“Don’t Worry, Be Happy….Because Research Says So!”

happiness

Happiness is everywhere. It’s heard on the radio, it’s seen on billboards, it’s expressed as a smile or a good laugh, and it’s supported in the research. As I approach the end of my time as a physical therapy student at Foundational Concepts,  I reflect on how happiness and positivity can be such a powerful component to each patient’s plan of care. Additionally, research supports that a positive outlook can lead to positive outcomes.  By making small, positive habits a part of a daily routine, those habits could become second nature and could play a large role in relieving chronic pelvic pain.

Chronic pelvic pain, or continuous or episodic pain in the lower abdomen or pelvis for at least 6 months, is a common occurrence for many patients at Foundational Concepts.2 If left untreated, this chronic pain has the capability to compromise quality of life, function, and increase the likelihood of psychological impairments.2 Negative thoughts about pain can proceed pain-related fear, and further play into functional disability.5 In order to target pelvic pain, a multidisciplinary approach that includes physical therapy interventions, and emphasizes an improvement in day-to-day pain management and function, should be utilized.

Chronic pain is more than just a feeling of agony, it is a sensory and emotional experience that is related to how the brain organizes input and stimuli.1,4 Treating chronic pelvic pain should embody a mind-body approach to target more than the muscles and tissues affected but also to retrain how the brain perceives pain.4 Thoughts are considered to be nerve impulses, and research finds that negative thinking can exaggerate perceived pain states.4 However, the thoughts that the nervous system develops about threats and pain can be changed over time.4 Neurons in the brain can become less sensitive and stop misinterpreting a non-threatening stimulus as painful.4 Physical therapy encompasses the “mind-body” approach through manual skills, neuromuscular therapeutic interventions supported by research, and with the development of a unique plan of care to each patient.  Practice, persistence, and patience in conjunction with physical therapy, can restore function in a way that does not just mask the pain, but targets the pain.positivity

Negative beliefs and persistent stress, particularly without positive thoughts, lowers resistance, weakens the immune system, and increases the risk of health problems.4 Researchers believe that successful results can come from visualizing not only the movement, but also visualizing a positive outcome as well as imagining a movement performed perfectly.6 If your goal is to run a half-marathon or even to sit for an hour without pain, research considers that even visualizing success through positive thoughts can be beneficial to reducing pain.  Affirmations and positive thinking can potentially help one to better learn how to control thoughts regarding pain and how to handle stress and conflict to be better managed.4  Furthermore, pain was found to be reduced, as seen on imaging by use of positive pictures, sweet tastes, and expectations.4 

There are a variety of ways to make positive thinking a part of your everyday lifestyle. One technique may suit you better, but here are a few places to start:

1. R-E-L-A-X: Research shows that people who mediate better stimulate the region of the brain that is important for attention and regulating emotions.4  In addition, meditation can also decrease anxiety and improve self-confidence.4  Deep breathing, a good tool for EVERYONE (see blog post September 6, 2014) is believed to calm down a hypersensitive nervous system, which exacerbates pain states.4 (Stuck on how to mediate? Refer to our Resources tab for a recorded step-by-step meditation piece.)

2. Exercise: Research supports that exercise can lower a response to stress and improve one’s mood.

-For cardiovascular exercise, the American College of Sports Medicine ACSM), suggests up to 30 minutes a day for 5 times a week, of exercise of moderate intensity (walking, biking, swimming, etc.).4

-Yoga is another great form of exercise that targets body perception, deep breathing, and awareness of one’s mental and physical state.4 Yoga has been shown to increase the amount of positive thoughts and emotions and could potentially reverse the effects of negative thoughts through a physiological effect.4

-Pilates has been found to provide pain relief by increasing flexibility, mobility, and strength. Literature supports that pilates-based exercises provide a significant benefit to reducing pain.3

happy3. Take note: Document your day in a positive way! A journal (or even just a blank piece of notebook paper) can act as a place for all of your positive thoughts and actions throughout your day. With the holidays approaching, a journal makes the perfect gift for a friend or loved one, and mostly for you. Take time from your day to see all that there is to be thankful for and document those positive actions that you should take responsibility for. If you made someone’s day by holding the door or by calling a loved one, take note. You may come across a day where writer’s block takes over or where you need a different approach to your journal. If so, write down at least 1 thing that was good about the day. If it snowed, if it was sunny, or if you got the promotion you had wanted, anything that was good. Write down 3 random acts of kindness: 1 to a stranger, 1 to a loved one, and 1 to yourself. Embrace each day by starting and ending it with a positive thoughts or statement.

