Beyond Basics’s Pro-Bono Clinic for PT Day of Service!

201510_blog_globalptdayofservice

Victoria LaManna, DPT

October is around the corner! And a busy month for many. Whether you are getting back into the swing of school or work after summer vacation, preparing your Halloween costume or getting ready for all the upcoming holidays right around the corner – there is a lot going on!
This time of year is also an opportunity to do good and give back. October is National Physical Therapy Month, where physical therapists celebrate their amazing field of healing and getting people back to optimal function. In addition, many of the PT’s throughout the U.S. give back to their communities during this month. This year we are taking it up a notch. Physical therapists WORLDWIDE are getting involved for the second annual Global PT Day of Service Saturday, October 15th. Whether it is by hosting a pro-bono clinic, serving in a soup kitchen, participating in a 5k for a cause, or cleaning up a community garden – physical therapists globally as a profession are coming together to make a positive impact on the world around them.
At Beyond Basics, we have decided to host a pro-bono clinic Saturday, October 1st to give back to those in the New York City area who may not have insurance or access to physical therapy. We are providing 30 minute one-on-one evaluations and recommendations for home programs to up to 30 participants. For more information and to sign up please visit: http://signup.com/go/Nu1T4Q
You can also check out PT Day of Service here and follow on twitter (#PTDOS) to see how the day unfolds! http://ptdayofservice.com/
The American Physical Therapy Association (APTA) is also involved in hosting National Physical Therapy Month. This year the APTA’s focus is on it’s national public awareness campaign, #ChoosePT. This campaign lets consumers know about the risks of opioid use and that physical therapy is a safe, non-opioid alternative for managing pain.
I encourage you to check out educational resources provided by the APTA (www.apta.org) and Move Forward PT (http://www.moveforwardpt.com/Default.aspx). Learn all about how physical therapy can help you overcome pain without the use of opiods, improve mobility and maintain independence throughout your lifetime.

day-of-service

Amy is Live with Integrated Pelvic Health!

Fiona McMahon DPT

amy2016What would you ask a pelvic floor physical therapy expert about exercise, or about the pelvic health as an athlete, if you had the chance? Don’t miss Amy Stein, founder of Beyond Basics Physical Therapy and author of Heal Pelvic Pain answer some commonly asked questions in a webinar hosted by well-renowned Jessica Drummond of Integrated Women’s Health Institute. Jessica is a nutritionist specializing in abdomino-pelvic health and dysfunction.  She will be interviewing Amy on the athlete and pelvic floor dysfunction, treatment paradigms, and practical tips for relieving the under active and the overactive pelvic floor.

Details:

Time: Friday, Sept 23, from 12-1pm EST.

Place: www.facebook.com/IntegrativePelvicHealth

Remember this interview can be replayed later if you cannot view it live.

 

 

Resources for Pelvic Pain:

Beyond Basics Physical Therapy: http://www.beyondbasicsphysicaltherapy.com/

 

Heal Pelvic Pain: http://www.healpelvicpain.com/

 

Integrated Women’s Health Institute: http://integrativewomenshealthinstitute.com/

 

Link to hear Amy and many other wonderful pelvic health experts speak in December about the female athlete and pelvic floor dysfunction:

https://km132.isrefer.com/go/WIWH/AStein/

 

A Fitbit for your Vagina?!

Fiona McMahon, DPT

Elvie

 

For a while you could find me strolling around the clinic with a little fitness tracker on my wrist. I used it to track my steps, sleep, and heart rate. I’m a girl who loves gadgets and apps. From Venmo to Spotify, technology enriches my life and makes it easier. So when Elvie sent their kegel trainer to Beyond Basics, I jumped at the chance to volunteer myself guinea pig, to try out this new fitness tracker.

 

Unboxing, Aesthetics, and Set Up

Man, oh man is the product design gorgeous on this one. It comes in a beautiful silver embossed box with the tagline “ your most personal trainer”  ( wink, wink, nudge, nudge). Inside there is an inch diameter cylinder “vessel” for lack of a better term, which houses the Elvie tracker. The vessel functions as both a carrying case and a charger. It’s pretty slick looking.

The Elvie itself looks like a little tadpole with a tail. It’s about an inch long and half an inch in diameter not counting its little tail. There is also an optional cover provided in the box, which may be more comfortable for some ladies.

