Strong and Mobile Scars It’s pretty like

Strong and Mobile Scars

It’s pretty likely we all have at least one scar; from the time we fell off our bikes in the driveway or a major surgery. They range in size, depth, and methods of healing but they all have one thing in common; when they heal they should be STRONG and the should MOVE.
Intact skin has been laid down in a relatively patterned fashion. It has several functions including keeping us warm, protecting what lies underneath, and helps us feel. When injury comes to the skin, a scar is a natural part of the healing process. The tissue heals back thicker and more fibrous where the wound is located so that it can return to it’s proper function, primarily of protection and give strength.
Depending on the size of the scar it may heal naturally on its own and have no issues being stretched and moved around. Other scars from surgery, c-sections, or larger injuries may be larger and get “stuck” to the tissue around them to try to create better strength. As tissue heals, in order to make it as strong as possible, the fibers laydown in all directions; imagine a meshy spiderweb where there is a lot of overlap. In order for a scar, the larger and deeper ones especially, to be mobile they need some extra help to aid the fibers in lying down in a more regular fashion that is similar to the old tissue. This can be accomplished through scar work or mobilization.
After a certain period of time in the healing process when the wound or incision is completely closed and there is no risk of re-opening this work can be started. It involves rubbing the scar in a lot of directions at different depths of the tissue, picking it up, and wiggling it around. If a scar is not mobile, it can pull on the muscle or other tissues below it and create a variety of symptoms (difficulty with bowel movements, pain, pain with bladder emptying, muscle spasms, limited range of motion, etc). It’s never too late or too early to ask your physical therapist about scar mobilization. If you have recently had surgery, delivered a baby, or have a wound from years ago talk to you pelvic floor therapist and have your scar assessed. We want those scars STRONG and MOBILE too.

Recommendations for Diastasis Rectus Abd

Recommendations for Diastasis Rectus Abdominus

Diastasis Rectus Abdominus (DRA) is a lengthening along the fascia (called the linea alba) between your rectus abdominus muscles or your “six pack muscles.” DRA typically occurs during pregnancy as the abdomen and uterus extend. However, this can also occur with genetics and/or repetitive straining through the abdomen, therefore men can also experience DRA. The goal of physical therapy for DRA is to reduce the width between muscle bellies or to prevent further separation from occurring while improving your abdominal strength and recruitment.
There are several gentle exercises that your physical therapist will instruct you on to work on properly recruiting the rectus abdominus muscles as well as your transverse abdominus muscles. These exercises will then be progressed over time, based on your improvements. Your physical therapist may also recommend use of a DRA splint and/or use of taping techniques to help with manual approximation of the muscles. You will also be given recommendations for your daily activities, such as proper alignment, lifting techniques, and transitions, such as rolling in and out of bed to protect your abdominals.
In addition to exercises to work on, your physical therapist will also guide you on activities to avoid while the tissue is healing and you are building strength. Activities that you may be asked to avoid include: crunches, sit-ups, certain types of swimming strokes, heavy lifting overhead, planks, leg lowering exercises, cobra stretch, and others that may stretch your abdomen or pull on the linea alba fascia. Most of these activities will be temporarily “put on hold,” but a few activities you may be advised to permanently discontinue, such as sit ups and crunches. But don’t fret! You will you be given alternatives to these exercises that are better for your body and your healing DRA. If you haven’t already been assessed for DRA ask your healthcare provider or PT to assess this to see if treatment may be needed!

Pregnancy and Sleep For those of who you

Pregnancy and Sleep

For those of who you are currently pregnant you may start to notice more difficulty sleeping during the second and third trimester. The lack of sleep may be related to intense, vivid dreams, but for most women it is the discomfort associated with a growing baby and changing body. Depending on which trimester you are in you may be limited in sleep positions.

The American Congress of Obstetricians and Gynecologists (ACOG) recommend that you avoid lying on your back after the first trimester for longer than 3 minutes at a time because of blood flow. You have a large vessel in your abdominal cavity, called your inferior vena cava, which provides blood flow to your body and baby via the uterine arteries. When you lay on your back the weight of the baby compresses this blood supply and decreases the amount of blood provided to you and your baby. Generally speaking, if you accidentally roll onto your back in the middle of the night your body will become aware of any blood flow deficits and you will roll to your side. However, when you are awake or exercising you should avoid prolonged time on your back, especially if you start to feel symptoms of nausea, swelling, dizziness, or light headedness.

