Postpartum Strong®

“When will I fit back into my pre-baby jeans?” – …And Other Post-Pregnancy Questions

Q. “Are sit-ups the best way to strengthen my abdominals after childbirth?”

A. No, sit-ups should not initially be done to reduce the pooch, your waistline, and to regain solid, supportive abdominals. A woman should initially draw in her abdominal muscles, especially the transverses abdominis, towards her spine while exhaling. When she can engage the muscles correctly, she will slowly progress, performing more challenging exercise with longer and varying duration of contraction and lever arm resistance.

Q. “A little bit of leakage is normal after giving birth. There’s nothing I can do, right?

A. Due to the stretching of the pelvic floor muscles and the displacement of bladder during pregnancy, the bladder does not always fill to capacity and the muscles do not have the same strength, endurance, coordination, or timing. As the muscles recover from the challenge of the birth process, they will function more quickly with rehabilitation exercises.

Q. “When will I be able to fit into my pre-pregnancy jeans?

A. The average length of time to be able to don your jeans is three months to a year post birth. Depending on your weight loss after weight gain with pregnancy, comfort of your connective tissue after having a C-section, episiotomy tenderness, or trauma to the perineum will determine when you will comfortably wear your jeans.

Q. “Is regaining my pre-pregnancy weight realistic?

A. Yes, however most people lose twenty pounds soon after the baby is born. Nursing does help to stimulate your metabolism and melt the pounds away. If you eat well balanced meals and drink at least 48 oz of water, weight loss is more dramatic. A nursing woman should not eat less than 1800 calories. Nursing a baby helps you burn calories by making breast milk.

Q. “What is a diastasis? Does it go away?”

A. A diastasis is a separation of the two muscle bellys of the rectus abdominis. The linea alba stretches sometimes with weight gain, and cumulative trauma, bearing down while holding your breath during delivery, and lack of orthotic support during morphological changes of the connective tissue during pregnancy. These are all contributing factors to the development of a diastasis. The condition can be significantly resolved through proper rehabilitation exercises, not holding your breath during functional activities, or during a bowel movement. Othotics, like a belly binder or taping can approximate the right and left rectus abdominis. While the connective tissue is still malleable is the time to address this issue: up to three months post delivery or up to three months of ceasing nursing.

Q. “I love being a new mom, but when will this pain between my shoulder blades disappear?”

A. Pregnancy hormones continue to circulate for three months after you discontinue breastfeeding. Therefore, all ligaments are loose, and can be strained if the muscles can not support the bones and joints of the skeleton. Proper position for feeding your baby so you do not strain the muscles between the scapulae is important. Many women have weak and poor endurance parascapular muscles. These muscles can become strong to support the spine and work more easily with less fatigue when picking up or carrying baby or baby’s paraphernalia.

Q. “Why does my lower back still hurt?

A. After delivery, patients often have difficulty regaining correct aligned posture. Muscle imbalances are often created. The abdominals are often weak; therefore, they do not offer good lumbar stabilization of the spine.

Q. “I just attempted intercourse for the first time postpartum, but it is so painful. Will this pain eventually go away?”

A. Sometimes after the birth of a child the mother experiences pelvic floor muscle relaxation or hypertension. Either condition can result in pain or a different sexual response than in the past. Muscles can be facilitated to be more responsive resulting in muscle contraction, orgasm from thrusting. If the muscles are too tense for penetration or comfortable during thrusting, modalities such as heat, connective tissue release, with or without trainers, ultrasound, downtraining, and learning five ways to relax a muscle can be most beneficial. A skilled, advanced trained physical therapist in pelvic health can assist you in meeting your goal of resuming comfortable, satisfying sexual intercourse. Sometimes post birth the estrogen circulating in a woman’s body is so high the elasticity of the pelvic floor muscles is decreased. The use of topical education cream for a short duration can be most helpful.

Q. “I really want to get back to running long distances, but my bladder won’t last that long! Is this just something I’ll have to live with?”

A. No, everyone should be able to return to running after regaining the strength of the pelvic floor muscles in isolation and in synergy with the deep intrinsic trunk muscles which include the transverses abdominis, deep back extensor and the diaphragm. When performing exercises, the diaphragm should be relaxed and lift up as you blow out gently, therefore, decreasing the intra-abdominal pressure.

These are just the top 9 questions we hear from women, but by no means are they the only questions women have after giving birth! Do you have a question that we didn’t touch on? Let us know in the comment section below!

Postpartum Culture Around the World : How Does The United States Compare?

