Why Your 6 Weeks Postpartum Check-up Should Also Be Performed By A Pelvic Floor Physical Therapist

What I experienced at my 6 weeks postpartum check-up

At my 6 weeks postpartum check-up, my OB did not assess my pelvic floor strength, organ prolapse, diastasis recti, etc. She only checked my scar tissue and cervix. I even specifically asked her to check me for organ prolapse but she didn’t. She only said everything looks like it's healing well and I should be fine.

I went back to my first CrossFit class that Monday. My body definitely does not feel the same even though I did my breathing and pelvic floor engagement exercises in combination with other movements.

9 months of pregnancy changes our body structure, movements, and proprioception. Your body won’t be back to normal in 6 weeks. Having a check-up with a pelvic floor physical therapist can help you understand where you are physically.

You will have a better understanding of which areas you need to work on and the process of getting back to the things you love to do prior to pregnancy.

Postpartum fact-check series 1: Why do I still look pregnant even after labor?

Our Co-Founder Jessica recently gave birth to a healthy baby boy! Here is a series where she shares her own experience during prepartum/postpartum. She hopes that this information can help moms or soon-to-be moms clear up any uncertainties as well as give advice and encouragement.

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My tummy still looks 3 months pregnant from day 1 postpartum until the second week. On social media, people always post how fast they can get back into shape or how fast their tummy flattens. However, in reality, your tummy will still look 2-3 months pregnant after labor, that is normal. It takes a while for your tummy to get back to its original shape and there's also a chance it might never get back to pre-pregnancy form.

9 months of pregnancy is a joyful journey full of excitement but the journey of postpartum is always overlooked by people. 20 minutes after labor, I took my first shower since I was covered in blood. When I stood in the shower, I looked at my tummy and felt weird. My tummy felt hollow, nothing was in there, I even poked at it and it was soft and empty.
My husband saw my tummy a few hours later, he thought it would be flat right after. He asked me what was in there now? Air? I was like "swollen uterus, loose skin, and I don’t even know".

I did some breathing exercises with pelvic floor movement. It’s hard because your private part is so swollen but it’s okay to initiate the movements from day 1. This can help you to start to initiate muscle engagement, and restore motion. I’ll post more exercises down the road about what I did in these 6 weeks of postpartum.

Just remember:
1️⃣ Your tummy won’t become flat immediately
2️⃣ Give yourself some mercy. Don’t be too hard on yourself with your new body image.
3️⃣ Look at your new body image as a triumph, you just did an amazing job laboring a human being.
4️⃣ This is just temporary. After you have established a routine schedule with your baby, It’s never too late to start the proper exercise. You'll get back to who you were in no time!

Improve Your Running Mechanics: Big Toe Extension Mobility

Big toe extension mobility is often overlooked when talking about efficient running mechanics, why is this so important?

During the phases of running, proper push-off requires your big toe to extend at least 45 degrees which is crucial to set up for an efficient propulsion phase. This is also known as triple extension when the trail leg is in full hip, knee, and ankle extension.

When there is a lack of big toe extension mobility we can see a decrease in hip, knee, and ankle extension. This can cause your stride length to be shortened which leads to an insufficient propulsion phase. Being able to push off your big toe also tightens the band of tissues underneath your foot (plantar fascia) to create a spring mechanism that propels your leg forward with less energy.

Here are some exercises to help improve your big toe extension mobility:

1️⃣ Lunge with big toe extension stretch

🔸Shift your weight onto the big toe on the back leg
🔸You should feel a stretch on your toe and/or bottom of your foot.
🔸Perform 5 slow repetitions

2️⃣ Quadruped rock backs

🔸As you sit back onto your ankles focus on stretching your big toe
🔸Perform 5 slow repetitions

3️⃣ Heel raises with elevated big toe

🔸Place a towel roll under your big toe right before the ball of your feet
🔸Focus your pressure on the big toe while pushing up
🔸Perform 3 sets of 15

If you are currently dealing with and injury, we can help!

