On November 3rd 2019, Molly Caughlan completed the New York City Marathon for the very first time! We at Beyond Basics are so proud and overjoyed for her! She ran to raise money for multiple sclerosis research. Read her last update before the big race, here!
I sit here writing this blog with just 6 days left to go before the big race. I’ve been tapering down milage, taking time to rest, stretch, and strengthen. The forecast, fingers crossed, is looking very ideal with highs in the mid 50s and looking like sunshine all day. I’m nervous, excited, and feeling confident that I’m going to cross that finish line.
Since my last blog, I’ve hit just a few bumps in the road with my training. In September right before a critical long run (my first 18 mile run), I had an acute onset of posterior tibialis tendonitis that made it difficult to even walk on. I was devastated and had to hold on running any distance all together. I was feeling incredibly anxious because of how close I was getting to the big day and at the thought of skipping such an important training notch. While I was healing, I did a Hot Vinyasa class that I hadn’t done in a while that help me hit a reset button and set up a strategy to manage these symptoms. I took a whole week off from running and had two sessions with Tina as well as doing some self treatment with modalities (ice/heat). I also had an acupuncture treatment with something called dry needling to my calves with a treatment for chi energy deficiency. With ALL of these treatments combined, the first run I did I was FLYING! I had so much energy and was going at such a fast pace that I shaved a few minutes off of my traditional 5 mile run. Things have been looking up since that week in September and looking back now, resting was the most important treatment I could have done.
As part of my training, I ran the New York Road Runner’s Brooklyn Half Marathon October 19 and had such an amazing time. The end of the race was in Prospect Park, which is essentially my back yard and where I’ve been doing a lot of my training. This helped me to finish strong and break my own personal record for a half marathon with a time of 2:07.
As the days wind down, I’m looking forward to having some of my family members come visit just so they can support me on Sunday. I’ll have support from my local friends on the sidelines and, with the help of modern technology, will have the spiritual support from friends across the country. I’m eager to see all of the other anonymous supporters with their signs and I’m excited to have all of this energy boost me across the finish line.
Last but not least, I must say that I am still working on my $5000 fundraising goal and I’m 71% of the way there. I’m sponsored by an organization called Team Tisch MS that performs groundbreaking research to discover the cause of Multiple Sclerosis, understand disease mechanisms, optimize therapies, and repair the damage caused by MS, as well as offering patient access to the best and most advanced treatment possible. Support Team Tisch MS by donating to my fundraiser!
Okay, you’ve got the referral in your hand. You have found the clinic that seems perfect for you. You are ready to improve your health and go to physical therapy (GO YOU!). But what if it doesn’t work? Your Aunt Gladys did great after her treatment and is back to hiking after a hip replacement, but your brother Dale is still struggling with his knee pain. Why? Will you be like your dear auntie or will you be like Dale? Is there anything you can do to improve your chances of absolutely rocking physical therapy (PT)? The answer is yes. There is a lot you can do to help speed your progress in PT.
One of the most common questions I get as a physical therapist, second only to “why did this happen to me?” is “how long will it take to get better?”. The answer is variable and to explain my answer, I hop in the way-back machine and bring back a picture of a standard distribution from high school.
I explain that most of my patients fall in the middle of the bell curve, and are seen for 7-10 visits. These patients tend to be pretty regular with appointments and more or less do there home exercise program regularly, with room for lapses due to normal life events. The middle is a really good stable place to be.
Now, there are always people far from the middle on the right side who just blow me away with how much better they do and how quickly they improve. They tend to be folks who don’t have many other conditions going on medically, manage stress well and tend to keep pretty healthy lives. These folks also tend to be very dedicated about adhering to their home exercise plan. Also, in my clinical experience, this accelerated group tends to not have had their condition for a long time, which speeds their recovery.
What about people on the left side, who stay in PT for a long time? This is definitely a tough group to be in and you can end up in this group due to factors both inside and outside of your control. People in this group may have many conditions contributing to why PT is taking so long. They also may not be able to keep regular appointments due to outside circumstances and adhering to a home program may be difficult, or they may have other medical conditions complicating recovery. Though this group is a challenging group to be in, we can still work on speeding up PT in small ways just as we can in other groups.