The small, positive thoughts can become everlasting habits into your day that can better target your pain. Try with just a few positive thoughts to start and see where your mind can take you.

– Lindsay Sureck, SPT

 

 

Resources:

1.  Bowering K, O’Connell N, Tabor A, et al. The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. J Pain. 2013 Jan;14(1):3-13.  http://www.ncbi.nlm.nih.gov/pubmed/?term=The+effects+of+graded+motor+imagery+and+its+components+on+chronic+pain%3A+a+systematic+review+and+meta-analysis.

2. Chao M, Abercrombie P, Nakagawa S, et al. Prevalence and use of complementary health approaches among women with chronic pelvic pain in a prospective cohort study. Pain Med. 2014 Oct 3. http://www.ncbi.nlm.nih.gov/pubmed/?term=Prevalence+and+use+of+complementary+health+approaches+among+women+with+chronic+pelvic+pain+in+a+prospective+cohort+study.

3. Sullivan A, Scheman J, Venesy D, Davin S. The role of exercise and types of exercise in the rehabilitation of chronic pain: specific or nonspecific benefits. Current Pain Headache Rep. 2012 Apr;16(2):153-161. http://www.ncbi.nlm.nih.gov/pubmed/22258395

4. Vandyken A, Hilton S. The puzzle of pelvic pain: a rehabilitation framework for balancing tissue dysfunction and central sensitization II: a review of treatment considerations. J Womens Health Phys Therap. 2012 Jan;36(1):44-51.   http://entropy-physio.com/wp-content/uploads/2013/10/Central-Sensitization-Framework-Article-21.pdf

5. Vlaeyen J, Linton S. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000 Apr;85(3):317-332.            http://www.ncbi.nlm.nih.gov/pubmed/10781906       

6. Warner L, McNeill ME. Mental imagery and its potential for physical therapy. Phys Ther. 1988 Apr;68(4):516-521.  http://www.ncbi.nlm.nih.gov/pubmed/3281175 

7. http://craniumcrunches.com/blog/hopeful-notes-the-middle-aged-brain-positive-outlooks-and-brain-research/

When chronic prostatitis doesn’t involve the prostate

I have many men who come to clinic with a long history of pelvic, testicular, penile, scrotal, and/or lower abdominal pain. They have been through the wringer when it comes to failed treatments.  Many rounds of antibiotics, every bladder and prostate test and scan you can think of, and multiple doctors—many who have thrown up their hands in defeat.   Almost all of them come in with the longstanding diagnosis of chronic prostatitis.  When a new male patient comes in to clinic with this history, I take a different approach.  What if the prostate isn’t involved?  What if it is more a problem of pelvic floor tension and pain?

male side viewThe prostate gland sits below the bladder and above the pelvic floor.  It acts as a secondary urethral sphincter, helping to stop the flow of urine and giving the bladder support.  Often, men with chronic pelvic pain also have urinary symptoms—slow urine stream, pain or relief of pain with urination, or hesitancy.  Thus, it makes sense that they often seek the medical advice of urologists.

But, again I ask, what if the prostate is not the problem?  Right below the prostate are the pelvic floor muscles.  This group of muscles supports the prostate and the bladder.  They also have a role in urinary function.  With increased muscle tightness, the urethra is not able to completely open, creating the same urinary symptoms.  Tight pelvic floor muscles also correspond with the pain symptoms these men experience.  Pain with sitting, standing, walking, sports, playing with their kids, and having a bowel movement.

Looking at the male pelvic floor muscles, you can see the correlation of this pain and the urinary male caudal viewsymptoms.  From the penis to the sit bones, a triangle of muscles is formed called the urogenital triangle.  The transverse perineal muscles form a strut from sit bone to sit bone.  These muscles are stretched when you sit, stand, walk, etc.  The other sides of the triangle are formed by the Ischiocavernosus muscles.  These muscles line the inside of the pubic bones and support the penis, particularly with an erection.

Deeper in the pelvis, are the layers of muscles called the levator ani muscles.  These muscles act as support for the low back, hips, sacrum and tailbone, and abdominal organs. If these muscles have trigger points or areas of tightness, they can produce many of the painful symptoms these men experience.  When I palpate these muscles during an evaluation, many times my client will tell me, “That is my pain!”.

