate. After all, you have a little precious baby depending on you now.

Here at Duffy and Bracken Physical Therapy we have great pelvic floor therapists that can help equip you both pre and post natal. Give us a call to schedule your assessment. 

Candice Amat, PT, DPT

Pelvic Floor Therapist

(212) 402-5430

Top 7 Reasons EVERY Woman Should See A Pelvic Floor Physical Therapist After Having A Baby

This likely doesn't come as a surprise to you, but when it comes to women's health, the US is pretty far behind the eight ball. While we do have extensive measures in place to help ensure a safe gestational period and delivery, our healthcare system does very little in the way of caring for women following childbirth. In fact, our society has virtually taken the opposite stance, writing off those post-partum pathologies as normal, or part of the territory, thereby convincing women that they don't actually need to seek medical guidance. This couldn't be further from the truth. 

Childbirth is an extremely traumatic event for a woman's body. During a vaginal delivery, the muscles of the pelvic floor are significantly stretched and can tear. Cesarean deliveries decrease tearing at the pelvic floor, however the muscles of the abdomen do not fare as well as they are cut and stretched to allow the baby to be retrieved. Let's also not forget the 40 weeks during which the pelvic floor muscles need to support the weight of that growing baby. 

Enter pelvic floor physical therapists. As explained on my website, TheMovementMaestro.com, a trained pelvic floor therapist is able to evaluate your pelvic floor via an internal and external exam and assess muscle function directly. Additionally, pelvic floor physical therapists understand the relationship between the pelvic floor and the rest of the body, therefore making them well-suited to identify how dysfunction at a different part of the body could cause pelvic floor dysfunction and vice-versa. 

More specifically regarding the aftermath of childbirth, pelvic floor physical therapists, unlike the doctors delivering your baby, are concerned with YOUR functionality, YOUR ability to return to all the tasks required of you on a daily basis, and getting you back to doing all the things that YOU enjoy doing. If I haven’t convinced you yet, here are 7 reasons why EVERY woman should meet with a pelvic floor physical therapist, even if it’s only once, after having a baby.

 1. You and your baby shouldn’t be in diapers at the same time.

Although urinary incontinence is common both during and following pregnancy, it is NOT normal. Most women will either be informed by a health care provider that incontinence will go away on its own and to not worry about it, or they will be welcomed into the sisterhood of mothers by a female relative or friend with the sage advice that incontinence is part of having a baby and to just accept it. The only truth regarding these statements is that every time one of these phrases is uttered, a kitten dies. Incontinence indicates pelvic floor dysfunction. While it may resolve over time without formal intervention, the pelvic floor generally remains weak and is working on reserve capacity. To that end, it's not uncommon to see this incontinence returning down the road or following subsequent deliveries. Additionally, urinary incontinence isn’t the only type of incontinence caused by a dysfunctional pelvic floor. Two words for you, ladies: fecal incontinence. Pelvic floor physical therapists treat both urinary and fecal incontinence, often achieving full resolution of symptoms. Save the Huggies for your kid and get in to see a pelvic floor PT.

 2. Sex isn’t supposed to hurt.

Tearing is a very real part of childbirth, with the aftermath being scarring and tightening of tissues of the pelvic floor. Additionally, hormonal changes can lead to vaginal dryness. A pelvic floor physical therapist can work with you to decrease scar tissues, loosen tight muscles, and give you helpful hints on how to get your groove back. 

 3. Your organs should remain on the inside of your body.

The trauma and weakening of tissues that is associated with carrying and delivering a baby can cause what is known as pelvic organ prolapse. In layman's terms, this is when your insides end up on the outside. A falling or sliding out of place of the vagina, uterus, urethra, or rectum can occur, and can vary in severity from slight descent where the organ remains inside the body, to full prolapse where your organs are resting on the treatment table. Google it. It's real. Pelvic floor therapists can not only identify and assess a prolapse (many women don't even know they have the early stages of this), but they can provide exercises to prevent or improve this condition. Hint: there's more to it than just kegels. 

 4. Your belly button should be the only "hole" in your belly. 

As the abdominal muscles stretch during pregnancy, a split can develop at the central connective tissue of your six-pack. This connective tissue is known as the linea alba, and when it separates, it is referred to as a diastasis (di-as-ta-ses) recti.  I'm not sure that I need to go into detail as to why having a hole in the middle of your abs is bad, but let's start the list with back pain, core weakness, and breathing dysfunction to name a few. Like incontinence, diastasis recti a very common occurrence, however, it's advisable that you meet with a pelvic floor therapist so s/he can asses the size of it  (in finger-widths) and recommend not only exercises to help it close, but movements and activities to avoid so as to prevent it from getting any bigger. 

 5. Walking and exercising shouldn’t make you feel like your pelvis is going to break into a million pieces.

Many women experience pelvic and low back pain during pregnancy secondary to hormone-related changes that cause laxity in the pelvic ring. Most women think that this pain will automatically go away once that 8lb baby is no longer inside of them. Fast forward a few months and these same women want to kill their partners for helping them get pregnant once they realize that childbirth does not magically rid them of all of their hip/pelvis/low back pain. Pelvic floor physical therapists can help...a lot. Soft tissue techniques, exercises, movement modifications, the list goes on and on. PTs can help with the pain and get you back to being you. 

