One Fish, Two Fish

By Riva Preil

Forgot where you put your car keys?  Do you find yourself blaming those “pregnancy hormones” for occasional forgetfulness?  Believe it or not, it might not be the hormones talking…rather it might be your diet.

Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) and two fatty acids present in fish oil that are highly recommended for pregnant women.  These fatty acids facilitate brain development in the growing fetus.  In fact, studies have shown that children develop motor skills approximately two months faster if they received these important nutrients during pregnancy.

DHA helps with the development of motor skills, language skills, and the ability to concentrate.  EPA helps with mood enhancement and development of positive outlook.  If your diet is lacking DHA and EPA, your baby will snatch them from YOUR brain!  This can result in forgetfulness …so remember to eat your fatty acids.

Many obstetricians recommend fish oil as an excellent source of fatty acids.  However, not all fish oils are created equally.  Salmon, tuna, and sardine based oils from a CLEAN ocean are recommended.  In addition, you want to make sure that the oil underwent MOLECULAR DISTILLATION purification process (please refer to this link for more information).


In Case You Missed Them: Great Health Resources!

In case you missed them, here are a few great resources and insights about pelvic health from the last few weeks.

Sex Therapist Talli Rosenbaum on The Pelvic Messenger, Interviewed by Alexandra Milspaw, PhD, LPC
On The Pelvic Messenger radio show, internationally renowned sex therapist Talli Rosenbaum spoke with healthcare educator Alexandra Milspaw about using mindfulness techniques to help treat pelvic pain. Check it out here.

Invitation to Dialogue: Alternative Therapies by Dr. James Gordon, The New York Times
With rising healthcare costs, Dr. James Gordon has sought to open a dialogue about the benefits of alternative medicine in place of costly medications and surgeries. Do you think it’s a valuable option? Check out the article in the New York Times here.

Interview with Amy Stein–Author of Heal Pelvic Pain by Sara K. Sauder, DPT
Amy was interviewed by Sara K. Sauder, DPT of Sullivan Physical Therapy! Check out the link to the interview here, and read Amy’s insights into physical therapy’s role in pelvic pain.

A Pelvic Knowledge Primer

By Riva Preil

“Pelvic Floor” is the new buzzword.  You have read about it in Elle and Prevention, you saw Amy discuss it on the Dr. Oz Show, and you do your Kegels religiously, as you have been instructed by your OB-GYN.  But really now, what the heck IS the pelvic floor?

If you have ever found yourself wondering the aforementioned question, you are not alone.  You along with many others don’t truly understand what the pelvic floor is.  After all, it is a relatively small, unfamiliar area of the body which (hopefully) functions on autopilot, and its awareness is only drawn to our attention when it is not performing its tasks properly.  Dysfunction of the pelvic floor may manifest as urinary and/or fecal incontinence, sexual dysfunction, or pelvic pain, to name a few symptoms.

I don’t know about you, but I am a VISUAL LEARNER.  It is much easier for me to wrap my brain around concepts when I can see the structures being discussed.  That being said, I encourage you to check out the following 3D anatomy tutorial about the pelvic floor here.

It includes the skeletal structure, muscles, tendons, and pelvic floor organs.  I am well aware that most people don’t get as excited about anatomy as I do, but this video is excellent, informative, and extremely clear.  Even though it never went viral on YouTube, it happens to have more than 150,000 hits, for what that’s worth!  (I promise, they are not all from me)

Next time you visit your doctor or pelvic floor physical therapist, you will know exactly what they are referring to when they mention the pubococcygeus muscle or the pubic symphysis.  Enjoy your newfound knowledge!

All the Pregnant Ladies

By Riva Preil

Beyoncé has given a shout out to all the single ladies, and now I will do the same for all the pregnant ladies. Last week I discussed acupuncture for pregnant women, and today I will take the opportunity to discuss EXERCISE DURING PREGNANCY.

The benefits of exercise during pregnancy are innumerable! Exercise decreases low back pain, decreases constipation, improves sleep, and improves flexibility. Furthermore, it improves overall self-perception and body image during those nine blessed months, when the body undergoes changes (and dimensions) it has never previously experienced.