The whole set up: The tracker had the feel of opening an iphone, in that the directions provided in the tracker were kept pretty minimal. There was a small pamphlet with cleaning instructions, on charging, how to insert, and exercise. As a pelvic floor physical therapist, I definitely felt that the instructions on how to properly kegel left a lot to be desired. The instructions were literally two bullet points instructing the user not to hold her breath or tighten her buttocks, while she lifts her “pelvic floor”. For many of my patients, I find that they come to me with little knowledge of how to properly kegel or are doing it wrong, “lift the pelvic floor” is rarely a cue that allows for a fully correct kegel.

My next step was to download the Elvie app. I have an iPhone 6. You need a smartphone to run the elvie. They recommend iPhone 5 or later or Android phones running version 4.3 or later. The app download was easy. It was time to get started.

 

Elvie: Day 1

The moment of truth had arrived. Time to insert one of the cuter inanimate objects I had come accross “up there”. “Bye, little guy. Safe travels” I thought as I bid Elvie adieu. Insertion was no problem. For me, it was pretty comfortable, the caveat being, I have a pretty healthy pelvic floor. The one thing I did not like was that Elvie’s tail kept bopping me in the clitoris, which wasn’t very comfortable. Other than that no complaints.

The first thing I did was try and trick Elvie into thinking I was kegeling when I wasn’t (I really want to ensure this thing is fool proof). Elvie is unfortunately a gullible little thing. Bulging my pelvic floor, ( mimicking the action you would do to have a bowel movement, essentially the opposite of a kegel) and thrusting my hips tricked Elvie into thinking I was doing a really good job when I wasn’t. My favorite activity to trick Elvie was to do a little dance around my bedroom, while wiggling my bottom. Thank goodness my doors lock.

But enough goofing off, it was time to give Elvie a good old honest college try. The package recommends either standing or lying to do your kegel exercises, but they say to pick a position and stick with it. I chose lying down.

The minute I got on the bed, Elvie’s connection was lost. Poor Elvie! It was deep inside a strange place with no connection to the outside world. The app instructed me to move my phone closer to my vagina, which restored the connection but was pretty awkward, kind of like my lady parts were trying to facetime someone.

Once I got through the technical difficulties, I loved the way the exercise program was set up. They have 3 different stages that work on pulsing or “quick flicks”, endurance, and pure power. I was mediocre at all three, but it gave me a good start to go with.

Screengrab
Screen grab from the Elvie App

 

Elvie Day 2:

Today was the day I decided to experiment with how distracted one can be while using Elvie. We all like to multitask, so I decided to try it out while continuing my current Netflix binge. It was a bad idea, I missed a lot of my targets and kept forgetting to keep my legs open to allow Elvie to stay connected. It was clear to me that Elvie requires your full attention to get any benefit from it. I did improve on my ability to pulse and my endurance, which was super gratifying.

After I was done with my workout I spent some time exploring the app. Nestled in the “help” section, were much more detailed and helpful directions for performing a correct pelvic floor contraction. I wish this was more easily accessible. I think the lack of concise directions was a major failing of this product.

 

Elvie Day 3:

I decided this would be my last day using Elvie. I run on the tighter side of things, and I know from my clinical experience that doing kegels on an already tight pelvic floor can cause a whole host of issues from constipation, fecal leakage, painful sex, even urgency urinary incontinence!

I decided to give my all out full attention to the vagina workout ahead of me, but first I would try and cheat again. Lying down I tried my old tricks, wiggling my butt, thrusting my hips, but Elvie was not fooled! It appears that lying on your back is a way better way to train your pelvic floor using Elvie.

My last day, I really had the hang of things. I had no connectivity issues and was able to complete the whole workout uninterrupted. The only bummer was that on two of the three measures, I regressed!

 

Thoughts on Elvie

My thoughts on this device are mixed. It is so rare that I see someone walk into the clinic only needing strengthening of the pelvic floor. Usually there is some component of tightness or boney (structural) malalignment that needs to be corrected before kegels can be done effectively or safely.