 6. C-sections are no joke.

Far too often I hear women say they want to schedule a c-section and avoid the aftermath of a vaginally delivery. Clearly these women have never spoken to anyone who has actually had a C-section. The trauma experienced by the abdominals during a C-section is significant, and often renders a woman unable to do much of anything for a few weeks. Imagine having your abs and uterus cut open, your insides sifted through like a game of hide and seek, a 7lb baby pulled out through a 4-inch incision, and then everything sewed up. I really can’t imagine doing much more than blinking my eyes after something like that, nevermind coughing, sneezing, pooping, or taking care of a human life. Pelvic floor physical therapists help women deal with what comes after the c-section, from regaining abdominal strength to preventing back pain and scar adhesions in the future.

 7. Kegels don’t work if you do them wrong. 

I have plenty of moms coming into my office telling me how their incontinence never went away even though they tried doing kegels a couple of times. Here’s the deal: 1) If you’re not performing a kegel correctly, utilizing all the layers of the pelvic floor (wait… there’s more than one layer? More on this in upcoming posts), and getting a full 360 degree contraction, you’re squeezing in vain. 2) The pelvic floor works in conjunction with the rest of your ‘core’, and requires not only the participation of the rest of those muscles for proper functioning, but correct pelvic alignment. Long story short, there’s more to it than just kegels. Let a pelvic floor physical therapist assess your ability to perform a kegel and then instruct you on functional exercises to help facilitate normal pelvic floor function.

I realize that once you have a baby you have very little time to take care of you. That is even MORE of a reason to get in and see a pelvic floor PT. A therapist can and will work with you to educate you on things to avoid and empower you with the knowledge of how to TREAT YOURSELF. Additionally, most therapists are super understanding and are more than willing to having you bring in your baby with you if childcare is an issue. Pain, dysfunction, and wetting your pants does NOT have to be your reality following child birth. Pelvic floor physical therapists are here to help. To locate a pelvic floor physical therapist in your area click here.

C. Shante Cofield, PT, DPT, OCS, CSCS 

Shante@duffyandbracken.com

Pregnancy Aches & Pains

Every pregnant woman dreads being a victim to pain! You can't pop any medications and if you really need some relief you can ONLY take Tylenol.

Why do we have to experience pain & discomfort during such a wonderful experience? 

So let's understand pain and pregnancy. During pregnancy our bodies change shape, that's because of a hormone called Relaxin that allows our joints and muscles to loosen up to accommodate the weight gain. Our breasts become larger, waists widen and hips become round. This increase in SIZE makes our muscles work harder.

In a nutshell, the pain and discomfort we feel just points to the structures and areas of our body that are being overloaded! Rather than getting alarmed or accepting pain, speak out and seek help. Your best bet is a physical therapist that can help you to alleviate pain through joint techniques and teach you stability exercises so your weak areas become strong.

At Duffy & Bracken we see at least six pregnant women per week with pain....with successful outcomes. We explain why that particular area hurts and then offer solutions to avoid undue stress.

Stay tuned for later blogs were I will cover how pregnancy affects individual areas like your spine, feet and pelvis in more detail.

Renuka Pinto, MPT, PGDR, CSCS, CES

P3 Pregnancy Program: Don't Become A Statistic!

P3 is a program I developed after my first pregnancy to help women achieve their full potential as moms to be and new moms!

Let's back track a few years, after I gave up my stint with the sports world where I spend almost a decade of my career......and settled into my current Downtown NYC clinic!

Every day we saw women for pregnancy related headaches, shoulder, back and knee pain and then two years later I found myself pregnant...... and I decided "NOT ME", I'm not becoming a statistic.

So the P3 pregnancy program was born four months after the birth of my first child and of course I repeated the program again when I had my second.  

So come along with me on this journey through my blog where I will share tips, secrets, and honest truths plus teach you how to have the best pregnancy journey ever!  

Stay tuned and check out an overview of the program below.

Renuka Pinto, MPT, PGDR, CSCS, CES

The P3 Method: Plan, Prepare, Prevent

The P3 Method is tailored to your particular needs and is even covered by some health insurance plans. The class is held by appointment only, and can be scheduled at your convenience.

Your custom program may include the following:

MANUAL THERAPY

One-on-one, hands-on approach to address musculoskeletal changes

PELVIC MUSCLE RE-EDUCATION

A technique that uses computerized equipment to measure baseline pelvic floor strength at onset of pregnancy and then re-train pelvic floor post delivery

PELVIC FLOOR EDUCATION

Kegel and breathing techniques to facilitate integrity of pelvic floor

POSTURAL RE-EDUCATION AND MOVEMENT TECHNIQUE

A visual and proprioceptive feedback is utilized to adapt to bodily changes

 

STRENGTH BUILDING

GRAVITY small-group personal training is a non-impact tool to help build muscle strength and cardio efficiency

CUSTOM SHOPPING

Individualized education on baby products in relation to your body type and muscle strength (e.g. sling versus carrier)

BABY TRAINING

Specific stretches and strengthening exercises to prevent post-delivery musculoskeletal breakdown when caring for your newborn

GETTING YOUR BODY BACK

Post-delivery exercise program to get back to your pre-pregnancy weight

Q&A

Tips on how, what, when, and where while pregnant, immediately postpartum, and post-labor

© Total Gym

DIARY OF A PREGNANT THERAPIST!