  • Walking
  • Pre-natal yoga
  • ANYTHING aquatic related (ex. swimming, water aerobics, even simply walking around in the pool! Exceptions: Refrain from the performing the breaststroke- it’s not friendly to the pre-natal pelvis.  Furthermore, when pushing off from the pool wall, use BOTH legs simultaneously)
  • Light weight training
  • Low impact exercise


  • Plyometric type exercise (exercise that involves sudden change in direction and/or intensity)
  • Heavy bouncing movements
  • Heavy resistance training
  • Contact sports
  • Any exercise that involves holding your breath
  • Asymmetrical positioning/weight bearing activities (ex. Yoga tree pose position)
  • Excessive twisting (lumbar rotation)

For a PERSONALIZED PRE-NATAL PROGRAM, ask your obstetrician for a referral to physical therapy. We here at Beyond Basics Physical Therapy are prenatal pros, and we would be happy to help design a personal exercise program that suites your specific pregnancy needs. Good luck, and good health!

Pinpointing Prenatal Pelvic Pain

By Riva Preil

As any expectant or previously pregnant woman can attest, the body undergoes major changes during the nine glorious months of pregnancy.  One noteworthy change involves a particular hormone called relaxin. Relaxin is a very appropriately named hormone- it’s job is to relax the pelvic ligaments to allow for widening of the pelvis. This is required in order to accommodate the growing fetus during pregnancy and in preparation for labor and delivery. Additional relaxin is produced during the first trimester of pregnancy, and it peaks at 14 weeks of pregnancy and at delivery.

The results of increased relaxin include hemodynamic changes that occur during pregnancy, such as increased cardiac output, increased renal blood flow, and increased arterial compliance. It also softens the pubic symphysis.  This makes the pelvic region more susceptible to shifting out of alignment which can produce pain.

A recent study conducted at Gothenburg’s Institute for the Health of Women and children analyzed the effect of acupuncture on pregnancy related pelvic pain. Participants were divided into three groups:

  1. Standard home exercise program
  2. Standard home exercise program with acupuncture (three six-week treatments)
  3. Specialized exercise program aimed at improving mobility and strength, no acupuncture

Pain levels were recorded every morning and evening in all three groups.

The group that experienced the greatest pain relief was the group which received acupuncture, followed by the group which received a specialized exercise program.  Acupuncture is believed to release the body’s natural pain killers, an obvious perk considering that many women are hesitant to ingest extraneous medication during pregnancy.

Therefore, in addition to pelvic floor physical therapy, acupuncture is a highly recommended avenue for the approximate 33% of expectant mothers who experience severe pain. If you think that you or someone you know may benefit from this approach, please speak to your medical care provider. We here at Beyond Basics are pleased to offer both skilled physical therapy intervention for pregnant women as well as acupuncture with our experienced acupuncturist, Paula Haberman!  Please contact us if we can help you in any way.

Cracking the Colon Color Code

By Riva Preil

Recently, I had the opportunity to discuss the medical information that can be gleaned from one’s urine (refer to What Version is Your Urine? April 11, 2014).  Today, I have a similar opportunity to do so regarding … bowel movements!  Warning: If you are enjoying my blog while eating your lunch, or if you are about to do so, you might want to hold off until you have finished eating.  Just thought you would appreciate that public service announcement.

That being said…stool is the body’s garbage.  Waste products, dead blood cells, bile, gastrointestinal bacteria, and other non-absorbable items (remember that time that you accidentally swallowed that penny?  Yep, that’s what I’m referring to) are excreted in one’s bowel movements. Stool is covered in a mucus sheath to help it slide out of the body.  Those who don’t drink enough water may experience straining and discomfort while passing a bowel movement, because mucus production is dependent on adequate water intake (8 cups a day).

The color of one’s stool may provide valuable information regarding one’s health.