While pregnant sidelying is the recommended position for sleep, primarily on your left side, to help with the promotion of blood flow to your uterus and body. Side sleeping can be challenging and uncomfortable, especially as ligaments become more lax. With ligamentous laxity, there is more separation around the sacroiliac joint which makes hips feel and appear wider for preparation of childbirth. The other aspect of discomfort is the growing abdomen which will also put strain on ligaments around the uterus and sacrum. The best recommendation is to find a supportive body pillow or pregnancy pillow (such as the snoogle). When the pillow is positioned properly, your knees should be approximately hips width apart and your abdomen supported. Though the added pillows may feel cumbersome, you will be happy to have the added support even if it means repositioning when you roll side to side. If you are still having difficulty with sleeping or positioning, speak to your physical therapist who can assist you with these issues. Enjoy your sleep now, Mamas-to-be!

Pregnancy and Sleep by Caitlin McCurdy-R

Pregnancy and Sleep by Caitlin McCurdy-Robinson, PT, DPT

For those of who you are currently pregnant you may start to notice more difficulty sleeping during the second and third trimester. The lack of sleep may be related to intense, vivid dreams, but for most women it is the discomfort associated with a growing baby and changing body. Depending on which trimester you are in you may be limited in sleep positions.

The American Congress of Obstetricians and Gynecologists (ACOG) recommend that you avoid lying on your back after the first trimester for longer than 3 minutes at a time because of blood flow. You have a large vessel in your abdominal cavity, called your inferior vena cava, which provides blood flow to your body and baby via the uterine arteries. When you lay on your back the weight of the baby compresses this blood supply and decreases the amount of blood provided to you and your baby. Generally speaking, if you accidentally roll onto your back in the middle of the night your body will become aware of any blood flow deficits and you will roll to your side. However, when you are awake or exercising you should avoid prolonged time on your back, especially if you start to feel symptoms of nausea, swelling, dizziness, or light headedness.

While pregnant sidelying is the recommended position for sleep, primarily on your left side, to help with the promotion of blood flow to your uterus and body. Side sleeping can be challenging and uncomfortable, especially as ligaments become more lax. With ligamentous laxity, there is more separation around the sacroiliac joint which makes hips feel and appear wider for preparation of childbirth. The other aspect of discomfort is the growing abdomen which will also put strain on ligaments around the uterus and sacrum. The best recommendation is to find a supportive body pillow or pregnancy pillow (such as the snoogle). When the pillow is positioned properly, your knees should be approximately hips width apart and your abdomen supported. Though the added pillows may feel cumbersome, you will be happy to have the added support even if it means repositioning when you roll side to side. If you are still having difficulty with sleeping or positioning, speak to your physical therapist who can assist you with these issues. Enjoy your sleep now, Mamas-to-be!

Postpartum Exercise- Why You Should Proc

Postpartum Exercise- Why You Should Proceed with Caution

Waiting in line to check out at the grocery store, it’s hard not to catch headlines about a celebrity getting her “pre baby body back” after delivery or someone else “still hanging on to their baby weight.” It seems like there’s a lot of pressure on new moms to get back to grueling exercise as soon as possible. However, as women try to jump right back into the same types of workouts they were performing pre-baby, we see many people really hurting themselves.
The misconception out there is that once you deliver, your body is ready to jump up and get back to all of its normal activities. In actuality, regardless of the method of delivery, even very straightforward childbirth is one of the largest traumas an average body will go through in a lifetime. You would not recommend a person return to Cross fit 2 weeks after a serious car accident- your pelvic tissues need similar healing time periods.
The following wisdom was shared with me by midwives at Austin Area Birthing Center:
Week 1 postpartum: IN the bed. That means laying down. You may get up to go to the bathroom. All baby care can be performed in the bed or at bedside. Others should be responsible for cooking, housework, running after additional children. Do not be entertaining visitors. Sleep as much as your baby will allow and eat nutrient rich foods to replenish your energy stores and healing capabilities.
Week 2 postpartum: ON the bed. You are still mostly sedentary, but can now sit up to interact with baby, nurse, take slightly longer showers, sit in the bath. You are not doing chores or running errands.
Week 3 postpartum: NEAR the bed. Get up and combine some quick ingredients for a snack or walk around the house without lifting anything heavier than baby. Your day is still mostly comprised of rest and baby care, but you are not going grocery shopping and are not going out to exercise.
In the realm of exercise, gentle walking is the best way to start getting back around week 4.
Why so strict? Your uterus needs to be resting to shrink back to its original size and, pending you had a vaginal delivery, your pelvic floor was just stretched to its extreme and needs to slowly return to a functional length. Don’t pay it the respect it deserves? Your organs may start descending downward and result in prolapse, urinary leakage, or bowel dysfunction. Tears will be very painful and have a difficult time healing if tissues are strained. Also, your placenta detached from the uterus and left a salad-plate-sized open wound behind. Bleeding slightly more one day? You opened up your scab by doing too much.
We want you to get back to exercise, but it needs to be done slowly.
Contact a pelvic floor physical therapist for assessment and a rehabilitation plan to allow you to get back to your favorite form of exercise safely. We’d rather see you for 1-2 visits postpartum to make sure you’re safe and have a plan to reach your workout goals than see you down the road when you’ve already done damage.

