By: Elizabeth Leeds, PT, DPT

One of Comprehensive Therapy Service's philosophies is education of the therapist and the patient. Comprehensive Therapy has become a host sight for multiple physical therapy courses. We have embarked on a mission this year to become a host sight for educational empowerment for our patients and community with the launch of our 2014 workshop schedule. The workshops range from lectures to movement based ones, and are intended to assist you in understanding movement and the human body. The intention is to enhance learning versus a class to get a workout.

In January, we kicked it off with learning a core conversion workshop. This
workshop covered the ins and outs of core activation and how to incorporate this into squats and pushup variations. February focused on pregnancy and post partum. We discussed the hormonal and bodily changes associated with pregnancy, exercise and pregnancy, as well as post partum considerations. March was Yogalates. This workshop discussed the history of Yoga and Pilates, as well as broke down a series of Yoga and Pilates exercises for a home program. April was Circuit Circuit Circuit. This workshop featured two 25 minute routines for home. May is Improving your Yoga practice, where we deconstruct 6 Yoga poses to meet your needs. We end the year with workshops on Autoimmune and Lifestyle Management, the Hip and Pelvic Floor, Post partum and Pregnancy lecture, TRX routine and use, a new Circuit Routine Review and Progression, and lastly Resolution Check In.

To complement these workshops, we have decided to follow some of these
workshops with fee based one-hour classes. The workshop is not mandatory to
attend these classes; however, it is recommended. Such workshops with follow
up classes include, Yogalates, Circuit Circuit Circuit and Pilates. The class will
keep a consistent routine, to allow for learning of technique, progressions and
modification.

Since this is a new journey for us, we welcome feedback. We want to be the clinic that not only assists you in recovering from your current condition, but the resource to achieving a healthier, new you.

By Maureen Mason, MS PT

There are multiple guides for women on strategies to create a healthy pregnancy, and these are primarily nutrition focused. A physical therapist's guide to a healthy pregnancy will include the following strategies for your musculoskeletal health and fitness: A) Facts about body changes in pregnancy, B) Potential sources of musculoskeletal problems, and C) Guidelines for safety. Here is your outline:

A) Changes during pregnancy:

Pregnancy involves changes in the endocrine, gastrointestinal, genitourinary, cardio-pulmonary, musculoskeletal, and integumentary (skin) systems. Focusing on musculoskeletal changes, in the first month there is a surge of relaxin hormone, which allows joints and muscles to loosen and stretch. Relaxin helps ligaments to loosen to allow for increased flexibility to accommodate the growing uterus and placenta. Relaxin levels off in the second and third trimester, however all the combined metabolic changes create increased demands on a pregnant moms body. Blood volume must increase, along with metabolic rate, so pregnant women need to hydrate well and optimize nutritional input. The cardio-pulmonary system needs to ramp up its function, so the volume of air moved per each breath increases during pregnancy. The rib cage widens 1 to 2 cm as the pregnancy advances, and the diaphragm muscle moves into a position higher up in the thoracic region. Weight gain of 20 to 30# occurs, and insulin sensitivity may vary and pregnancy related diabetes, gestational diabetes, might occur.  

B) Potential sources of musculosketal problems: 

Relaxin may also lead to an increase risk for instability or strain, so do not undertake any new advanced stretching routines! Women may be most vulnerable to strain during the initial relaxin surge, however joint and spine and pelvic regions may be more susceptible to strain throughout the pregnancy and early post partum time, associated with hormone and other changes. Spine and pelvic joints have an optimum range of functioning for daily activities, so do not place yourself in prolonged slouching or twisting poses, and this follows for the rest of the pregnancy. Muscle spasm often ensues to protect or "guard" your spine and pelvis. Additionally, sitting on one cheek, or with legs crossed, may strain and unbalance the pelvic bones so they are out of alignment. Bladder support muscles and ligaments must support extra weight, and urinary urgency and frequency and urinary incontinence may ensue from pressure changes. Women may feel lightheaded from exercise, and they may actually compress the abdominal aorta with prolonged exercise while lying on their back, therefore the American College of Obstetrics and Gynecologists (ACOG) advises no exercise be performed while lying on your back after the first trimester. (See ACOG guides below). The abdominal muscles may overstretch, and form a separation, termed a diastasis rectus abdominus (DRA). Pelvic ligaments may loosen and allow pubic symphysis or sacro-iliac (SI) pain. Women need more family and community support in order to engage in exercise programs, so lack of support has been identified as a barrier to exercise for women. The calcium needed for the pregnancy may cause a depletion in the mothers skeletal system if she is deficient and not receiving optimum calcium along with other nutrients; this may create a transient period of bone loss of mineralization and osteopenia or osteoporosis, so take the nutrition guidelines seriously! 