 

pelvic girdle

So why am I suggesting that the prostate may not always be involved?  Because often it is not!  The National Institutes of Health groups prostatitis into 4 groups.  Type I and II are pelvic pain with bacterial infections and IV is prostate inflammation without symptoms.  Type III or chronic prostatitis accounts for 90% of all men with chronic pelvic pain.  That’s right—90%!!  Type III is defined as “chronic pelvic pain symptoms and possibly voiding symptoms in the absence of UTI”. (http://www.aafp.org/afp/2010/0815/p397.html).   That means no infection, no bacteria, and most likely, no prostate involvement.   The European Urological Association has recently changed their terminology to Painful Prostate Syndrome.  I still don’t love this term, but at least they’re taking the infection off the table!  Maybe looking at it as a pain syndrome instead of an infection, we can decrease the time it takes for these men to receive appropriate treatment.

So what can physical therapy do for “Chronic Prostatitis?”  Well, it turns out quite a lot.  In a recent study by Dr. Colleen FitzGerald (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872169/), men had a 57% improvement with physical therapy with a focus on myofascial mobility compared to a massage.  This  shows a significant improvement and is even a significantly more effective treatment then medications (http://www.intechopen.com/books/clinical-management-of-complicated-urinary-tract-infection/chronic-prostatitis-chronic-pelvic-pain-syndrome).

 

So, let’s take the prostate out of the corner!  If you have been experiencing pelvic related pain and have not been able to find a cause or a definitive diagnosis, find a trained pelvic floor physical therapist and rule in or out the pelvic floor muscles.  We can make a huge difference in helping with your treatment.

- Jennifer Cumming, PT, MSPT, CLT

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at foundationalconcepts.net for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT or @AmandaFisherPT and like us on Facebook/Foundational Concepts for updates.

Hysterectomy for Chronic Pelvic pain? 7 questions to ask first!

Great post by Dr. Jen Gunter.  Enjoy!

http://drjengunter.wordpress.com/2014/05/03/hysterectomy-for-chronic-pelvic-pain-ask-these-7-questions-first/

Just Breathe

My mother used to always say “Take a Deep Breath” when I was angry at my sister, or upset about something as a child.   I never realized how very valuable that advice was until much later.  I teach breathing techniques to my patients every day.  We go over and over it everytime they come in.  I get into a rut with it and doubt it’s importance and then I do a little reading and google searching and am reminded of the amazing, beautiful importance of the diaphragm and its amazing ability to impact so many of our bodies functions.  It truly is at the heart of “holisitc” healing.  So these days when my children push my buttons, or I have had enough of traffic, or my phone seems to buzz constantly, I take that deep abdominal breath and think of my mother.  Then I remember all the things that are benefitted by that simple action.  I wanted to share all the reasons it is important to exercise the diaphragm muscle and just breathe.

First, lets review the normal mechanics of breathing.  The diaphragm muscle sits at the top of the abdominal cavity, separating the chest cavity from the abdominal cavity.  Upon inhale, it contracts pulling air into the lungs.  At the same time, the muscles between the ribs, the intercostal muscles  contract expanding the rib cage.  As we exhale, the diaphragm muscle relaxes and air moves out of the lungs.  The intercostal muscles relax and the rib cage gets smaller.

breathingThe pelvic floor muscles are a very important piece in this system as well, functioning alongside the diaphragm for breathing.  During inhale they relax and descend down. With exhale, they recoil back up, mirroring the movement of the diaphragm. This piston-like movement provides massage and movement to the abdominal and pelvic organs, helps to pump blood and lymphatic fluid through the trunk, it helps to aid in pelvic floor muscle healthy function and keeps a balance through the trunk musculature.

Taking even 5 minutes every day to practice abdominal breathing is beneficial to us as humans!  The more you do the longer the carry-over becomes greater and greater.  Abdominal breathing teaches self-soothing to allow for better stress management, less anxiety and better sleep.  It is calming to our bodies in a world of stimulation from phones, tablets, computers, and TV.  Abdominal breathing turns down our sympathetic nervous system. Wait! it sounds too technical but keep reading…The sympathetic nervous system is responsible for “fight or flight”, meaning if you walk up on a bear in the woods this system is what tells you to RUN! Of course like all things in nature, there has to be a balance, and the sympathetics’s partner is the parasympathetic system. We need a good balance between the two. When one is overstimulated (ahem, put down your cell phone for a minute and focus here!), we tend to live in that mode of heightened awareness.  This increases heart rate, blood pressure and decreases blood flow away from our organs to divert it to where it needs to be to get away from that bear.  Helpful when we really need to get away, but not helpful in our daily lives when really all we need to do is calm down.