  • GREEN stool may indicate sensitivity to Anise oil, an ingredient found in some licorice candies.  It may also indicate that stool is passing through the large intestine (aka colon) too rapidly for bile (which aids in the digestion of fats) to be fully broken down.  This may also occur when one consumes large amounts of green leafy vegetables and/or artificial food colorings.
  • WHITE or clay colored stool may indicate a bile duct obstruction, perhaps by a gallstone, enlarged lymph node, or scarring of the bile duct.  Other symptoms that accompany bile obstruction include abdominal pain, dark urine, and jaundice.
  • YELLOW stool that smells like sour eggs and appears greasy may indicate excessive amounts of fat in the stool. This is a common symptom of Celiac Disease, during which bile does not properly break down fat
  • BLACK stool could be a result of too much Pepto-Bismol, black licorice, or even beer.  However, if the stool is black, sticky, and foul smelling, it may also be a result upper gastrointestinal tract bleeding.  One should seek medical attention if they experience the aforementioned symptoms.
  • BRIGHT RED stool, as with black stool, may simply be the result of overconsumption of certain foods (ex. beets, cranberries, tomato juice, red gelatin, or Kool-Aid)…or it may indicate lower gastrointestinal tract bleeding.  Once again, one should consult with their physician if they suspect anything “out of the ordinary.”

For more information check out this article, “What Your Poop Is Trying to Tell You,” on Gizmodo!

The Hysterectomy and Chronic Pelvic Pain

Often because of the lack of understanding behind chronic pelvic pain, a hysterectomy is performed in hopes of eliminating said pain. The problem is that this can also to rectify the problem. In her latest blog post, “Hysterectomy for chronic pelvic pain? Ask these 7 questions first,” Dr. Jen Gunter, board certified in OB/GYN and pain medicine, discusses some questions to ask yourself to see if a hysterectomy is really necessary. For starters, have you checked for Irritable Bowel Syndrome? Have you seen a pelvic floor physical therapist?

Before undergoing such a serious surgery, it’s important to make sure there are no other possible alternatives, that your pain could not have another cause. Imagine undergoing a hysterectomy and discovering your pain was still there? It can be traumatizing, and to save yourself the trouble, give Gunter’s list a good read-through, link above. She’s a smart cookie, and we like her up-front style. And of course, come talk to us if you have any concerns about your chronic pelvic pain–physical therapy can be a tremendous help, and we’re glad to help ease your pain!

Pelvic Pain in the Media

This coming Friday, May 9, at 5pm EST, 2pm PST, Amy will be participating in a discussion about pelvic pain in the media on The Pelvic Messenger radio show, hosted by founder Elisabeth Oas.

Pelvic pain has, to say the least, been very underrepresented in media. Amy will be discussing her experience promoting pelvic pain awareness. This will include what changes she has seen in the media as a pelvic health expert for the last 15 years, from her experience on Dr. Oz and ABC’s 20/20 to Prevention magazine and Elle magazine.

Amy will also be discussing her new DVD, Healing Pelvic and Abdominal Pain: The Ultimate Home Program Guide and a Guide for Practitioners. If you have a question about the Dr. Oz show on which Amy appeared, or the Prevention or Elle articles, please call into the show! Elisabeth and Amy will randomly be selecting callers to receive a free copy of Amy’s new DVD.

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Posture Ponders

By Riva Preil

“Sit up straight and be mindful of your posture!”  These may not have ever been anyone’s famous last words, but they are definitely ones that most of us have heard at some point or other in our lives, probably from parents or teachers.  (Would it be terrible if I were to confess that I was chided on the matter during physical therapy graduate school by one of my professors?  #practicewhatyoupreach!)

Many people admit it is difficult to be mindful of their posture at all times, and they are accustomed to their old poor habits.  While old habits die hard, nevertheless practice makes perfect.  That being said, I challenge you to rise to the occasion (literally and figuratively) and to commit yourself to improved biomechanical alignment.

Julie Wiebe, a physical therapist with over seventeen years of clinical experience in sports medicine and women’s health, has created a fantastic video demonstrating how to achieve proper posture. Julie also discusses the delicate balance between posture, the diaphragm, and the pelvic floor.  I encourage you to watch the video (approximately three minutes only) in order to better learn how to maneuver your body and achieve optimal biomechanical alignment.  Thank you, Julie, for your contribution to the health and wellness of so many individuals!