We can’t always control our lives, how long we’ve had conditions, and our medical histories, but everyone has the ability to make the most out of PT. In this blog, we will discuss the factors that are in your and your physical therapist’s control to get the best out of your physical therapy experience.
Set Realistic Goals with Your Physical Therapist
When we physical therapists meet a new patient, we always make PT goals to help guide our treatment. These tend to be pretty dry and based on things like range of motion, strength, etc.,. But really, what is most important is what you want to do. Often times we think exclusively of our pain at the expense of function. Think very specifically about what you want to do or what you could do if your pain was more manageable. Do you want to dance? If so, for how long? What type of dancing? Do you want to sit at work comfortably for 1-2 hours? Do you want to get on the floor and play with your 1-year-old? Being specific about your goals serves a dual purpose. It helps us zero in on exactly how to conduct our treatment and it provides you with motivation when life gets crazy, PT gets hard or you have a setback, and the last thing you want to do is your home program.
We work a lot on constipation here at Beyond Basics, but that’s not what I’m talking about. Regular appointments can help us augment a term we call “carry over”. Carryover is one of the most important things we try and achieve as physical therapists. It’s all well and good to improve pain, range of motion, or strength but if it only lasts a day or two, what good is it? Many of the things we do are cumulative and may require a few visits relatively close together to get things to stick. A practical way to get regular appointments is to schedule way out in advance to ensure you get the appointments that best fit with your schedule. I often have my patients schedule 10-12 appointments out. With the best case scenario being they don’t end up needing them, which is fantastic but they have them if they need them. I also encourage my patients to get on our clinic’s waitlist if they can’t get appointments. Many physical therapists will experience cancellations during the week, and can often fit patients in when it appeared at first that they were completely booked. If you can’t get in, speak up. Physical therapists don’t want you to lose your progress either, they will often work with you to make sure you get seen.
The home program is one of the most important parts of physical therapy. Even if you are going to PT relatively frequently, 3 times a week or so for one full hour, you are still spending less than 2% of your time in PT, versus 98% of your time in the real world. Although I truly believe in the work of myself and my colleagues, most people really need to take PT home with them in terms of their home program. It takes a lot to change how your body moves and works. Muscles take time to grow, the nervous system takes time to learn how to use them and or calm down, and inflammation takes time to go away. It often takes a lot, either a large injury or years of repetitive microtrauma to get yourself at a point where you find yourself in need of physical therapy. It can take a lot of consistent work to get to recovery. A good home exercise program can really help shorten your time at physical therapy and ensure that the results you achieve stick around for the long haul.
Don’t Let Perfect be The Enemy of the Good
Some physical therapists can prescribe a ton of exercises. They usually do this because they see the potential for your improvement, but sometimes neglect the fact that the real world exists and spending over an hour a day on physical therapy is not always possible. Yours truly is often guilty of this. If you feel overly burdened by your home exercise program (HEP in PT lingo), don’t throw the whole thing out. Pick 1 or 2 exercises you can do consistently until you next see your PT. When you see your PT next, discuss your HEP with them. Your HEP may need a revamp, or your physical therapist may work with you to find ways for you to be more consistent with your HEP, or they may help you to prioritize your exercises into “must do”, “should do” and “nice to do” exercises. We don’t take offense to this type of frank talk, because it helps us help you get better.
Your HEP Should Evolve as Your Needs Evolve
The super buff guy or girl at the gym isn’t lifting the same amount as the day he or she started lifting weights. As he or she got stronger, they progressively increased the challenge of his or her program. The same thing should happen with PT home programs. Your program may not change week to week but the program should be regularly updated as you improve. If this isn’t happening ask your therapist why your plan has not progressed, they may have a good reason or they may welcome the nudge to push you to harder activities.
Do Your Research
Physical Therapy practices can vary a lot and some can be better suited to fit your individual needs better than others. What do you value? Would you rather have 1 on 1 time with your physical therapist, or would you thrive in a place surrounded by other patients working out together? Does your physical therapist have an interest in treating your condition? Has your physical therapist contributed to the field in ways outside of clinical practice, like getting advanced certifications, teaching new students, or contributing to the literature? The website of a prospective clinic is a good place to start. Often times, you can find information on what the general treatment approach is like, as well as the personal biographies of physical therapists you may be working with to see if they will be a good match. If you still have questions, call the clinic. Often times the front desk can set you up with someone to answer your questions.