Abdominal breathing favors the parasympathetic nervous system. It brings increased oxygenation to our blood stream, it slows heart rate and decreases blood pressure.  It turns the sympathetic nervous system down a notch, putting that bear into hibernation mode. This allows for decreased stress, decreased anxiety and improved cognition and brain function.  This improves blood flow to vital organs, keeping systems mo ving happily. It relaxes muscle groups, reducing pain and inflammation. In a world where we are going every minute it would greatly benefit everyone to take just 5 minutes daily and JUST BREATHE.

Here is how to do it:

Find a comfortable position, the one shown below should work for most people.  Do this at a time of day when you can follow it with a calm activity or are ready for sleep, as this is designed to soothe you and put you in a sedated state.  Place one hand on your belly and one on your chest.  Inhale through your nostrils, allow your abdomen to expand and blow up like  a balloon.20140904_093026

Exhale, and the abdomen falls down.  Repeat this for 5 to 10 minutes, feeling and allowing your entire body to relax.

Try working this into your day, every day and see and feel the benefit!

– Sarah Dominguez, PT, CLT

Urine leakage in the female athlete

fitnessjog

I continue to be blown away by the number of young female athletes who are leaking urine during their sports activities.  I have heard that many women who leak think it is normal.  I also hear women say that it is normal for them to leak urine because that’s what women do. It is never normal to leak urine especially in a young woman who has not had children.  Urine leakage is a symptom that occurs when there are musculoskeletal dysfunctions within the pelvic girdle.  pelvic girdle

I would consider urinary leakage or incontinence to be a sports injury.  No, it may not be a sprained ankle or a torn ACL, but having urinary incontinence is a sign that there is something wrong with the stability system within the spine and pelvic girdle.  When a female athlete has knee pain, a coach, guardian or physician would suggest she see a physical therapist.  This is prescribed to help rehab her knee back to good health, because knee pain prevents an athlete from performing her best.  But what about a female athlete with urinary leakage?  Leaking urine can be embarrassing, frustrating and can greatly limit the athletes’ performance, therefore it is an important issue in the lives of these women.

The International Continence Society states stress urinary incontinence is the “complaint of involuntary leakage on effort or exertion or with sneezing or coughing”.  Some studies over the years have reported a prevalence of incontinence, up to 69% in the general population.  This occurs, due to the muscles and support structures in the pelvis being unable to withstand the pressure that is created in the abdomen with activities; such as coughing, sneezing or changing positions, like moving from sit to stand. You can read more about this on a previous blog, “Why do I pee my pants when I laugh”.

Recent research is showing a rise in incontinence in the young and athletic female population.  Having a teenager with urinary incontinence, just doesn’t seem right.  While it is more common for women who have had children to experience urinary incontinence, younger female athletes are also experiencing urine leakage with their sport. Young women who haven’t had children shouldn’t experience incontinence, right?  Well, no they shouldn’t but they do.

Risk factors for stress incontinence include: increased age, pregnancy and vaginal delivery, being a female, strenuous work, and exercise. A 2011 study that looked at urinary incontinence in female athletes found that a whopping 41% of elite female athletes experience urinary incontinence with their sport, and 95% of them would not dare discuss this issue. (Jacome et al)  Another study from 2006 found 29% of athletes studied had incontinence versus just 9% of their non-athlete counterparts. (Caylet et al.) Not all female athletes have incontinence, but there are sports which have a higher prevalence of incontinence in females; usually due to increased ground reaction forces through the body from landing after jumping or weight shifting movements. For example, one study found 0% female golfers had incontinence, while 67% of female gymnasts had leaking with their activity.  Leakage is reported both during competitions as well as practices for female athletes.

Research suggests female athletes have a stronger pelvic floor than the general population. So if they have higher pelvic floor strength, then why are female athletes leaking?  One theory suggests the added impact of repetitive stress on the muscles, ligaments and connective tissue can cause stretch weakness or overuse to these structures, causing them to become weak or fatigued and less able to control the increase in pressure which then makes them more likely to leak.

