PH101: I’m Pregnant – Help!

 

Having a baby is exciting, fascinating, and nerve-wracking. If you have never been through the process before, chances are you have a lot of questions and concerns about what changes your body will go through during your pregnancy, what the birthing process entails, and how your recovery will go once you’ve had your baby.

Join us and childbirth specialist, Ashley Brichter, in our Pelvic Health class to discuss the ins and outs of having a child.

Register at pelvichealth101.eventbrite.com   today.

Location:

110 East 42nd Street, Suite 1504

New York, NY

10017

Time: 7pm on  November 6th , 2019

Pelvic Health 101 Flyer-jpeg

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

Research Proves Yet Again…

By Riva Preil

The Journal of Orthopaedic and Sports Physical Therapy recently published a “Perspectives for Patients” article (July 2014) about the benefits of physical therapy in pregnant and post-partum populations.

The authors of the article reviewed 1,284 articles that were published between 1992 and 2013, and they found there is abundant evidence in support of exercise as a primary tool to target pregnancy-related low back and pelvic pain. This is great news considering that anywhere between 24 to 90% of pregnant women experience pain during pregnancy (and that approximately one third of those women continue to experience pain after delivery)!

Exercise has been shown to decrease pain, improve function, and reduce sick leave amongst expectant mothers.  Furthermore, physical therapists perform manual therapy as well as patient education on proper lifting techniques and transferring techniques.  In addition, they can fit patients for braces or support belts if and when appropriate.

Are you pregnant and experiencing pain?  Or have you recently delivered a baby and your body is still feeling “off”?  An individualized home exercise program from a specialized physical therapist might be the solution for you! Fortunately, we here at Beyond Basics are trained to help women with their pregnancy and post-partum related physical challenges.  Please request a prescription from your doctor so we can help you as soon as possible!

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).

 

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.

DO LIST:

  • 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

DON’T LIST:

  • 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)
  • ANYTHING THAT CAUSES PAIN!

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.