At Beyond Basics Physical Therapy, we value 1 on 1 treatment in order to give our patients the most individualized treatment possible. We believe this treatment allows us to treat our patients as efficiently and return them to full function sooner. We are the experts on pelvic floor dysfunction in both adults and children, but also offer expert treatment for orthopedic conditions with advanced orthopedic physical therapists. We offer phone consults to our patients to help them determine if we are the best clinic for them. If you are thinking we might be a good fit for you, give us a call today at 212-354-2622 for our Midtown location and 212-267-0240 for our Downtown location.
Finding a good PT and going to physical therapy can seem like a lot, and sometimes it is. That being said, the rewards are often so spectacular. There is nothing like being able to do what was once painful or extremely difficult with the help of physical therapy or avoiding a surgery because of physical therapy. When setting out on your journey remember: do your research, do your HEP, and be open with your physical therapist about what’s not working and what is. After that, the sky’s the limit.
Fiona McMahon PT, DPT treats at our Midtown location
Is kegeling the one true way to a healthy pelvic floor? Not always. We can end the blog here. Just kidding, of course there is nuance to be considered here. But as pelvic floor physical therapists, nothing is more cringe inducing than hearing the phrase “just do your kegels” thrown around for myriads of ailments from low libido, to pain, incontinence, and erectile dysfunction. While it is true the pelvic floor muscles can be involved in all of these conditions and in some cases kegels may help, there are many cases where kegels are the EXACT opposite of how you should be treating these muscles.
To understand kegels we must first understand the pelvic floor. To understand the pelvic floor we must also explain the muscles at a very basic level. Bare with me readers, this will help us as we bust through this myth. Muscles, all muscles do what they do, by contracting and getting shorter to produce force. This is easy to see on a bodybuilder doing a bicep curl. As she curls her hand up you can see these muscles shortening into a little ball. Not only is this a great way to show off your gains in the gym, the shortening of these muscles are providing the strength to perform this task. We call this shortening a concentric contraction. Kegels are concentric contractions too! A good kegel will cause the pelvic floor to shorten and provide strength. Let’s go back to our body builder for a second. She has done her lift now she needs to lower her dumbbell back to the floor. In order to lower that dumbbell back to the floor in a controlled way, she needs what’s called an eccentric contraction, which is the controlled lengthening of the muscle. If she did not have a good eccentric contraction she may not be able to lower that weight effectively after she curled it. What if she couldn’t lower her bicep at all or just very slowly after her bicep curl? Maybe her weightlifting wouldn’t be as effective, she’d tire more easily, or she could develop pain. Would you tell this woman that more bicep curls would help? Or might you suggest a program of stretching first? Telling someone to do kegels, when you don’t know the status of their pelvic floor and how well it can relax is similar to telling the bodybuilder with the non relaxing bicep to just do more bicep curls. At best it certainly won’t help the situation and at worst it could cause more pain and dysfunction.
“But Fiona, I have incontinence, so that definitely means I have weaknesses, so it’s good for me to do kegels, right?”. Maybe… but in my experience, probably not. Let’s agree on one thing, it’s completely intuitive that people would think that kegels would help incontinence. The muscles of the pelvic floor are responsible for continence… so they must be weak if one is experiencing incontinence. You are right! When we think weak with muscles, we often think weak and loose, which is one form of weakness, but we rarely think weak and tight. Let’s go back to our body builder lady. She deserves a name at this point. Let’s call her Kendra. If Kendra has a tough time moving her lifting her arm from fully straight to a full bicep curl, we could guess she is weak and loose. But if Kendra could not fully straighten her arm out she would be considered weak and tight. Both of these versions of Kendra would have trouble curling heavy weight. One Kendra due to frank weakness another Kendra because she simply does not have enough room or range of motion to generate enough force to curl that dumbell.
