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.

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Our Monthly PT Meeting with Newest Staff PT Christie Silvers!

Christie Silvers, who has an extensive background and training in manual tehcniques spoke on the thoracic spine at our recent PT meeting and how it can effect lumbosacral (low back), pelvic and cervical (neck) dysfunction. She quoted Diane Lee’s “rings of dysfunction” and looking for the primary driver as well as Mulligan’s snags techniques and mobilization for the thoracic spine accompanied by deep diaphragmatic breathing.  Christie mentioned how a dysfunction in the thoracic and rib area can affect and possibly be the primary driver of the dysfunction in the pelvic floor region, whether it is weakness resulting in urinary or bowel leakage or pelvic girdle muscle overactivity, resulting in urinary or bowel retention, frequency, urgency and/or pelvic and sexual pain. She demonstrated techniques that can be used gently or with moderate pressure to help with mobility in the the thoracic area. Christie reiterated that you should treat soft tissue restrictions and in some cases that alone corrects the dysfunction, but in some cases the joints require more mobilization. It was a great presentation and the main point was to always look up and down the spine, and to look at the whole body, because you may be missing initiator on the dysfunction.
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Pilates: Scapular Stability and Serratus Push-Ups

By Denise Vidal

In our previous two blogs we spoke about the movement of the pelvis in relationship to the legs. Now, we will discuss the relationship between the arms, the shoulder girdle, and the ribs. Like the lower limbs, the upper limbs are only as strong as they are able to maintain proper joint mechanics. One of the most fundamental joint movements of the upper body is the shoulder blades’ ability to glide along the ribcage. If the shoulder blades move well against the ribcage, then the ribs can become a strong base of support for the movement of the upper limbs.

To begin, come onto your hands and knees into what we call a “table top” position. Your hands and knees should be underneath your shoulders and hips, as if you were making a “table” out of your torso (picture 1). If necessary you can put a mat or a cushion under your knees for more support. Or, if being on your knees is not at all comfortable, you can do this exercise standing with your hands against a wall.

In this position start to breathe deeply, seeing your ribs expand as you inhale and your abdominals pull inward as you exhale. In Pilates we like to give the image that you are a pregnant cat and every time you exhale you are lifting your litter of kittens towards your spine. It may sound silly, but this image works for a lot of people! The idea is that you want to gain core support without changing the length of your spine and the width of your ribcage.

On your next inhale, maintain the straightness of your spine and arms as you sink your chest towards the floor and slide your shoulder blades together. In Pilates we refer to this movement as a “schlump” (picture 2). As you exhale, push into your hands and widen your shoulder blades on your back (picture 3). Do this movement 5-10 times, remembering to incorporate your breath and to keep your spine lengthened.

If you are experiencing any shoulder or wrist pain, speak to your doctor or physical therapist before attempting this exercise.

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Pilates: Spine Stretch Forward

By Denise Vidal

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Building on the twisting movement of the last blog, I would like to share with you a traditional Pilates exercise called the Saw. However, before we progress to the full movement, there is one more fundamental we need to discuss.

We need to take a closer look at spinal flexion, and for that we need to take a closer look at the vertebra of the spine. Each vertebra has different protrusions which serve specific functions for spinal movement. Today we are going to look at the protrusions both above and below the vertebra, called facets. When I imagine the facets of the vertebra, I think of window blinds, how each blind fits above and below the others.

When you flex your spine, it is similar to drawing the blinds closed, with each facet sliding away from the others. When you extend your spine, it is similar to drawing the blinds open, with each facet sliding towards each other.

See if you can take this image and put it into movement. You can do this exercise either sitting down or standing up. Although, if you do this standing up, keep your knees slightly bent to lessen the force of gravity. To begin, take a deep breath. As you exhale drop your chin towards your chest and start to roll your spine down. In your mind’s eye, see the facets above and below your vertebra slide apart as if you are drawing the blinds closed. You need only to roll as far as you begin to flex at your waist. When you arrive there, take another deep breath. When you exhale, begin to roll your spine up. In your mind’s eye, see the facets slide over each other, like drawing the blinds closed.