Postpartum Strong® is a unique musculoskeletal program developed for women to regain muscle strength of their abdominal and pelvic floor muscles. Clinical research now supports rehabilitation after a normal or challenging birth or pregnancy to prevent incontinence, prolapse and sexual dysfunction. Routine care around the world is quite different than postpartum care in the United States. After preparing for nine months to assist the developing fetus, and taking care of yourself, the six week check up consists of a check to see that the mother is recovering, baby is growing and birth control is offered. Very seldom is the muscular status of the woman checked or questions asked about leakage with laughing/coughing/sneezing, backache when lifting or holding your baby, pressure or a bulge in the pelvic. Therefore, if women were screened for abdominal separation, pelvic floor muscle relaxation or increased tension, as well as postural problems . . . many of these issues could be averted.

CULTURE

Other countries offer a different postpartum culture for women, such as:

Germany – Midwives visit for 10 days and women get body coaches for 6 weeks to check on the baby and exercise with the mother.

France – Midwives visit for 5 days and women receive 10-20 sessions of la rééducation périnéale.

Other countries, like New Zealand and Canada, check for separation of abdominal muscles. In America, because women are uninformed about muscle rehabilitation and post delivery care, they have a difficult time distinguishing fact from fiction when researching topics on the internet. Mostly, they expect their body to snap back and not be the one who has the problems with pregnancy, birth, nursing and regaining body function to preform everyday tasks.

Not one physician has told me they have been educated on postpartum musculoskeletal rehabilitation emphasized during medical school or residency. Therefore, unless they have gained knowledge over the years, this is a topic that is not addressed unless the patient brings up a concern.

CONCERN

The more women are educated, the less we will hear comments such as this: “I was cleared for exercise at six weeks, so I ran five miles. At the end, my bladder fell out.” “My belly pooch never went away after doing hundreds of sit ups. I found out it was because my stomach muscles were pulling apart.”

And hear more of this: “I tried to have intercourse and the pain was like a hot knife. Having another glass of wine didn’t help. Learning how to relax my pelvic floor muscles made all the difference in the world.”

EDUCATION

Many medical professionals are unaware of women’s health physical therapy for post-birth screenings or intervention. Demands of taking care of a newborn and yourself are often not balanced. As a result, many women become fatigued taking care of others, to be the best mother, wife. What women sometimes do not realize, is that you must take care of yourself as well!

An analogy would be: for an orthopedic knee surgery, the patient receives a couple of visits of physical therapy prior to the surgery and typically a month or two post surgery to have the best outcome. Without screening postpartum women do not know they have a condition that could be treated.

Insurance will cover for muscle disuse and muscle incoordination, which all women have post delivery. Muscles Vaginal delivery is a trying event, affecting muscles, nerves and connective tissue.

Recent clinical evidence aids our understanding of morphological changes in the pelvic floor and abdominals during pregnancy and after childbirth. Tissue trauma takes time to recover. Pregnancy hormones continue to circulate for three months post-delivery or cessation of nursing. Without intervention, little change of the pelvic outlet opening changes after four months. Therefore, the importance of muscle rehabilitation is critical.

1 in 3 will have bladder leakage

36% discover separation of stomach muscles

30%-50% experience a heavy feeling that could be a descent of pelvic organs

Postural Maintenance can Prevent Back Pain during Postpartum

Regaining coordinated function of the deep trunk muscles requires effort! The muscles do not just snap back post birth.Genetic differences in connective tissue, weight gain, sustained stretch of abdominal muscles and hypertension of the back muscles affect recovery of the body post childbirth.

superficial and deep pelvic floor muscles

First, each component of the deep intrinsic trunk muscle synergy usually must be facilitated. In order for the muscles to work efficiently and effectively, women are able to exercises better if they understand the anatomy and physiology of muscles. Often one muscle can enhance other muscles in performing a functional task. For instance, when contracting the pelvic floor muscles with a sequential contraction of the deep abdominal muscle, the contraction of the pelvic floor muscles is greater in motor units recruited and endurance. These two muscle groups create stability of the pelvis.

The four components of the deep trunk muscle synergy are the transversus abdominis, deep back paraspinal muscles ( spinalis, longissimus, and iliocoastalis), superficial and deep pelvic floor muscles, and the diaphragm. First, the pelvic floor muscles are composed of 70% deep, and 30% superficial. They often work in concert, supporting the pelvic organs and reducing the size of the pelvic outlet offering more integrity of the pelvis. One component of the abdominal muscles offers approximation of the two side of the pelvis in the anterior portion of the body. The abdominals and deep back muscles perform lumbar stabilization when contracted. Intra-abdominal pressure increases when a person holds their breath causing the muscles of the pelvic floor and abdominals to work more intensely at first. However, fatigue occurs and less support of the organs and skeletal structure is offered from the muscles.

