Exercise, The Female Athlete, and the Pelvic Floor

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Fiona McMahon PT, DPT

In honor of National Women’s Health and Fitness Day ,September  28, we are exploring the benefits of regular exercise for women as well as addressing some pitfalls (pelvic floor included), that female athletes can fall into too. It is far too often that women find themselves sidelined from their favorite sports and fitness routines secondary to issues like orthopedic or sports-related pain or incontinence. Although all the issues outlined in this blog can occur to both genders, many of these conditions are more likely to happen to females, secondary to their pelvic structure and physiology.

 

Exercise and Its Benefits

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The benefits of exercise are too numerous to discuss every single one here and span the physical to the emotional. There are a number of conditions that have profound effects on the health of women nationwide. Let’s explore some of exercise’s specific benefits for these conditions together.

Heart Disease

According to the American Heart Association, Heart disease is the number one killer of women in the US and is responsible for 1 in 3 female deaths.  Exercise and a healthy lifestyle have been shown to reduce the risk of heart disease by 80%. The American Heart Association recommends 150 minutes of moderate activity or 75 minutes of vigorous activity to stave off heart disease.

Osteoporosis

Osteoporosis is unfortunately a common affliction among white and asian urban dwelling females.  It is characterized by reduced bone density, which causes bones to be fragile and increases the risk of fracture in individuals that have osteoporosis. Exercise has been shown to be helpful in both reducing the risk of osteoporosis as well as improving the bone mineral density of those who already have osteoporosis.

Other benefits of regular exercise include:

  • Reduced risk of diabetes
  • Reduced risk of colon cancer
  • Improved psychological well being
  • Maintenance of healthy body weight

Remember, it is important to consult with a trained healthcare professional before commencing a new fitness routine.

 

The Female Athlete Triad- Aka the Downside

All things in moderation. Although exercise is beneficial it is easy to over do it. It becomes easier to slip into an unhealthy relationship with exercise, especially in women who are training at elite levels, have eating disorders, or body dysmorphia issues.

The  female athlete triad consists of three disorders that can have severe health consequences in both the near and long term. The three disorders that compose the female athlete triad are:femaletriad

  1. Disordered Eating
  2. Ammenorrhea (absent periods or periods that are irregular)
  3. Osteoporosis

The female athlete triad is often attributed to the expectation that women keep a slender appearance. Girls and women who have body image issues may be at greater risk. The female athlete triad is dangerous and has the potential to be deadly. Osteoporosis can result  in fractures and eating disorders can seriously impact fertility, or even throw off the delicate balance of electrolytes in their system, putting them at serious risk for a cardiac event.

Warning signs of the female athlete triad include:

  • Yellowing of skin
  • Stress fractures
  • Rapid fluctuations in weight
  • Development of baby hair over skin
  • Daily vigorous exercise to an excessive level

 

The female athlete triad requires a multidisciplinary approach from medical, to psychological to nutrition.  It is important for someone who is suffering from the female athlete triad to seek help in order to safeguard their health and emotional well being.

 

Athletics and The Pelvic Floor

d14e2-tipsforahappyandhealthyvaginaLike any muscle, the pelvic floor can get fatigued, strained, or even go into a painful muscle spasm. The thing about the pelvic floor muscles, is that they have to work in almost every athletic pursuit. They work in partnership with the multifidus of the back, the transverse abdominus of the belly, and the diaphragm to stabilize and protect your spine. They also contract with every step during running activities to prevent your pelvic organs from dropping down in your pelvic cavity and to prevent urinary and or fecal leakage. Things can go wrong when the pelvic floor or other core muscles don’t function properly. Athletes’ pelvic floors can become tight and restricted, preventing closure of sphincters and support of pelvic organs. They may go into spasm from working too hard to stabilize the spine, if one of the other core muscles is failing to pull its weight.

Recently there has been more work to investigate the link between athletes and pelvic floor dysfunction. A recent study found that self identified female triathletes suffer from urinary and fecal incontinence at rates as high as 37.4% and 28.0%, respectively. Similar results were also found on a group of runners. Of the triathletes studied, nearly a quarter of them fit the criteria for female athlete triad, discussed earlier in this post.

Does this mean you have to give up your penchant for running? NO! (hellooooooo the author of this post is a runner), but if you find yourself experiencing incontinence, pain, constipation, and or painful sex, something is wrong and you must intervene in order to protect your long term health and your ability to participate in your favorite sport. At Beyond Basics Physical Therapy we combine orthopedic and pelvic expertise to help return athletes to their sports in a more functional and less painful condition. We relax tight muscles of the pelvic floor, train the core, including the pelvic floor if needed, to do its fair share, and return normal postural and structural alignment to our patients. We work one on one with you to develop a home exercise plan to help you reach your goals and prevent a reoccurrence of your pelvic floor or core disorder.