For those patients who only require strengthening, I think Elvie can make an excellent motivator to regularly do your kegel exercises. I would eliminate the pure power part of the Elvie exercise program. Doing a max contraction of the pelvic floor usually does more harm than good. In a perfect scenario, I see Elvie being used by patients under the guidance of a pelvic floor physical therapist and only doing the “pulse” and “hold” portions of the program. These are patients who have been screened for any tightness or trigger points that may need treatment before starting out with strengthening

 

Pros and Cons of Elvie

 

Cons

  • Not appropriate for everyone
  • Poor connectivity to iphone
  • Not always consistent in measuring a true kegel versus a fake one, especially in standing
  • Requires a later model smart phone
  • Only brief instructions easily accessible
  • Max contraction not very helpful

Pros

  • Charts on the App to track your progress
  • Incredibly adorable product design
  • Much more comfortable than many other biofeedback sensors
  • Structured training program to target many components of muscle function

Pro Tips for Elvie

  • Use Elvie lying down; it’s way more accurate that way
  • Use a water based lube for insertion, silicone lubricants usually don’t mix with instruments designed to go into the vagina
  • If you have pain, Elvie is definitely not for you. Even if you don’t have pain it is wise to consult with a pelvic floor physical therapist to ensure that your muscles are not in fact, too tight and that you are doing the exercise correctly.

Disclaimer: Product was provided by Elvie. No other form of compensation was provided by Elvie for this review.

Postcard from Ryanne’s Exercise Inservice

This week the BBPT team went back to BASICS with exercise programming. Ryanne, one of our staff PTs, led us through basic routines and their progressions with a focus on different manual and verbal cues that can be used with each exercise. Every patient begins physical therapy at different levels of exercise experience, as well as differences in body awareness. When starting patients on an exercise program, even if they are avid exercisers, it is important to start with the BASICS to see HOW exactly they are performing them and to be able to screen for any dysfunctional movement patterns:

.We went over different ways to facilitate the core to allow the for symmetrical engagement in exercises like pelvic tilts, bridging, and planks. Through the use of facilitation, we can actually CHANGE the motor plans (how one moves) of our patients to more efficient ones, thereby reducing their symptoms.  These techniques are useful for patients that are recovering from injury and even those wishing to return to high level fitness classes.

Below, Ryanne is leading us through a basic bridge exercise with different manual and verbal cues, resistance and progression

 

.

 

facilitation
Denise and Amy trying their hands in facilitation
Ryanne
Fiona and Melissa trying it out themselves

We encourage you to work with a physical therapist to begin or perfect your exercise routine!

MuTu System Exercises with Wendy Powell

Our friend Wendy Powell, a postpartum recovery and fitness expert in the UK, has created MuTu System, a 12 week program to get your body back into health after pregnancy. It offers great explanations of posture, body mechanics and nutrition. Wedny has shared with us some great exercises for getting rid of what she calls ‘mummy tummy’ (hence MuTu!) and healing pelvic pain. Check out some of them below, and learn more about her and MuTu System on her website here.

All text + images copyright ‘MuTu® System Limited 2014’

Lie Back + Squeeze

MUTU-LBAS-2-300x167
Lie on your back with your knees up + a small ball between your knees. Bring your knees into your chest far enough so there is no strain on your abs to keep them there.
Turn your feet out. Exhale as you squeeze the ball + draw your belly button towards your spine. You’ll feel your pelvic floor contract at the same time. Relax + repeat.
As well as the ‘belly button to spine’ movement, another way to make sure you get it right is to imagine your lower abdomen as a clock face, with your belly button as 12 o’clock, pubic bone at 6 o’clock + your hipbones as 3 + 9. As you exhale, draw in your belly button, draw up your pelvic floor + imagine pulling 3 + 9 o’clock apart. Inhale + relax, then repeat. Keep your spine in neutral + don’t let your pelvis tilt as you move.

Lamp Post Pee

4-lpp-german-shephard-300x168
Start on all fours, with shoulders directly over hands, hips over knees. Keep your arms straight + try to shift your upper body weight into your fingers rather than all on your wrists.
Exhale + engage your core muscles (gently draw in your lower abdomen as you breathe out + move) + lift one knee out to the side. Just off the ground is fine, but no higher than parallel to the ground. Bring it back down as you inhale, then repeat.
Try not to let your weight shift right over to the supporting leg, you want the movement to happen by rotating at the hip, not by leaning or twisting your whole body to one side. You are stabilizing your torso + engaging your core as you lift your leg, + then relaxing as you lower.
It’s harder to initiate or feel a pelvic floor contraction when you abduct your legs, but be assured that the transverse muscle + the pelvic floor can co-contract – one movement is making sure the other happens!