Multiple Sclerosis (MS) is a disease tha

Multiple Sclerosis (MS) is a disease that affects the central nervous system. When the immune system attacks the myelin, which is the protective coating around the nerves, it results in a process called demyelination. The exact cause is unknown, but is believed to be contributed by a combination of genetics, environmental factors and immune system deficiencies. Common symptoms include fatigue, weakness, blurred or double vision, changes in balance or coordination, pain, and impaired attention or concentration. How does this relate to the pelvis? Unfortunately, with this patient population, up to 80% have bladder dysfunction, more than 40% experience constipation, and 91% of men and 72% of women report sexual dysfunction, according to some studies. Most common bladder dysfunctions include urinary urgency, frequency and incontinence. This happens because the demyelination process affects telling the bladder muscle and pelvic floor muscles what to do. Constipation is a common result not only from changes in nerve function, but also due to a lack of inactivity as weakness and fatigue worsen. Sexual function changes include decrease in sensation, vaginal dryness, erectile dysfunction, and reduced libido.
Research in this patient population is limited, but shows that the best candidates for pelvic floor therapy are those who get treated in the early stages of MS. Pelvic floor physical therapy, with or without the use of biofeedback, has been shown to improve urinary incontinence, nocturia (nighttime voiding), and bladder emptying. Patient education for behavioral modifications including timed voiding, bladder training, and fluid and dietary management assist with improved bladder storage. Conversely, improved bladder emptying can be improved by techniques for triggered reflex voiding, muscle training for both the pelvic floor and abdomen, and positioning. Extensive research has been performed for managing constipation utilizing abdominal massage; this massage helps facilitate fecal matter through the colon. A pelvic floor therapist can provide education on direction, pressure, intensity and frequency of massage routine for optimal results. In regards to sexual function, a skilled physical therapist can assess pelvic floor muscle tone, flexibility and ability to relax for optimum function in both men and women. It may also be important to look positioning, lubricant, mindfulness and fatigability for improved intimacy. With this in mind, please speak up to your provider regarding pelvic health as symptoms may change over time.

Intimacy and Incontinence Incontinence c

Intimacy and Incontinence
Incontinence can impact several aspects of your life: travel, exercise, work, quality of life, and even sexual function. Approximately 1/3 of women with stress urinary incontinence avoid sexual activity because of their fear of incontinence. Let’s talk about some ways to regain confidence in the bedroom:
1.) Seek treatment. This may start with a trip to your PCP, OBGYN, midwife, urologist, or urogynecologist to discuss your incontinence and make sure there are no systemic issues. While at this visit, I recommend asking if pelvic floor physical therapy is appropriate/recommended.
2.) Address your diet. Avoid drinking caffeine or excess fluids prior to intercourse.
3.) Prepare your bedroom. Consider using a mattress cover or laying down towels on the bed to lessen worry about ruining your bedding.
4.) Pay attention to your bladder. Urinate before sexual activity and take a break during sexual activity to use the bathroom if needed. When you do urinate, try double voiding. Double voiding is where you urinate, stand up, sit back down, and try to empty again. Keep your abdomen and pelvis relaxed and sit fully on the toilet for best results.
5.) Try different sexual positions. Sidelying, kneeling, or woman on top may be better positions for your bladder. Your physical therapist can instruct you on different variations of these positions to help minimize pressure on your bladder or straining through your abdomen which can create more leakage.
6.) Avoid excess exercise prior to intercourse. If your muscles are fatigued, it will be harder to control leakage. The best time of day to attempt intercourse is early in the day.
7.) Talk to your partner. You may be surprised at how supportive your partner is and how much more relaxed you feel after. Your partner may be relieved to know that you haven’t been avoiding sexual activity from lack of interest. Open dialogue will also allow the two of you to plan sexual activity and gives you another person to discuss your treatment options with.
Urinary incontinence is difficult to discuss, let alone discussing how it impacts your sexual function. However, your healthcare providers, including your physical therapist, are here to listen and help you with these issues. Please speak up and seek treatment to help you improve your sexual function and quality of life!