C) Pregnancy guidelines for safety:

The American college of obstetrics and gynecology has a free file on the their recommendations for exercise safety, please note all precautions and contraindications to exercise per MD guidelines:

http://www.acog.org/~/media/For%20Patients/faq119.pdf 

  

Musculoskeletal PT tips for safety include: 

1) Posture and Body Mechanics: Sit squarely on chairs, and place a pillow behind your back if you need support to maintain a "neutral" or natural spinal curve. CLICK HERE for more details. Seated posture pain prevention also includes not slumping with feet up on a footstool and the back and tail -bone rounded for a prolonged period, as this may overstretch already lax ligaments, and create a strain. Moving into and out of bed also can cause pain and strain, so "log roll" with shoulders and hips in the neutral position to allow all the trunk and core muscles to hold the spinal joints in neutral.

HERE is a link on the actual technique.

 

2) Strength train with pregnancy safe exercises, which include typically biceps curls, rows, squats, shallow hip bridges, side-lying hip strengthening, and abdominal and pelvic muscle strengthening. There is no cookbook for all, the actual exercise prescription must consider your starting fitness level, any musculoskeletal injuries or concerns, and the program must be within a low to moderate level of exertion. Studies have shown that women may maintain fitness throughout pregnancy, and maternal and newborn well being are positively impacted. Stabilization exercises have been identified as the best treatment for pelvic musculosketal pain problems, and specific abdominal, back, and pelvic exercises may be prescribed in a PT session for pregnancy related pain. However, if there is a mal-alignment or strain, manual therapy for spinal and pelvic alignment is needed before exercise may be successful. PT techniques may include massage, joint and spinal mobilization, and therapeutic home exercise programs to re-align and strengthen muscles. Abdominal, Pelvic, and back muscle strengthening programs are prescribed for each individual based on the presence or absence of DRA, SI, pubic bone or spinal pain. Urinary incontinence may be reduced or lessened by correctly performing pelvic muscle exercises. Correct recruitment of pelvic muscles is difficult for many women, and 60% or more of individuals require specialty training to avoid incorrect exercise. Incorrect pelvic muscle exercise may include overuse of hip or abdominal muscles, and breath holding, so see your PT for a performance screening.

 

3) Cardio programs during pregnancy are important for maintaining muscle strength, endurance, weight management, and insulin regulation. Additionally, improved quality of life, or sense of well-being is associated with aerobically trained pregnant women. Three times a week, up to 6 x a week is recommended for cardio programs, with the intensity and duration based on baseline fitness and maternal training and comfort levels in regards to ACOG guidelines. 

 

4) Maternal bracing and taping may help reduce pain and reduce or stop progression of ligament and muscle over stretch. This is a growing area of research, and several specialty binders, SI braces, and kinesiotape applications are available. 

  

Look to a future blog for more information on this topic, and see your PT at CTS if you need an evaluation and custom bracing or taping system.

 

Resources: 

Depledge J, McNair W, l Keal-Smith C, and Williams M, Management of Symphysis Pubis Dysfunction During Pregnancy Using Exercise and Pelvic Support Belts Physical Therapy December 2005 vol. 85 no. 12 1290-1300  http://ptjournal.apta.org/content/85/12/1290.long

http://www.befitmom.com/diastasis_recti.html

Sampselle CM1 CL.Effect of pelvic muscle exercise on transient incontinence during pregnancy and after birth. Obstet Gynecol. 1998 Mar; 91(3): 406-12.

Kari B� and Margaret Sherburn,Evaluation of Female Pelvic-Floor Muscle Function and Strength, Physical Therapy March 2005 vol. 85 no. 3 269-282

Malmqvist S1 of low back and pelvic pain during pregnancy in a Norwegian population.J Manipulative Physiol Ther. 2012 May;35(4):272-8. doi: 10.1016/j.jmpt.2012.04.004.

Emily Norman, Margaret Sherburn, Richard H. Osborne, and Mary P. Galea An Exercise and Education Program Improves Well Being of New Mothers, A Randomized Controlled Trial, PHYS THER. 2010; 90:348-355.

http://ptjournal.apta.org/search?author1=Margaret+Sherburn&sortspec=date&submit=Submit, Miller JM, Mims BL, Delancey JO, Ashton-Miller JA, Antonakos, Kjaermann I, Andersen K, �kland I, Br�nnick K, Larsen JP.Prevalence

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In This Issue
Workshops at CTS
Strategies for a Healthy Pregnancy

Pilates

Exercise for Health

Pilates Reformer Group
Group Apparatus
Class Schedule

Reach your fitness goals, then challenge yourself to new ones!
 
Check out our expanded class schedule and find a Pilates class for you.

Bladder Basics
Educate Yourself
Beach Yoga
Join us for our next round of educational seminars to learn all you need to know about bladder health!
 
Call CTS for upcoming seminars!
  

 CoreAlign

Balance & Strengthen

Contact our office for information about this new way to activate your core and balance your body. Free 15 minute trials available.

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