Exercising While Pregnant

By Fiona McMahon, DPT

If you were paying attention to the Boston Marathon this April you probably heard about 35-year-old Amy Keil of Minneapolis who ran the 26.2 mile course while 7.5 months pregnant. Reactions to pregnant women competing at a high level run the gamut from awestruck at the mother-to-be’s sheer fortitude to furious at the seemingly blatant disregard for the health of her unborn baby. Seeing these athletes compete at high levels sparks the questions, how much exercise is safe for these women and how much physical activity should the average woman get while she is pregnant?

Up until recently, there has been a dearth of scientific studies examining the effects of high-level exercise on the health of the mother and her child. In 2012, Linda Szymanski and Andrew Satin published an article in the American Journal of Obstetrics and Gynecology examining the effects of strenuous exercise on the fetal and maternal well-being in both physically active and inactive women. In the study women were classified by self report as “non exercisers” (women who exercised for less than 20 minutes for fewer than 3 sessions a week),  “mild to moderate exercisers” (women who worked out for at least 20 minutes per session up to 3 times a week), and highly active exercisers (women who exercised greater than 4 times a week).

The women in this study participated between the 28th and 32nd week of their pregnancy. The participants ran on a treadmill with a 2% incline that increased every 2 minutes until the grade reached 12%, at which time the speed was increased by 0.2 miles per hour every 2 minutes. When the women no longer wanted to continue, they were allowed to stop and the well-being of their fetuses was examined by measuring the blood flow through the uterine and umbilical arteries, fetal heart rate, and maternal heart rate.

The women all reached a heart rate of well over 140 beats per minute, which was beyond the traditional limit on physical activity in expectant women prior to 1994. All women also exercised at a perceived exertion rate consistent for the definition of strenuous exercise. The study found that the blood flow through the uterine and umbilical arteries did not significantly change with exercise in any of the groups of women who participated in the study indicating that in short duration strenuous exercise may not be harmful to the fetus. The study did find that five women in the highly active group experienced fetal heart rate decelerations when they finished running on the treadmill. The fetal heart rate returned to normal within 2-3 minutes and did not meet the inclusion criteria for fetal bradycardia (slow fetal heart rate). The authors of this study were reassured by the transient nature of these fetal heart rate changes in the highly active group.

The work presented by Linda Szymanski and Andrew Satin provides athletes who are pregnant with some reassurance that they are not harming their baby by continuing to exercise. The authors do point out that the work presented in their article should be interpreted cautiously as it includes only one data point from the third trimester of pregnancy and should not be taken as definitive proof that strenuous exercise absolutely won’t harm an unborn child.

So you may be thinking that you absolutely have no intentions of running until exhaustion when you are pregnant, but should you still exercise? Much of the research published on activity and pregnancy says yes.

In a 2012 review conducted by Tiffany Field in infant behavior and development, exercise was found to be protective against depression, cramps, edema (swelling), low back pain, and gestational diabetes. She found the Tai Chi was particularly helpful in improving oxygen consumption, and that yoga reduced stress.

Safety is important to keep in mind while exercising when pregnant. The pregnant body undergoes a multitude of different changes that will affect your ability to exercise. During pregnancy your blood volume will increase. With the blood volume increase, the ratio of plasma to red blood cells (your body’s oxygen delivery system) will change leaving you with relatively few red blood cells compared to plasma, which will make you feel more tired more quickly. Your need for oxygen will also increase as you progress through your pregnancy. Your growing baby will also put pressure on your diaphragm making the amount of oxygen available for exercise decrease. These changes may make you feel more tired than you would when you were not pregnant and you may have to cut back the amount of activity you do.

The American College of Obstetrics and Gynecology (ACOG) advises that women who are inactive be examined by a health care professional before starting exercise while pregnant. They recommend that women try to get 30 minutes of exercise a day. They advise women with a history of pre-term labor or fetal growth restriction to reduce their activity in the second or third trimester. The ACOG recommends athletes with uncomplicated pregnancies continue to exercise as tolerated during their pregnancy.