Repeat this action two more times, being sure to begin and end each movement with breathe.

Pilates: Spinal Rotation

By Denise Vidal

The best way to maintain a healthy spine is to move it in all possible directions everyday.  So far, in our Pilates blogs, we have focused on flexion of the spine (abdominal curl) and extension of the spine (lying prone). In this blog we are going to discuss spinal rotation. The movement of rotation is relatively simple; however, the mechanics of the spine in rotation require a little explanation. If we can do the movement of spinal rotation while visualizing the proper mechanics, we’ll get much more out of the exercise.

As you may know, there are cartilaginous disks between the vertebra of your spine which absorb the shock of your spinal movement.  As we flex, extend, or rotate the spine, the disks expand and disperse to allow the vertebra to move while still protecting the spinal cord and surrounding nerves. The disks, in return, need the movement of the vertebral column to maintain its flexibility. I like to compare the disk to a ball of silly putty. The more you play with it, the more it maintains it’s ability to stretch. Once you leave it alone, it becomes hard and stiff.

Think about the disk’s pliable quality while doing this spinal rotation movement.
You can do this either sitting or standing, just make sure that whichever position you choose your head, spine, and pelvis are aligned. That’s just a fancy way of saying, ‘sit up straight’, but without tension. Once you’re in an aligned position, take a deep breath.  As you exhale slowly rotate to look to the right. In your mind’s eye, see the disks of your spine soften and spread. You can imagine a marshmallow between your fingers as you push down on it. It stays soft and fluffy while responding to the pressure of your fingers.

Slowly go back and forth from your right to your left side, taking a deep breath before each rotation. You can do this as many times as you want throughout the day. Eventually, you can think about this idea while doing rotational movements throughout the day, like whenever you turn to reach for something at your desk.

In the next blog we’ll apply this thought to a rotation exercise in Pilates. As always, if you’re experiencing any pelvic or back pain, please consult your doctor or P.T. before attempting any exercise.

Pilates: Spinal Extension

By Denise Vidal

Continuing with our prone series, we’ll now focus on extending the spine while in the prone position.

With so much of our lives spent focused on computer screens, our postures have taken on a sort of rounded forward position. Our spinal extensor muscles are continually overstretched, and over time lose their ability to shorten. As I have mentioned before, healthy posture comes from healthy muscular support, which requires the muscles to both shorten and lengthen to their fullest ability. The following exercise focuses on shortening the muscles of the spine, specifically the muscles of the cervical and thoracic parts of the spine.

Lie in the prone position that we discussed in the previous two blogs, your head will be resting on the backs of your hands. This time, however, you can eliminate the use of the pillow.

To start, take a deep breath into your back ribs. As you exhale engage your abdominals. Feel the front, back, and sides of your waist hug towards the imaginary sphere in your abdomen. Try to keep that tone as you feel the muscles on either side of your spine narrow inwards. I like to use the image of a little baby fist wrapping it’s hand around my spine. The tone of the muscles should be supportive, not tense. Slowly float your forehead off your hands. Keep your focus downward, and only lift your head about an inch off your hands. Just like we did with the legs, the head should feel a sense of lengthening as it lifts. Also, the height which you lift depends on your ability to maintain support in your lower back and pelvis. As soon as you feel tension in your spine and your abdominals disengage, know that you have lifted too high.

When you have reached your maximum height, lower your head as you feel your upper back muscles lengthen.

Lift and lower your head five times, each time getting longer as you go higher.

Give it a try and let me know how it goes. It you have any questions leave a comment below. If you are experiencing any pelvic or back pain, you should consult with your physical therapist before attempting this exercise. In the meantime, work on the breathing exercises discussed in the previous blogs until your pain lessens.