So, as I said before, a female athlete with knee pain would see a physical therapist for rehabilitation of the knee.  A female athlete experiencing urinary incontinence, with sport or daily activities, should do the same. It is stated in the literature that conservative treatment, namely pelvic muscle training should be the first line of treatment for stress urinary incontinence (Bo et al).  There is something wrong with her stability system, therefore, she should rehab it. It is important to bring this issue up in order to reduce the stigma associated with it, and get these athletes help.  Improving the function within the pelvic girdle can not only cure incontinence, it can greatly improve sport performance as well.  There are physical therapists who are specifically trained in pelvic floor rehabilitation, which is the kind of therapy a female athlete with urinary incontinence needs.  These physical therapists know how to diagnose impairments and improve the coordination of “the core” to ensure continence.

At Foundational Concepts, specialty physical therapy is what we pride ourselves in.  We treat pelvic floor dysfunction, prenatal/ postpartum pain and especially urinary incontinence in female athletes.  If you would like to learn more about pelvic floor physical therapy you can visit our website at www.foundationalconcepts.net or call us at 816-569-2802.

Please share this with the female athletes you know and the people that care for and work with them. Let’s encourage them to speak up and hopefully we can contribute to decreasing the rate of urinary incontinence in female athletes.

Amanda Fisher, PT, DPT 

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at foundationalconcepts.net for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT or @AmandaFisherPT and like us on Facebook/Foundational Concepts for updates.

Hospital based outpatient PT more expensive than Private clinic

http://www.apta.org/PTinMotion/NewsNow/?blogid=10737418615&navID=10737422527

be informed in your healthcare choices!

Why is the tailbone (coccyx) so important?

Often during my conversations with patients, they will mention an old tailbone injury from a fall, an accident, or a challenging birth of a child.  Many times, the injury is blown off with an “It was just my tailbone.”  Oh, the little attention the tailbone gets!  How is this little bone so often involved with pelvic pain, urinary incontinence, constipation, and pelvic organ prolapse?  Let’s take a closer look at this little bone that gets so little respect.

The lack of coccyx support has far reaching consequences, beyond the pelvic floor.  Let’s start with the pelvic floor and expand outward.  The coccyx (tailbone) is the very end of the spine, attaching to the bottom of the sacrum, and is the anchor for the many of the muscles in the pelvic floor.  It is the attachment site for the levator ani muscles which are the muscles that form the bottom of the pelvic bowl connecting the pubic rami to the sacrum.  These muscles act as a support system for the sacrum, pelvis, rectum, bladder, and in women, the uterus.   When the tailbone has been injured, the angle of attachment for the levator ani muscles changes, causing tightness and spasm in some muscles and weakness in others.  This can contribute to hip and back pain with sitting, walking, lifting, bending and squatting. 

pelvic diaphragm

With decreased muscular support for the sacrum, external support must be provided to decrease the hypermobility and pain.  In many cases, this can be provided by a sacral support belt to stabilize the sacral iliac joints and to prevent sacral torsions and innominate rotations.  However, even with this external support, some people will continue to have a decrease in balance and proprioception due to the internal decrease of core, hip, and pelvic floor stability and strength.  This can lead to an increased risk of falls and injury with everyday activities.

SI belt

The coccyx and levator ani muscles also play an important role for lymphatic and blood flow to the trunk.  Changes in lymphatic and blood flow occur due to decreased or changed pelvic floor muscle activity.  In conjunction with the thoracic diaphragm, the pelvic floor muscles act as a pump for the lymphatic system, issuing fluid to the thoracic duct, the main drain for the lymphatic system.  A backup of fluid often occurs when there is poor coordination of the diaphragm and the pelvic floor muscles.  This will appear as abdominal swelling, bloating, or pelvic heaviness.  A pelvic floor physical therapist who also has a strong understanding of the lymph system can work to coordinate both diaphragm activation and relaxation patterns and to pelvic congestion management.

abdominal contents

With the changes in the pelvic floor muscles, patients will also have decreased support of the pelvic organs.  The weakness of the pelvic floor and core muscles lead to pelvic organ prolapse of the bladder, rectum and/or uterus.  Pelvic organ prolapse can contribute to urinary leaking, constipation, and pelvic heaviness.  If the prolapse is not advanced, often muscle strengthening and pelvic floor PT is successful in reducing the symptoms. 