What warning signs should you look for when exercising while pregnant? The NCAA has released guidelines on exercise in their Policy on Gender Equality. Athletes should not start exercising, or should stop exercising, if they experience vaginal bleeding, leaking of clear fluid from the vagina, headaches, chest pain, decreases in fetal movement, calf pain, muscle weakness, or breathlessness prior to exercise.

While the jury may not have completely reached its verdict on whether or not ultra intense athletic events are safe while pregnant, exercising at mild to moderate levels while one is pregnant is largely considered to be safe and to yield many benefits to expectant mothers. Keeping an open dialogue about your fitness goals with your gynecologist can help you to formulate a fitness plan that will allow you to reap the many benefits of staying active while pregnant.

Stay tuned for more Blogs on prenatal pain and leakage, postpartum pain and other conditions, and sexual health after childbirth.

Sources

  • Davenport M, Giroux I, Sopper M, et al. Postpartum exercise regardless of intensity improves chronic disease risk factors. Medicine & Science in Sports & Exercise. 2011; 951-958
  • Ferreira C, Alburquerque-Sendín. Effectiveness of physical therapy for pregnancy related low back and/or pelvic pain after delivery: A systematic review. Physiotherapy Theory and Praticce. 2013: 29(6):419-31
  • Field T. Prenatal exercise research. Infant Behavior and Development. 2012; 35: 397-407
  • Hogshead-Maker, N, Scrensen E. Pregnant and Parenting Student- Athletes: Resources and Model Policies. NCAA Gender Equity.
  • Noon M, Hoch A. Challenges of the pregnant athlete and low back pain.  Curr Sports Med Rep. 2012; 11(1):43-8
  • Szymanski L, Satin A. Strenuous exercise during pregnancy: is there a limit? American Journal of Obstetrics and Gynecology. 2012

PT In-Service: Alignment and Core Exercises

By Amy Stein

Our famous Dania Kafka, who is an amazing physical therapist and Pilates instructor, recently discussed alignment, posture and core exercises correctly at our latest PT In-Service. She helped us with proper cueing because we don’t want pelvic pain patients to utilize the pelvic floor muscles, or limit their use, with any core stabilization exercises. We went over how to gently engage the transverse abdominus, which is one of the core muscles and helps with pelvic and trunk stability. If this muscle is weak and the patient is overusing their pelvic floor, they can end up with pelvic pain. Core and trunk muscle imbalances can be one of many reasons a patient ends up with pelvic pain and/or pelvic weakness. Therefore, it is important to have a strong and balanced core. Dania proceeded to lead us through a series of transverse abdominus exercises that were adapted by Shirley Sahrmann, PT, and we incorporated diaphragmatic breathing with each exercise. We practiced neutral spine versus posterior pelvic tilt to compare the difference, and discussed with which populations we would use which position.

2015 3762015 377

2015 372

With any pain condition, if there are active trigger points, tightened and/or shortened tissue, you need to address these impairments prior to strengthening these muscles. Otherwise you can exacerbate trigger points and continue to shorten tissues. It is essential to make sure these conditions are resolved prior to starting a core exercise to that specific area.

With regard to pelvic floor weakness, including incontinence and post surgical weakness (prostatectomy, prolapse, etc.), it is important to strengthen the pelvic floor muscles correctly and the transverse abdominus correctly, as well as the rest of the core muscles.

Monitoring each patient with each exercise, is essential for their recovery, in order not to worsen any condition. Starting slow and in a controlled environment is key.

If you have any questions with regard to Pilates and core exercises and when to introduce them for pelvic pain, or pelvic weakness, feel free to call us and ask for any of our PTs. Or, attend our upcoming Pelvic Health 101 this spring!

Exercising the Blues Away

Winter can be a difficult time for many people, physically and emotionally. Bodies may hurt from the cold, or there may be feelings of anxiety and depression. Exercise can help ease all of these feelings, however. In a recent article on the Mayo Clinic website, the Mayo staff details a list of ways this can work. While getting motivated can be difficult, the clinic writes, beginning on a path of regular exercise can only benefit your health in the long run.

Exercise releases brain chemicals that produce positive feelings throughout the body–neurotransmitters, endorphins, and endocannabinoids are some of them. When these chemicals are released, you can feel happier and more confident within yourself. Exercise  helps you manage your emotional stress in a positive way. Instead of thinking about what makes you sad, you’re taking steps to change it, which can lead to continued feelings of motivation and confidence. Exercise also fights chemicals in the immune system that can make depression worse, and increases your body temperature, fighting the metaphorical and literal cold.