Improve Your Running Efficiency: Increasing Step rate to prevent Over-striding

What is over-striding and why is it bad?

Over-striding is defined when your initial foot strike lands in front of your center of mass (picture on the left). This causes an increase in joint loading, ground reaction forces, and breaking forces. If your body is not able to adapt to these forces an injury can occur. Ideally, your foot should be landing close to your center of mass, somewhere between your ears and eyes.

Here's a quick strategy to improve your running efficiency and decrease joint loads

One simple strategy is by increasing your step rate per minute (SPM) by 5-10%. This has been shown to reduce lower extremity joint loading and improve running kinematics. The picture on the right shows me running at a 10% increased SPM which puts my initial foot strike closer to my center of mass.

🔸Increasing your SPM by more than 10% requires greater oxygen consumption which can affect your running efficiency
🔸I use an app called RunTempo, which is a metronome to help find and modify your SPM when training
🔸Give this a shot and see if it helps!

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References:

Bramah C, Preece SJ, Gill N, Herrington L. A 10% Increase in Step Rate Improves Running Kinematics and Clinical Outcomes in Runners With Patellofemoral Pain at 4 Weeks and 3 Months. Am J Sports Med. 2019 Dec;47(14):3406-3413. doi: 10.1177/0363546519879693. Epub 2019 Oct 28. PMID: 31657964; PMCID: PMC6883353.

Lyght M, Nockerts M, Kernozek TW, Ragan R. Effects of Foot Strike and Step Frequency on Achilles Tendon Stress During Running. J Appl Biomech. 2016 Aug;32(4):365-72. doi: 10.1123/jab.2015-0183. Epub 2016 Mar 8. PMID: 26955843.

Heiderscheit, Bryan C et al. “Effects of step rate manipulation on joint mechanics during running.” Medicine and science in sports and exercise vol. 43,2 (2011): 296-302. doi:10.1249/MSS.0b013e3181ebedf4.

Dealing with a Stiff Hip? Try some of these hip mobility exercises

1️⃣ Frog pose + Alternating IR liftoff

🔸Lift your ankle up and out, hold for 3-5 seconds before alternating

perform 3-5 repetitions of each

2️⃣ Half kneeling hip flexor stretch + Ant/Post pelvic tilts

🔸Forcefully exhale to engage your core as you perform the posterior pelvic tilt, perform 3 seconds per rep

perform 3-5 repetitions of each

3️⃣ Elevated pigeon stretch

🔸Forcefully exhale to engage your core as you lower your knee to the ground, perform 3 seconds per rep

perform 3-5 repetitions of each

How to Prevent Running Injuries

There is a high incidence of lower extremity running injuries occurring in recreational and competitive runners, the knee being the most predominantly injured joint. Some risk factors that can increase the probability of a running injury include long training distances per week and a history of previous injuries. So how can we help prevent injuries like this from happening and keeping us off the sideline?

We need to prepare our bodies to adapt to ground reaction forces during running. On longer runs (more than 3 miles), it’s important that we prevent the breakdown of running mechanics and improve running efficiency.

Here are some areas that can be addressed to improve your resilience to injury:

🔸Training plan modification to safely balance your weekly workload
🔸Muscle strength and joint mobility deficits to improve load absorption
🔸Modifying running form and technique to improve energy efficiency
🔸Proper recovery and nutrition to prevent burnout

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van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SM, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41(8):469-480. doi:10.1136/bjsm.2006.033548

Arnold, Michael & Moody, Aaron. (2018). Common Running Injuries: Evaluation and Management. American family physician. 97. 510-516.

How to get back to running and avoid injuries

Injuries from running can be preventable if you prepare your body for the sport. One common cause of running pain/injury is a sudden increase in mileage, frequency and/or pace following a period of rest. Knowing how to increase your running workload over time can help prevent repetitive stress injuries from occurring.