The coccyx truly is our anchor and is not to be overlooked or taken for granted.  Pelvic floor physical therapy can make a world of difference when dealing with issues of the coccyx.  A hand’s on approach to treatment can assist in the decreased pain and improved strength of the muscles surrounding the tailbone. 

–Jennifer Cumming, PT, MSPT, CLT 

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at foundationalconcepts.net for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.

Fix your Baby Belly, and stop doing crunches, forever!

What is Diastasis Rectus Abdominus?  A Diastasis is a separation, the Rectus Abdominus is the abdominal muscle better known as the six pack muscle.  A separation, or tearing of the fascia in the center of this muscle, the Linea Alba, happens to many women during and after pregnancy.  This condition can be very visually unappealing, especially as we head into summer and swimsuit season.  Besides this tummy condition being quite displeasing to us moms, it is also a significant risk factor for back pain, pelvic girdle pain, incontinence and pelvic organ prolapse.  It often resolves on it own within 8 weeks. If it lingers, do not stress, it can be very successfully treated with exercise, education, awareness of postures and body mechanics and an abdominal binder.

Let’s begin with the anatomy.  The abdominal canister is a functional unit made up of components of the abdominal cavity that synergistically work together. It is made up of abdominal and pelvic organs that are housed by several muscles.  The

abdominal cannister2

diaphragm, the psoas muscle, the pelvic floor musculature, the transversus abdominis (TA) and multifidus muscles. These muscles all share associated fascial and connective tissue connections.  They are supported by boney structures of the thoracolumbar vertebral column and rib-cage and the pelvic bones.  There are many joints within the cannister which need stabilization during daily activities.  Improving the function of this cannister will provide spinal and pelvic girdle stability, support pelvic organs and restore continence or prevent incontinence.  The intricate relationship of these muscles is such that when one is injured and weak or painful and tight the entire system suffers and becomes dysfunctional.  In particular when the Rectus Abdominus muscle and it’s fascia is torn or separated by pregnancy, the front wall of this cannister is weakened. This allows for poor postural support, poor organ support and causes the other muscles of this unit to have to work harder in a disadvantaged position. abdominal wall

 

The image on the right shows a good example visually of what happens when there is damage to the abdominal cannister. The front abdominal wall weakness allows for posture to suffer, the rib-cage falls forward, the cervical, throacic and lumbar spines are impacted negatively, the pelvic rotates forward, causing pull on the Psoas muscle.  the Psoas muscle often responds by over recruiting itself to make up for the lack of support in the anterior wall and becomes tight and painful.  The poor posture also creates pressure into the pelvis, weakening the already insulted pelvic floor musculture and decreasing support for the pelvic organs.  All of the muscles of this unit share fascial connections so poor posture and poor positioning of one muscle effects every muscle in some way.  The many joints in the spine, rib-cage, pelvis hips and knees are all affected. When a joint is under constant stress cartilage is damaged and joints become painful.

Many women get to work exercising and most women start with crunches and abdominal work, that seems like a reasonable place to start, right?  If this applies to you, stop those crunches now and keep reading!  No more crunches!  Hooray!  What actually needs to happen is you need an abdominal binder and you need to wear it for a good 6 weeks with all activities and exercise.  Think of it like a cast for your broken belly, The binder brings the fascia back together and supports the weakened abdominal wall and allows it to heal in the correct position.  Crunches are a repetitive injury to an already injured tissue, as well as putting stress on the discs of the low back and putting you at risk for disc injury.  So, step one is stop those crunches and get an abdominal binder.  I marvel at old wisdom. Those uncomfortable looking girdles our grandmothers wore, were ahead of their times! They knew a lot more than we gave them credit for!  They weren’t going to have that unsightly belly bulge, so they bound it up, and in doing so, likely resolved their diastasis unknowingly.

The exercise progression that is appropriate for improving Diastasis Recti focuses on strengthening the Transversus Abdominus, Multifidus and Pelvic floor musculature together with improving diaphragm function.  As well, a skilled physical therapist can examine you to determine other musculoskeletal concerns that are also impacting your recovery.  Often a vaginal exam of the pelvic floor may reveal not entirely weak muscles, but also muscles that are in spasm, for which strengthening will cause more harm.  There may be tightness in not just Psoas but in other hip and pelvic muscle imbalances.  It is important to evaluate your system from head to toe to determine the best individualized exercise program for you. This will optimize your exercise efforts and save you time and money spent on programs that are not right for everyone.  We are all very different from our postures and structure to even our daily activities and our emotional state.  This requires an individual program to see best results.