If taking up an exercise routine is daunting to you, you can start small by incorporating more physical activities into your life. This can be anything that gets you moving: going grocery shopping, doing laundry, cleaning the house, taking a brisk walk, things like that. You can also think about a physical activity or exercise that you enjoy doing, and make that your outlet. This way, it’s not a chore–it’s something you love that’s also really good for you.

As little as 30 minutes of exercise per day for five days can begin to improve symptoms of depression. While the links between exercise, anxiety, and depression aren’t totally clear, exercise has been shown time and again to improve those symptoms.

Learn more about the link between anxiety, depression, and exercise in this article on the Mayo Clinic’s website here. What activities will you be participating in to lift your mood? Tell us in the comments!

Know Your Nodes, Part IV

By Riva Preil

So, how does physical therapy help treat lymphedema?  Great question, I am glad you asked.  The gold standard of care to treat lymphedema is COMPLETE DECONGESTIVE THERAPY (CDT).  CDT consists of four components:

  1. Manual Lymphatic Drainage (MLD)
  2. Compression
  3. Exercises
  4. Skin Care

MLD was pioneered by Dr. Emil Vodder in the early 1900s, and it is series of various manual techniques (including “pump,” “rotaries,” “scoop,” “and pump-push,” to name several) which promote moving the excess lymph fluid from the distal extremities towards proximal, healthy open lymph channels.  Another way to think about lymphedema due to lymph node removal is that there is congestion on one “road”.  Therefore, the certified lymphedema therapist (CLT) seeks to open up and create new channels on uncongested “roads,” thereby creating detours for the lymph to return to the venous system through alternate routes.  MLD allows the CLT to direct the lymph along healthy, open lymphatic pathways.

In addition, appropriate compression must be applied to promote the return of lymphatic fluid and to prevent it from improperly pooling in affected areas.  Therefore, compression is an appropriate component of CDT.  During the acute first phase of treatment, bandaging should ideally be worn 23 hours during the day and removed only for showering or bathing.  CLT therapists bandage patients with short stretch bandages and they teach patients how to perform self-wrapping.  During the chronic second phase of treatment, compression garments can be substituted for bandages during the day, either custom made or over the counter.  Bandaging is continued for nighttime usage in most cases.

No physical therapy experience would be complete without some exercise, right?  Exercises are important in treatment of lymphedema because the musculoskeletal system helps with venous return and promoting fluid movement by acting as a pump mechanism.  That’s why ankle pumps (ankle dorsiflexion and plantarflexion) are recommended after ankle surgeries, in treatment of postsurgical edema (swelling).  So too, similar upper extremity and lower extremity “pump-like” exercises help return lymphatic fluid to the venous system.  Depending on the type of lymphedema (upper vs. lower extremity) several examples of lymphedema appropriate exercises include ankle pumps, knee and hip flexion and extension, shoulder flexion and abduction, elbow flexion and extension, and wrist flexion and extension.

Finally, skin care is a huge component of CDT.  The reason for this is that increased swelling of any extremity increases the DIAMETER of the extremity.  This increases the distance that gases (ex. oxygen) and nutrients must travel to reach the surface of the skin.  This is referred to as increased diffusion distance.  Oxygen is a necessary component in skin healing after any injury, even simply a paper cut!  It is harder for oxygen to travel long distances compared to short distances, therefore increased diffusion distance (as in the case of lymphedema) SLOWS the healing process.  Slower healing rate increases the likelihood of developing an infection through the open wound.  Therefore, it is crucial for all patients with lymphedema to be vigilant about skin care and inspection.  Their wounds heal slower than those of other individuals, and it is important to minimize the chance of developing infection by keeping wounds clean and covered.

So there you have it!  That was a brief overview of “How I Spent My Summer Vacation.” I could not think of a better way to spend my time this summer.  Don’t get me wrong, a week in Italy or an Alaskan cruise are trips that I look forward to hopefully taking one day, but I am grateful that I had the opportunity to take this incredible course his past summer.  This course is rarely offered in New York, so I had to jump on my chance when I saw it advertised. Thank you to Amy for supporting my continuing education and to my co-workers for helping to treat my patients while I was at the course. Italy and Alaska can wait for me, because my patients are more important!