Here are a few rules that can guide you on how to properly increase your weekly mileage:

1️⃣ If you don't have any prior running experience, start with a walk/jog combination (0.1 mile walk/0.1 mile jog up to 1 mile). If you have prior running experience and can run at least 3 miles, start with that as long as you don't experience any discomfort that alters your running mechanics.
2️⃣ Your pace should be at a comfortable intensity where you can easily have a conversation with someone.
3️⃣ Keep your running schedule to no more than 2-3 days a week with a day rest in between to start.
4️⃣ The 10% rule: increasing your total weekly mileage by no more than 10% per week. (if you ran 10 miles total in the week, the following week should not exceed 11 miles)

‼️These guidelines will help give you a general idea on how to safely increase your running load. Everybody is different and guidelines can change depending on your running experience and injury history.

If you are experiencing pain or currently dealing with an injury and need help, contact us for a discovery call!

What Is a Pelvic Floor Physical Therapist?

We specialize in pelvic-related issues, including using internal and external diagnosing techniques to evaluate the function, muscle strength and muscle / neurological control of the pelvis. We also have to knowledge to discuss issues that you may not feel comfortable talking about such as urine Incontinence, pain during sexual intercourse, pelvic area pain, painful bowel movements, etc.

Things You Need To Know About Transgender Men and Pelvic Health

After starting hormonal treatment, how will my body change?

There are three different treatments that we need to discuss about transgender men’s pelvic health:

1. Testosterone Therapy

2. Surgical procedures

3. Psychosocial

Testosterone Therapy

After the start of testosterone therapy, the balance of estrogen and testosterone in the body starts to change. This can lead to a deficit of estrogen that can cause problems such as vaginal tissue atrophy and vaginal dryness. The change of environment in your vagina may increase your risk of cervix, vagina, and/or bladder infections. 

Surgical Procedures

Some surgical procedures that transgender men undergo include Bilateral mastectomy, hysterectomy, vaginectomy, and metoidioplasty. Following these procedures, we can see the development of scar tissue that may lead to scar tissue adhesion and muscular dysfunctions. 

Psychosocial 

Unisex restrooms in public are still not easily available and this can cause issues such as holding in urine instead of going to the restroom or waiting until there is more privacy to go. Also, some transgender men are not happy with their bodies or feel that they don't belong in it. This denial can lead to the development of chronic pain and/or high tension in the nervous system.

How do I know if the pain I am feeling is related to pelvic health?

Symptoms such as painful sex, stomach cramps, pain during urination/defecation, hot/burning/electric shock-like pain, or feeling of pressure/heaviness in your pelvic area can be related to pelvic pain. You should consider consulting with your OB/GYN or pelvic floor physical therapist if you experience any of these symptoms.

How can pelvic health physical therapists help you? 

Pelvic health physical therapists can do internal/external assessments to identify pelvic floor dysfunctions following hysterectomy, vaginectomy, and metoidioplasty procedures. Also, we can educate you on how to address certain issues such as intercourse, vagina dryness, minimizing pain while going to the restroom, and/or sensation of heaviness in your pelvic area.

Guidelines For Safe Exercise During Pregnancy

Can I still work out when I’m pregnant?

What exercises can I do and what can’t I do?

Is exercising going to cause anything bad to my baby during pregnancy? 

These are the concerns that moms get when they find out they’re pregnant. There are so many benefits of exercising during pregnancy, however, there are also some factors that we need to be aware of. As long as you understand the rules, you are good to go! 
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‼️If you have a history of chronic heart and lung disease, history of premature labor or diagnosed with the following: Placenta Previa*, Cervix Insufficiency*, Preeclampsia*, please consult with your OB/GYN and pelvic rehab physical therapist for a tailored exercises program. These conditions need to be monitored carefully when performing exercises. We do not want you to stop what you love doing, but there are some conditions that we need to be cautious.

🔑The first rule of thumb is to listen to your body! If you sense something is weird or just not right please stop what you’re doing and consult with your OB/GYN and pelvic rehab physical therapist. Do not overexert your body! 