Individualized deep intrinsic trunk muscles exercises can be developed by a women’s health physical therapy specialist after an assessment of the postpartum woman is done. Exercises are based on posture alterations, abdominal strength and integrity, pelvic floor muscle strength and endurance, with consideration of any comorbidities such as incontinence of bowel or bladder, prolapsed pelvic organs, back pain including sacroiliac joint dysfunction. Individual exercises are started for all components of the synergy starting with proper breathing, especially exhalation with execution of a contraction.

diastasis 1 — Diastasis – separation of abdominal muscles

Next, the basic pelvic floor contractions, quick flicks of the superficial muscle fibers, and long holds of the deep diaphragm will be started. As soon as these two muscle groups are performing the correct contraction, short lever arm or leg movements are added to the base of the pelvic floor and abdominal co-contractions. As the postpartum woman is able to progress, the exercises are made to be more challenging with longer lever arms of resistance in different positions such as quadruped versus prone or supine. In addition, functional carry over is always addressed with ergonomics and correct integration of deep intrinsic trunk synergy.

Correct rehabilitation and recruitment of the deep intrinsic trunk muscles will support the spine and pelvis. Due to pregnancy hormones continuing to circulate for three months post birth or at the completion of breast feeding, the ligaments are loose; therefore, requiring even more coordinated, strong, good endurance and well timed muscle function to prevent back and pelvic pain.

Let’s Talk About Organ Prolapse

Pelvic Organ Prolapse (POP), is defined as weakness of the muscles, ligaments and connective tissues of the vaginal wall, causing descent of the pelvic organs. This weakness can result in bulging of the urethra and bladder, cervix and uterus, small intestine or rectum into the vaginal wall.

Causes of prolapse are:

1) childbirth

2) weak pelvic floor muscles

3) repetitive straining or bearing down

4) heavy lifting

5) chronic coughing

6) family history of Prolapse

7) Hysterectomy

8) decreased estrogen

9) constipation

Signs and symptoms of prolapse are:

1) feeling of something falling out of the vagina

2) lower back pain

3) constipation

4) painful intercourse

5) groin pain

6) heaviness, fullness or pressure in the vagina

7) incomplete emptying of bladder or bowel

Types of Prolapse:

Cystocele – (anterior vaginal prolapse) – When the bladder protrudes in the vaginal canal

Rectocele – (posterior vaginal prolapse) – When part of the rectum pushes into the back of the vaginal canal

Uterine – (apical/superior prolapse) – When the uterus descends into the vaginal wall. In those women who have had a hysterectomy, the top of the vagina can descend into the lower half.

stages of pelvic organ prolapse hysterectomy, the top of the vagina can descend into the lower half.

Enterocele – When the small bowel protrudes into the front or back of the vaginal wall.

A recent article published in the British Journal of Obstetrics and Gynecology, informed the readers that 50% of women undergoing a routine gynecological internal assessment, had an identified prolapse. Pelvic organ prolapse often significantly impacts their functional daily activities.

Childbirth (parity) is a well established risk factor for the development of prolapse. According to current body evidence, the alteration in pelvic organ support, during pregnancy and birth, may increase a woman’s risk for POP to eight-fold after one vaginal delivery, and a twenty-fold increase after three vaginal deliveries, compared to women who have had cesarean sections.

During pregnancy, due to circulating pregnancy hormones and increased weight of the expanding uterus and fetus, the pelvic floor muscles often relax. Pelvic organ prolapse at 36-38 weeks of gestation, first trimester body mass index, newborn birth weight and smoking status almost are variable with affect on POP development. More research is needed regarding mechanisms leading to persistent and/or progressive pelvic organ prolapse after childbirth labor.