Prevention: Diastasis Recti, Part II

By Stephanie Stamas

So now that you’ve learned how a Diastasis Recti (DR) can be created during pregnancy, how can you prevent it from happening to you? There is currently a lot of available information on the positive benefits of aerobic exercise for the pregnant mother and the fetus, but little research focuses on the effects of exercises on abdominal muscle strength, function during pregnancy and exercises to prevent linea alba separation. While studying at Columbia University I had the privilege of conducting research with Dr. Cynthia Chiarello, who is a pioneer in examining the relationship between diastasis recti, exercise, function and prevention. A research article published by Dr. Chiarello, “The Effects of an Exercise Program on Diastasis Recti Abdominis on Pregnant Women” found a significant difference in the presence of a DR between women involved in an abdominal exercise program (12.5%) versus non-exercising women (90%)1. This conflicted with results reported in an article by Gillard & Brown that found no difference between the exercising and non-exercising groups2. Dr. Chiarello argues that the key difference between the two prescribed exercises protocols was the purposeful activation of the transversus abdominis (TA), a deep abdominal muscle that acts as the body’s natural corset (the circumference of the Coke can discussed in part I), and promotes continued linea alba approximation throughout pregnancy.

Activation of the TA is implicated in the prevention and resolution of a DR for several reasons. First, contraction of the TA acts like an internal splint, helping to stabilize your core and decrease the width of the linea alba from the inside out.  Secondly, because the linea alba is made of two fascial layers (deep & superficial), targeted strengthening for separation prevention of both layers is required. Typical abdominal exercises – crunches, curls, etc – target the rectus abdominis and oblique muscles which only strengthens the superficial fascial layer. The deep fascial layer and inner abdominal wall, which is mainly formed by the TA, is not addressed with these exercises and is under the most tensile stress with a growing uterus. The inclusion of rectus abdominis and oblique exercises should only be introduced once the TA has become adequately strengthened. In summary, strengthening the TA first should be the foundation of any pre-natal or post-natal exercise program (also, an added bonus – the TA aids in the pushing phase of labor!).

To help you begin strengthening your TA, I have created a two-phase abdominal exercise program. The first phase focuses on isolated TA activation (week 1-2) and the second phase begins to add dynamic activities on top of TA stabilization exercises (week 2-6). Click on the links below and then enter the corresponding codes to gain access to the exercise programs.

Phase 1TA activationCODE: W9KNTZK

Phase 2TA activation with dynamic activitiesCODE: HDQ7JN2

Adaptions for Pregnant Mothers
For those in their second trimester – It is recommended that you don’t lie onto your back more than 5 minutes at a time as there is a (low) chance of decreased blood flow to the uterus. So either do the exercises with your back elevated on a wedge, in modified squat position against a wall or take breaks lying on your back by switching to another exercise in a different position. If you notice that you are starting to develop a diastasis recti, be sure to splint your rectus abdominals during all exercises – cross your arms around your waist as if you were hugging yourself and pull the muscles towards midline in sync with the TA contractions.

Adaption for post-natal mothers with DR
Start with the phase I exercises all supine (lying on your back), making sure to splint your abdominals with either the sheet wrapped around your abdomen (See Part I), using your hands to manually bring the edges of the muscle bellies together or while wearing an abdominal binder. These are by no means the only exercises out there, but are foundational stepping stones required to return to crunches, planks, bicycles, etc diastasis-free and pain-free!

I’ve had great feedback from Part 1 and a lot of excited expectation for this post on prevention. I knew a lot of my friends would benefit from this series, but I couldn’t not have imagined how hungry people were for this information. I have received some excellent questions that I was not able to address in these two posts, therefore you can now look forward to Part 3! I will be answering questions that I have received and have not been able to address. Feel free to reach out to me if also you have any questions: stephanie@beyondbasicspt.com

*While abdominal exercises are generally safe during normal pregnancies, it is important to observe the ACOG precautions for exercise & consult with your physician prior to starting a new exercise program.

References
Gilleard WL, Brown J Mark M. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate post-birth period. Phys Ther. 1996; 76(7):750-762

Chiarello CM, et al. The Effects of an Exercise Program on Diastasis Recti Abdominis on Pregnant Women. J Women Health Phy Ther. 2005; 29(1):19-24