*Placenta Previa: When the placenta lies low in the uterus, it may partly or completely cover the cervix. This is called placenta previa and can cause vaginal bleeding.
*Preeclampsia: A disorder during pregnancy or after childbirth in which high blood pressure and other signs of organ damage can occur.
*Cervical Insufficiency: A condition in which the cervix is unable to hold a pregnancy in the second trimester.

Click Below to download the full guidelines

includes postures to avoid, types of exercises that are safe to perform and an exercise regimen

When and What Exercises Can I Do After Having a Baby?

After delivery, new mothers start to become busy with nursing, learning their baby’s schedule, preparing food, doing house chores along with many other tasks. Throughout this busy time, one question that always arises is, when is the proper time for me to back to get back to exercising and being active? Also, where do I start?

According to the American College of Obstetricians and Gynecologists (ACOG) committee, exercise routines may be resumed gradually after pregnancy as soon as medically safe, depending on the mode of delivery (vaginal or cesarean birth) and the presence or absence of medical or surgical complications.

Pelvic floor exercises (Kegels) can be initiated in the immediate postpartum period. However, I highly recommend you consult with a pelvic floor physical therapist to properly perform a Kegel exercise if you’re not familiar with it.

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Remember your body just underwent trauma from delivery...

Week 1-4 is a healing period for your body. At this time, the most important thing to do is to practice Kegels in a variety of different positions and activities as well as build up a relationship with your baby.

Week 4-6 you might be able to start light abdominal/core engagement exercises. This could help you prevent Diastasis Recti from occurring. However, everything has to start with light intensity (30%), do not overstress your abdominal muscles. If you see a gap or dome on your belly while performing exercises, please decrease the intensity or consult with a pelvic floor physical therapist.

Week 6-12 is the phase when your body should be ready for higher-level activity, we want to start incorporating Kegels into gym exercises. Week 6 would be a good time to consult with a pelvic physical therapist to create a customized return to gym program. 

Week 6-8 you should be starting in the gym with no weight followed by light weightlifting (around your baby's weight). 

Week 8-12 you can begin fast pace walking, and increase reps with light weights. You should avoid high-impact activities such as box jumps, double-unders, sprinting, and also strenuous abdominal exercises such as toes to bar and kipping pull-ups.

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The key to postpartum life is patience, listening to your body, re-training your pelvic floor muscles, and building up a relationship with your baby. :)

Why Is There a Gap In My Tummy?

How do I tell If I Have Diastasis Recti?

Diastasis recti is commonly seen in pregnant mothers but men can suffer from it too. In women, this condition can present during pregnancy or after delivery. Initially, people often notice a dome on their tummy when engaging their abdominal muscles, especially when getting out of bed. Some people also complain of feeling like their organs are falling out or feel their tummy is loose and unstable.

The most common question I get from people is: "Will the gap in my tummy close at any point?"

My answer to people who ask whether the gap will ever close is "I'm not sure". The severity of Diastasis Recti varies significantly. If the connective tissue that holds both sides of your abdominal muscles (also known as the "linea alba") is stretched out too much then you may need to consult with your surgeon to address that. However, regardless of how severe your diastasis recti is, everyone needs to strengthen their transverse abdominal and pelvic floor muscles to improve the ease of performing daily activities. The transverse abdominal muscle is the main muscle responsible for creating tension in your linea alba. Having proper linear alba tension helps to create a firm midline instead of a gap.

I’ve been doing a lot of ab workouts and core strengthening, but why isn't it getting better?

*If you’ve been doing core exercises for 6 weeks or it’s been 6 months after your delivery and you still haven’t seen any improvements, please consult a pelvic physical therapist for further assessment and treatment. 

There could be many factors preventing you from getting better:

1️⃣Your body hasn’t fully recovered from hormonal changes during pregnancy.

Your body needs at least 1 year to let your connective tissues (Linea Alba, muscles, ligaments) recover. *Please be patient! Your body has experienced a lot during pregnancy and we need to be nice to our bodies to help with recovery.

2️⃣You’re not using the right abdominal muscles.