 

Please come see us so you can return to your sport in a better and more optimal condition than when you started: http://www.beyondbasicsphysicaltherapy.com/

 

 

Sources

American College of Sports Medicine. Information on … the female athlete triad. https://www.acsm.org/docs/brochures/the-female-athlete-triad.pdf. Accessed September 19, 2016

 

American Heart Association. Facts About Heart Disease in Women.  2016. https://www.goredforwomen.org/home/about-heart-disease-in-women/facts-about-heart-disease/. Accessed: September 6, 2016

 

Bø, K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Medicine, 34(7), 451-464. 2004.

 

Illinois Department of Public Health: Women’s Health. Facts about  women’s wellness exercise . http://www.idph.state.il.us/about/womenshealth/factsheets/exer.htm Accessed: September 13 2016

 

Loyola University Health System. “Female triathletes at higher risk for pelvic floor disorders.” ScienceDaily. ScienceDaily, 23 August 2016. <www.sciencedaily.com/releases/2016/08/160823165743.htm>.

 

Stampfer M, Hu F, Manson J, et al. Primary prevention of coronary heart disease in women through diet and lifestyle. The New England Journal of Medicine. 2000; 343(1). 16- 22
Todd J, Robinson R. Osteoporosis and exercise. Postgrad Med J. 2003; 79:320-23

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

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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

We Care About Your Flare!

By Riva Preil

With only two sessions remaining to the “semester,” have YOU taken advantage of your opportunity to learn at The School of Pelvic Health yet?  If the answer is no, bear in mind it’s never to late to educate– we hope to see you at the next class on Tuesday, November 11, at 7:00 PM.

At the next class, Stephanie Stamas will discuss My Symptoms Keep Flaring, Is That Normal?  Unfortunately, as many patients can attest, flare ups are often part and parcel of the therapeutic process. In fact, I try to educate patients at their initial evaluation about the potential for a “flare-up” (i.e., feeling worse immediately following physical therapy prior to feeling better).  When patients know what to expect, they are less fearful and worried when flare-ups occur as a result of treatment.

The way I explain a flare up to my patients is that it is the body’s way of telling us that this work is necessary and beneficial. The muscles, fascia, and connective tissue have become accustomed to a faulty shortened position. What feels “normal” to them is actually pathologic and tight. Therefore, after manual therapy that involves stretching and manipulation of the shortened tissue, the body is adjusting this new healthier state. Even though the adjustment phase may be uncomfortable and sore, it is EXTREMELY GOOD in the long run and it is a part of the healing process.

An analogy I give to explain the concept relates to when I educate patients about proper posture. After teaching correct sitting and standing posture, patients often report that it feels “weird” or “unnatural” even though it is BETTER for their body than the previous poor habits.  Creating new habits feels strange and awkward, even if the changes are improvements.

The same applies to the pelvic floor muscles and connective tissue- the changes made in physical therapy are beneficial and healing, despite feeling initially painful and uncomfortable.  To learn more about flare-ups and how to manage them (HINT: Think “Ice Ice Baby…”), be sure to attend Stephanie’s class on Tuesday! We look forward to seeing you there!

Contraction Connections

By Riva Preil

Surprise: you are more connected to yourself than realized!  A study was recently published in the Journal of Neuroscience (October 8) which reveals pelvic floor muscle contractions are strongly connected with the activation of other muscles, particularly the gluteal muscles.  Jason Kutch, corresponding author of the study and assistant professor in the Division of Biokinesiology and Physical Therapy at the USC Ostrow School of Dentistry, explains that when the pelvic floor muscle involuntarily contracts (say, to maintain continence or prevent flatulence), the gluteals automatically contract as well.

How did he prove this?  By employing ELECTROMYOGRAPHY, a tool that enables researchers to measure muscle contractions and co-activation patterns.  He discovered that when participants activated the gluteals, activation of the pelvic floor muscles occurred as well.  In essence, individuals were inadvertently performing Kegel exercises when activating the gluteals, however the same phenomenon did NOT occur when participants contracted intrinsic finger muscles.

In addition, Kutch and his team used functional magnetic resonance imaging (fMRI) to analyze which area of the brain is activated during pelvic floor muscle, gluteal, and finger muscle activation. Not surprisingly, the same region of the brain, the medial wall of the precentral gyrus of the primary motor cortex, is activated both during pelvic floor and gluteal muscle activation.

Practically speaking, this research supports that which I have been telling my patients for years. Namely, that individuals who suffer from pelvic pain should NOT participate in Pilates or other intense core workouts that involve abdominal and gluteal contractions.  The reason I discourage them from doing so is that these types of exercises will inevitably contribute to further tightening and possible pain within the pelvic floor muscles.

Instead, patients with pelvic pain should participate in pelvic floor STRETCHING exercises. To learn more about whether or not pelvic floor stretches are appropriate for YOU, please contact us at Beyond Basics Physical Therapy, where we can help create an individualized pelvic floor muscle program based on your specific needs.

 

Why Do I Still Look Pregnant?!: Diastasis Recti, Part I

By Stephanie Stamas

Is it just me, or does it seem like everyone is having a baby this summer? My Facebook feed is filled with pregnant belly time lapses and newborn pictures. I’m at the age where a lot of my friends are starting families and knowing that I am a pelvic floor therapist, I have been getting a lot of phone calls. One of the top questions that I have been asked is – I’ve had my baby, so why do I still look pregnant?