Tight and weak pelvic floors are a lot like second Kendra with the poor ability to lengthen her arm. Tight pelvic floors have less range of motion to generate force. You need a good amount of force from the pelvic floor to counteract the pressure of activities like lifting, coughing, laughing and sneezing and stay continent. Over loose and over tight pelvic floors can’t really do that.
If you have pain in your pelvis not from a medical condition, (although tight pelvic floors present with many medical conditions), your pelvic floor is probably tight. A tight pelvic floor may also have trigger points which can send pain to various locations in your genitals, back, legs, and abdomen. Continuing to tighten can cause this pain to get worse.
So how do you know what to do? This is where a skilled pelvic floor physical therapist can come in handy. They can assess the muscles by touching them either externally or internally to determine what course of action is right for you. If you are loose and weak, HAPPY DAYS! Strengthening can help them get better. If you have tight and weak muscles, HAPPY DAYS again! Gentle lengthening, stretching and down training of the muscles can help them get better. Did you know, because a tight pelvic floor can cause weakness itself, returning the proper length to the muscles can restore strength, without actually needing to kegel?! Wild! Regardless of the situation happy days can be ahead.
Really knowing the pelvic floor is a skill and requires advanced expertise. Kegels should not be initiated, unless the physical therapist has carefully examined your pelvic floor. Not all therapists are trained to do that technique so it is important to inquire about their background before starting pelvic floor PT. There are a lot of different ways to treat the pelvic floor, to read more What is Pelvic Floor Physical Therapy . If you are interested in learning more give us a call at 212- 354-2622 for a free consult if you live in the greater NY/NJ/CT area.
Breastfeeding, for all its two-way benefits, requires the mother to share her body and she often ends up feeling like the health of the baby comes at the cost of her well-being—physical, mental, and social. Physical activity improves all three realms for the mother but activity may be postponed because of the assumption that it will negatively affect the baby’s growth. Can a mother have it all–breastfeed a growing baby and get return to pre-baby weight? Multiple studies and reviews show that moderate physical activity and weight loss does not negatively impact milk supply or infant growth.
Should intentional weight loss be considered during the postpartum period?
Yes, for most mothers. At one year postpartum, about one in six women retains 10 pounds or more of weight gained during pregnancy. The weight gain during and after pregnancy often stays with the mother into post-childbearing years setting up for metabolic diseases and orthopedic complications (10). While moderate physical activity itself is not sufficient for postpartum weight loss (6), physical activity remains an integral part of restoring the body’s set point in conjunction with dietary modifications. Moderate physical activity influences maternal health not only through weight control but also mental wellbeing, bone health (9), functional tolerance, sleep quality, and establishing family patterns of recreation. Breastfeeding itself requires high levels of energy, 300-600 kcal/day (5), and is associated with improved postpartum weight management long-term over 24 months (2), but not short term within 3 months (4).
Does exercise for intentional weight loss affect milk supply?
No, for most mothers. However, when breastmilk is the sole source of nutrition, a fussy baby protesting or rejecting a feed can be worrisome. Multiple studies have shown that exercise is not related to decreased milk supply, milk quality, or infant growth (1, 3, 6). Some studies show that over time, moderate exercise is related to increased milk supply (7). Some babies show a distaste for post-exercise breast milk. Lactic acid produced in vigorous levels of exercise may be associated with a decreased acceptance of breastmilk (8), but it resolves within 30-60 minutes of exercise (1, 13). Weight loss in most situations, but particularly while breastfeeding, should not exceed 0.75-1 pound/week (6, 9, 12). Wait until milk supply is established for more aggressive caloric restriction.
Intensity: Most studies evaluate moderate exercise intensity, roughly measured as the ability to talk, but not sing during the activity. Depending on the mother’s fitness level, the activity varies from walking to jogging. Vigorous activity is cautioned mainly because of the lactic acid buildup that is associated with poorer baby nursing.
Duration and frequency: 45 minutes, 5 days/week for cardiovascular. 30 minutes, 3-4 day/s week for resistance training (6).
If not exercise, what else affects milk supply?