We have two layers of muscles, the superficial layer consists of the external and internal abdominals, and the deeper layer consists of the transverse abdominals. Most people overstress their abs and engaging the superficial layer more instead of the deeper layer.

How would I know whether I’m using the right muscles?

When you contract the transverse abdominals properly, you will see a flattened tummy from your ribs down to your pelvis instead of seeing your rib cage flare-up.

3️⃣The exercises that you are doing are not designed to help you return to your everyday activities. In other words, your exercises are not activity-specific.

We mainly performs activities in an upright position, but many people only train their muscles lying down. For example, only doing reverse crunches will not help you engage your whole abdominal wall when you have to carry your baby.

You should incorporate upright positions in your work outs, such as lunges and squats with weights, to help you train your muscles in different positions.

4️⃣Your exercises are not challenging enough or too challenging. 

How do I know whether my exercises are too hard?

If you see a dome in your tummy while performing core exercises.

How would I know whether my exercises are too easy?

I want you to take a second to think about the frequency and reps you do per week. I understand it’s hard to find the time to do exercises because your life is occupied by your baby and you are very busy. However, I also want you to spare some time for yourself and your body. The exercise dosage should be 3-4 times/week. The intensity should make your muscles feel fatigued. *Please watch out for the dome!

5️⃣You still need to lose some fat tissue from pregnancy.

I normally tell my clients this when discussing their diet and nutrition intake. Most of the time, moms don’t have enough time to eat regularly and properly, and thus don’t get enough nutrition. This makes it harder for your body to recover and get back into shape. Please don’t compare yourself with moms on Instagram with beautiful bodies. Everyone’s body is different and we all have different healing times. We need to listen to our bodies. Focusing on yourself is the most important thing to do now. 😊

Is Urine Incontinence Normal?

Do you always need to go to the restroom before a trip “just in case?”

Your pelvic floor muscles are working 24/7 nonstop just like your diaphragm. It’s not only contracting when you want to hold your pee, hold your poop, or having sex, etc.. You need to train your pelvic floor muscles to contract, relax, and push down during various activities, such as driving in the car, standing in line for food as well as watching cat videos on Instagram. 🐱 

Can't wear your new cute leggings for fitness classes because you're worried about urine leakage?

Performing basic pelvic floor muscle exercises is fairly easy because you don’t need any equipment or a specific time to workout. Contracting your pelvic floor muscles is not like lifting heavyweights. Imagine you are holding a baby's finger, you are not going to squeeze as hard as you can. This squeeze is equivalent to contracting your pelvic floor muscles. I sometimes tell my clients to use 30% of their force to squeeze and if done correctly, it might feel like they're doing nothing. But, Yes! 30%! 💪

Cautious about sneezing or laughing because you don’t want to pee your pants? 😐

You've probably already googled Kegel exercises before you read this. But pelvic floor health is not just about Kegel exercises. Consulting a pelvic floor physical therapist about your problem can help you to understand your issues in-depth and guide you through your rehab journey. 🙂

Having urge/stress incontinence or urine leakage should not be a normal occurrence in your life. You shouldn't be ashamed because this is an issue that can be addressed. 🙌

Is There a Correct Posture For Prolonged Sitting?

What is the best posture for me to sit in?

Neither! There is no perfect posture if you’re going to be sitting or standing for a long period of time. Our joints, muscles, and connective tissues need a certain amount of daily motion to maintain optimal joint health. Posture is context dependent! 

If there isn’t a right posture then why do I still have pain?

Your body is not prepared for the amount of the time that you spend in certain postures, or postures that you try to create. Many therapists instruct their clients to maintain a chin tuck position while sitting or standing to prevent  a forward head posture. However, if your muscles or tissues are not prepared to move repeatedly or constantly into this new position, you might start to develop neck pain. Injuries occur when your actions overpower the capacity of your muscles/tissues to perform.

I’m not saying that having good posture is not important. It’s also important to be constantly moving and changing positions throughout the day. Motion is lotion!