Here is the scoop – When you are pregnant, your abdominal muscles expand in length by the addition of more muscle fibers (sarcomeres) to accommodate your growing belly. After birth, it typically takes 6-8 weeks for the muscles to re-organize and shrink in length to a size that best supports your abdominal contents. This is how the body is designed to adjust to the changing abdominal circumference. Some women, however, grow very quickly and the muscles are not able to expand quick enough. When this occurs, the linea alba (the vertical line of the much-desired six-pack) stretches and the abdominal muscles move away from the midline. This is a more common occurrence in women with more than one pregnancy, multiples (twins, triplets, etc) or a non-exercising lifestyle prior to pregnancy. The stretched linea alba does not typically return to its previous length in a 6-8 week time frame and can allow the abdominal contents (your organs) to bulge through the thin tendonous structure, leading to the look of being pregnant.

Having a diastasis recti may not only result in the mother continuing to look pregnant, but it can also lead to low back pain, pelvic pain, constipation and pelvic organ prolapse. I like to compare the core to a closed canister (you can think of a Coke can) – The diaphragm is on top, the pelvic floor muscles are the bottom and the abdominal musculature – specifically the transversus abdominus and multifidi – are the circumference of the can. These muscles create a tight-knit closed environment that allow for proper support of the viscera (organs), stabilization of the spine with functional activities, and normal function of the bowel, bladder and sexual systems. Having a diastasis recti is similar to having a split along the side of the coke can, and therefore can compromise all systems that rely on that closed environment.

Great, so I think I have a diastasis recti – now what do I do?
Most separations can return to normal with progressive exercises. First off – stop all crunches and abdominal exercises you are doing.  If you have a separation, doing crunches will actually contribute to the muscles being pulled away from the midline and worsen the diastasis. We need to promote approximation, not separation. Some women benefit from wearing an abdominal binder to counteract distraction forces across the linea alba with physical activity. This is helpful for active mothers who are required to use their abdominal muscles, specifically the rectus abdominus, throughout the day (lifting, carrying, etc). The abdominal binder often gives mothers immediate abdominal support, but should not take the place of strengthening. Below is a basic foundational exercise that will begin to allow the rectus abdominus muscle to return to midline.

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If the muscles are not coming together within 4-6 weeks of starting the exercises, see your local women’s health physical therapist (like us!). Sometimes abdominal scars, muscle tightness (especially internal & external oblique) and thoracolumbar fascia tightness can prevent the muscles coming together in the front because of adhesions elsewhere in the core. Also, if you are experiencing low back pain, pelvic pain or dysfunction with bowel, bladder or sexual function, then seeing a women’s health physical therapist is highly recommended.

Just found out you were pregnant or trying to get pregnant soon? Stay tuned for Part 2, where we will discuss preventative measures to prevent a diastasis recti!

Which Twitch?

By Riva Preil

The pelvic floor muscles are composed of two different types of muscle fibers which can be thought of as two “speeds.” Approximately 70% of the pelvic floor muscle fibers are slow-twitch or slow-contraction fibers. The remaining 30% are fast-twitch fibers. The slow twitch fibers fuel endurance. They are the marathoners of muscles, providing support and resisting fatigue. Think of the muscles in your lower back: they are mostly slow twitch fibers that can work for a long time without tiring. That’s essential, because these are the muscles responsible for helping keep you upright. The slow-twitch fibers that comprise the bulk of your pelvic floor are the slow-to-tire, persistently supportive muscles.

On the other hand, fast-twitch fibers provide the swift forcefulness of sprinters. The ocular muscles that move your eyes, for example, are fast-twitch muscles. In the pelvic floor, the fast-twitch muscles assist in controlling the contraction and relaxation that open and close the bladder and bowel and that are involved in sexual function.

While both types of muscle fibers lost strength as the body ages, the fast-twitch fibers do so more readily. The slow-twitch muscles that make the pelvic floor a center of endurance and support generally maintain their power and function longer, unless there is trauma or injury. In a sense, the power to endure remains while the power to perform some of the pelvic floor’s key functions can diminish. That’s natural! As we get older, our powers diminish. That’s why it’s so important to stay fit for as long as we can; physical strength and vigor are the best defense against the aging process. If you have any questions regarding how to maintain a healthy and strong pelvic floor (ex. post partum mother or post abdominal surgery) please contact us at Beyond Basics Physical Therapy– we are happy to help!

Adapted from Heal Pelvic Pain, by Amy Stein

The Great Quad-Off

Think you have thunder thighs? Talk to a professional cyclist! But they’re not ashamed–it’s those thighs that help them win races. Just check out this article, “Thigh-Popping Success on a Bike Lies in the Quads” from The New York Times. With strength comes increased power, and that’s not just for quads. Physical therapy can increase your strength, too. After all, those muscles don’t build themselves! As one cyclist laughs, ” ‘Your friends love to hear about your muscles…Pull down your pants to show them your strong quads and muscle definition. Make them grab your legs in public….We can all be winners here.’ “