Despite the normalcy and frequency of breastfeeding, we have yet to fully understand the complexity of the mechanism to regulate calories and nutrition, to replenish based on need, and what can increase or decrease milk supply. While baby’s quantity and quality of nursing most directly affects supply, more subtle influences like maternal food and liquid intake, exercise, sleep quantity and quality, cortisol slopes (11) also contribute to short term milk supply fluctuations.
Anything else before squeezing into the WunderUnders?
Fatigue. At 6 weeks postpartum, the majority of mothers do not yet have their normal level of energy (9) making additional activity difficult and almost incomprehensible to include into long days. Physical activity is only one part of wellness in the postpartum period.
Fussy baby. Full breasts contribute to uncomfortable and leaky exercise. If possible, feed your baby before heading off to exercise. Clean off the sweat after exercise, wait for 30 minutes if your baby seems fussy after exercise.
Good fitting bra. The balance of support for comfort and managing compression to protect milk ducts is the goal for your sports bra. Take off your bra when feeding to allow for complete emptying of the breasts and maintaining supply.
Hydration. Although hydration is more important for mother thirst than milk supply, increase fluid intake during and after exercise by about 1 liter (5). Attend to the thirst signal.
Baby and mother health. Although studies show that physical exercise does not detrimentally affect infant growth nor maternal health, consult with your healthcare practitioner if baby or mother aren’t following expected patterns.
A postpartum exercise plan should be a gradual and systematic return to previous level of activity. The physical therapists at Beyond Basics Physical Therapy safely guide women through this postpartum period to address multiple factors in recovery and return to fitness.
1 Carey GB, Quinn TJ. Exercise and lactation: are they compatible?. Canadian journal of applied physiology. 2001 Feb 1;26(1):55-74.
2 da Silva MD, Oliveira Assis AM, Pinheiro SM, de Oliveira LP, da Cruz TR. Breastfeeding and maternal weight changes during 24 months post‐partum: a cohort study. Maternal & child nutrition. 2015 Oct;11(4):780-91.
3 Daley AJ, Thomas A, Cooper H, Fitzpatrick H, McDonald C, Moore H, Rooney R, Deeks JJ. Maternal exercise and growth in breastfed infants: a meta-analysis of randomized controlled trials. Pediatrics. 2012 Jul 1;130(1):108-14.
4 Elliott SA, Pereira LC, Guigard E, McCargar LJ, Prado CC, Bell RC. Association between breastfeeding, maternal weight loss and body composition at 3 months postpartum. The FASEB Journal. 2016 Apr;30(1_supplement):45-.
5 Kolasa KM, Firnhaber G, Haven K. Diet for a healthy lactating woman. Clinical obstetrics and gynecology. 2015 Dec 1;58(4):893-901.
6 Lovelady C. Balancing exercise and food intake with lactation to promote post-partum weight loss. Proceedings of the Nutrition Society. 2011 May;70(2):181-4.
7 Lovelady C, Lonnerdal B, Dewey KG. Lactation performance of exercising women. The American Journal of clinical nutrition. 1990 Jul 1;52(1):103-9.
8 Mortensen K, Kam R. Exercise and breastfeeding. Breastfeeding Review. 2012 Nov;20(3):39.
9 Mottola MF. Exercise in the postpartum period: practical applications. Current sports medicine reports. 2002 Dec 1;1(6):362-8.
10 Nascimento SL, Pudwell J, Surita FG, Adamo KB, Smith GN. The effect of physical exercise strategies on weight loss in postpartum women: a systematic review and meta-analysis. International Journal of Obesity. 2014 May;38(5):626.
11 Straub H, Simon C, Plunkett BA, Endres L, Adam EK, Mckinney C, Hobel CJ, Thorp JM, Raju T, Shalowitz M. Evidence for a complex relationship among weight retention, cortisol and breastfeeding in postpartum women. Maternal and child health journal. 2016 Jul 1;20(7):1375-83.
12 Thein-Nissenbaum J. The postpartum triathlete. Physical Therapy in Sport. 2016 Sep 1;21:95-106.
13 Wright KS, Quinn TJ, Carey GB. Infant acceptance of breast milk after maternal exercise. Pediatrics. 2002 Apr 1;109(4):585-9.