Posture and Body Mechanics are a huge factor in improving that mommy belly.  When you stand with your head forward, and your shoulders slumped you let that abdominal wall hang and increase pressure on the torn tissue, pressure on the pelvic organs and stress on the spine, ribs and pelvic joints; not to mention the bind that puts the diaphragm in for full function.  You can exercise and stretch to your heart’s desire, but if you leave the gym and spend you day in a yucky posture all you have done is for naught.  You return to bad habits, force muscles to function in poor positions.  Your mom knew something all those times she told you to stand up straight. It is so important for improving your baby belly and protecting your body from injury and pain.

So stop those crunches, bind that belly and find a PT who is knowledgeable about Diastasis and pelvic girdle dysfunction after baby to help you design a program that will be optimal for you.  The results are fantastic with consistent follow through and dedication to the program.

Sarah Dominguez, PT, MSPT, CLT 

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at foundationalconcepts.net for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT and like us on Facebook at Foundational Concepts for updates.

Meditation

Interesting article on meditation.

http://www.huffingtonpost.com/2013/04/30/meditation-health-benefits_n_3178731.html?utm_hp_ref=mostpopular

 

 

Because I’m Happy!

In the midst of moving to our new clinic location (happy) I wanted to take a moment to reflect on the year that has passed (happy).  Foundational Concepts turned one recently, on March 18, 2014 to be exact!  All the thoughtful processing, dreaming “big”, hard work, worry and care that went into opening our very own business has grown into a thriving practice.  I could not be more grateful. I could not be happier…like a room without a roof!

I have to begin with a very BIG thank you to Jenn, my business partner and dear friend. Had she not been sitting next to me one day,  and at the same time both said “we could do this on our own”,  the thought would still be just a dream. I would never have done this alone. Jenn is such a fantastic business partner.  She is a terrific clinician.  She is a great friend.  I am so blessed to be a part of this practice with her.

I am so thankful to all the wonderful physicians, psychologists, chiropractors and other healthcare providers who trust in us to care for their patients and help them on their road to wellness.  There are many options for physical therapy but you choose to send them our way, and for that I am grateful.  Both Jenn and I work hard to provide our patients with the best experience, and the highest quality of care. We combine years of experience with current evidence and a strong passion for what we do.  I appreciate the providers who recognize this and allow me to be a part of these patient’s healing path.

I am thankful for my husband, Sam and for Jenn’s husband Mike.  They have spent countless hours helping us along the way from financials to this website, to putting together furniture and taking the kids off our hands so we could work.  Their unconditional support from the start is phenomenal.  From day one, when i first mentioned to Sam what Jenn and I had been thinking I never heard “No”.  Your trust and willingness to take this risk with us is proof of your love and support for us.  I could not be more grateful, for there is no way I would be here without you.

I am thankful to every patient I have seen not just over this past year, but over my entire career. I learn more from you than can be taught in any textbook or course. I am grateful for your trust in me to help you find answers to your pain and dysfunction.  I am grateful you choose me to be a part of your team along the roadmap to better function and quality of life.  I enjoy each of your smiles, tears, and worries and I am humbled that you have shared them with me.  I love that I am able to lend a helping hand, a listening ear, a laugh, or a tissue along the way.  Thank you, Thank you for allowing me to really enjoy what I do.

Another HUGE thank you goes to Sushma Patel, owner of Bodies in Motion and Physical Therapist for allowing us the opportunity to open our practice with very little risk and overhead by sharing her space for the year.  She opened her PT clinic to us, allowed us use of the equipment, and her office staff and truly made us feel at home. We are forever grateful to you for helping us start off successfully.  We will absolutely find a way to “Pay it Forward” in some fashion as our practice grows. We learned from you and are so thankful for your generosity.

Last, I am thankful for all of those that I have met along the way this far in my career. Other therapists from whom I have learned, professors, researchers and students, have shaped my clinical career tremendously.  My dear friends who support me and love me and listen, you are amazing.  My three beautiful children who don’t understand now why this is so exciting and important to me, but will I hope when they grow up see what an accomplishment this is.  I hope most of all they see the importance of hard work, and pursuit of happiness and what it brings to your life.   My parents who have always shown support and love in my life, thank you.

Happy Birthday Foundational Concepts!

- Sarah Dominguez, PT, MSPT, CLT