For my last blog before going on maternity leave for the first time, I felt inspired to share some reflections related to my experience during pregnancy which has enhanced my insight as a physical therapist. This may peak the curiosity of others interested in the topic of pregnancy or even on the topic of creating new physical experiences.

As I have undergone childbirth preparation classes and read material on natural childbirth in hope of promoting a birth experience as normal/natural and, believe it or not, enjoyable as possible, it has been repeatedly pointed out that the prevalent portrayal of childbirth as a painful and dangerous experience has created a fear of this experience and belief that this description is inherently true. Thankfully, there is a widespread body of resources that helps to transform these beliefs into confidence in a woman's innate ability to birth. This makes a very simple point that fear of the birth process creates resistance to and intolerance of the physical experience of labor, and that by both understanding the physiology of normal uncomplicated labor and trusting the natural ability of mother and baby to safely complete the process, this fear can be eliminated, allowing an entirely different birth experience to unfold.

So though one of the hottest topics during pregnancy is the birth itself, there is a lot of "story" about what "happens to" a woman's body during pregnancy as well. A conversation develops about the potential dangers of childbirth as well as the potential for injury due to pregnancy. This includes not only impact on the mother's body during birth but during pregnancy and in life after pregnancy. What I found novel is that while it is well established that these unfortunate perceptions of childbirth are prevalent in modern civilized societies, so might our perceptions of the experience of carrying a child before and after birth be influenced by cultural expectations. What became tangible for me was that much like I wanted to undo my learned cultural beliefs about childbirth, I could change my perception of what my body was experiencing as pregnancy progressed. Though I felt that I possessed helpful knowledge that would enable me to care for myself and "prevent injury", I still needed to believe in nature's design just a little more.

To build upon this conversation, I would like to also point out that so far the conversation is talking about the mother as a pregnant individual, not a mother and child living, moving, birthing, and continuing to live together with ease, harmony and comfort, and actually establishing a relationship (though perhaps not with a lack of new sensation and experience for both parties).

Let me illustrate what these changes in perception boil down to for me. There were times I was distressed because of pain while walking. However, as the baby grew it dawned on me that I was already the mother of this baby.Then a bigger picture emerged illustrating that just walking down the street pregnant was at this stage already an activity in our parent-child relationship. I began to realize that it made sense that I could move in a natural way (though perhaps slower) with her (yes, it's a girl!), and not only feel less pain but feel happy in my new relationship. Sensations that I felt as physical stresses (abdominal muscle strain, pubic bone pressure when I walked or sacroiliac pressure with changing positions) began to be perceived differently- as evidence that my baby was resting on certain body parts of mine or guides for me to move with more mindfulness. Feeling “out of breath” and extra work in my legs going up stairs changed into “taking in more air” for the two of us.

Now am I saying that pain is all in the mind? No. Have I enjoyed the benefits of physical therapy to prevent, prepare and manage? Absolutely! Though attention to physical wellness continues to play an important role, what has also contributed to me feeling better and better while walking and moving are perceiving things in the following ways:

1. RELAXING and trusting that my body can "carry" my baby without additional effort or injury if I let it. In the early stages I noticed that as I walked there were times I tensed muscles around my waistline and in my hips, exerting effort to “carry the baby”.  When I realized I could relax all those muscles and move in a way that was harmonious with her, I soon saw that my body did not feel added stress. 

2. Building on the point about relaxing, being sure to BREATHE PROPERLY. Though the growing uterus takes up space near the diaphragm and ribcage, the diaphragm can still do its job. A breathing pattern which primarily originates in the diaphragm and is not restricted by tension in the shoulders, ribcage, abdomen or pelvis is an essential component of efficient posture. Being able to maintain efficient breathing is a good sign that you are feeling good!

3. TAKING TIME to move, whether it’s getting up, moving in bed, walking or squatting, not just because of being heavier or that it’s “harder”, but because “moving for two” may take that extra bit of mindfulness to negotiate how to move in a way that is kind to my body. I’m not saying that you couldn’t still run in the Olympics if you wanted to, but as for me, no more running for the bus!

As a PT, I have learned important lessons from experiences as the caretaker of my own human body which enhance how I help others help themselves. Whether you are carrying a baby in your womb, a child in your arms or even bags of things in a city schlep, I invite you to create a new language for what it is you are doing. Is there some way you could create more ease for your body, create more harmony between you and the person or things you are carrying, or learn to trust your body more? Time and time again it is a relief to find out that breathing easier and relaxing more creates more efficiency, comfort and pleasure in the body. If you are unsure of how to create ease in your body - pregnant or not - schedule an appointment with a physical therapist...we can help!

Sara Chan, PT, CFMT