Women’s Health Physical Therapy can offer the following care for POP (pelvic organ prolapse):

a. Pelvic floor strengthening, with supervised education. Recent research has concluded that a well adhered to exercise program for six to eight weeks will reduce prolapse one-half to a whole grade. — Pelvic floor strengthening, with supervised education. Recent research has concluded that a well adhered to exercise program for six to eight weeks will reduce prolapse one-half to a whole grade.

d. Femme - an orthotic that supports the pelvic floor and reduces gravitational pull causing descent of organs. — Femme – an orthotic that supports the pelvic floor and reduces gravitational pull causing descent of organs.

c. Electrical stimulation - a tampon sized probe is inserted into the vagina to stimulate, thicken and increase the activity of the muscle fibers of the pelvic floor muscles. — Electrical stimulation – a tampon sized probe is inserted into the vagina to stimulate, thicken and increase the activity of the muscle fibers of the pelvic floor muscles.

b. Trunk stabilization: The pelvic floor and deep abdominal muscles are linked. By activating the trunk correctly you can also strengthen your pelvic floor muscles and help support the pelvic organs. — Trunk stabilization: The pelvic floor and deep abdominal muscles are linked. By activating the trunk correctly you can also strengthen your pelvic floor muscles and help support the pelvic organs.

e. Pessary - an orthotic device which is designed to lift the pelvic floor muscles, connective tissue and ligaments. — Pessary – an orthotic device which is designed to lift the pelvic floor muscles, connective tissue and ligaments.

Many women have questions about prolapse and whether they may have this diagnosis. Please let us know if you have any questions or comments in regards to POP or how to ways to strengthen your pelvic floor.

National Women’s Health Week

We all realize the importance of setting aside time to take care of ourselves, but how many of us actually do it on a regular basis? Our lives seem to get so hectic and the “should do’s” start to pile up fast. This ever-increasing list can cause unneeded stress to our already busy lives, and guess what….stress is not healthy!

As part of this year’s National Women’s Health Week, we encourage all women to pick a few things from the list below and add them into their lives. These healthy reminders may seem simple enough, but can make a world of difference in how we feel!

As a women’s health specialist, I encounter women of all ages, activity levels and body types. I always encourage my patients to find an exercise routine that they enjoy…eat foods that make them feel vibrant, to be aware their your posture, engage their pelvic floor during activity, and so on.

Let us know which aspects from the list YOU are focusing on! Is there anything you would add to this list?

Happy National Women’s Health Week!

Women Deserve to Know: the Stretched Pelvic Floor Muscles (PFM) can recover after delivery!

Women Deserve to Know: the Stretched Pelvic Floor Muscles (PFM) can recover after delivery!

Pelvic floor muscles are very important because

a. they respond to stretch during sex which facilitates an orgasm

b. they support and promote function of the pelvic organs

c. they contract to delay urination or defecation

d. they relax to permit voiding or defecation

The pelvic floor, or pelvic diaphragm, is like a trampoline that spans the entire pelvic cavity. Urethra, vagina, and rectum pass through the diaphragm.

A recent study done in Norway done by Jette Star-Jensen and others was published in the March 2015 issue of Obstetrics and Gynecology looked at the postpartum changes in pelvic floor connective tissue which included muscles in a group of first time mothers. Throughout their pregnancies transperineal ultrasounds were taken at five times, 21 weeks, 37 weeks, and 6 weeks, 6 months, and a year post birth. Women were asked to be at rest, bear down (known as Valsalva), and contract the pelvic floor muscles. The connective tissue of the pelvic ring was assessed as the levator hiatus area, as well as bladder neck mobility.

85% the 274 women assessed before birth delivered vaginally, the others had cesarean deliveries. There was no difference in the women who delivered by c-section. The vaginal group displayed significant increased in all three measurements with comparing 12 months postpartum to 21 weeks of pregnancy.The group of women who had c-sections compared to the ones who had vaginal births were able to reduce the pelvic opening with muscle contraction more than those who had vaginal deliveries.

The ability of the deep diaphragm muscle and connective tissue to stretch might help protect the muscle during delivery(parturition). However, the stretch offers less stiffness to support the organs and hold the skeletal pelvis together. The levator ani (deep pelvic floor muscles) do not seem to recover completely twelve months after delivery. At twelve months, the vaginal and cesarian delivered women displayed no significant differences in an enlarged pelvic outlet. This phenomena might indicate persistent pregnancy changes as in other studies. Women need to be aware that the most change occurs during the first six months post delivery, but changes might persist. The pelvic floor appears to have great potential for recovery from pregnancy and birth, Due to the significant changes in the pelvic floor muscles during pregnancy and birth, the pelvic floor might be less able to develop pelvic floor disorders when other risk factors such as weight gain, poor deep synergistic trunk muscle strength and endurance, breath holding (valsalva) when having a bowel movement, excessive coughing with allergies. Therefore, we at Women’s Health Physical Therapy urge every women during the postpartum period to seek a pelvic health therapist for supervised individually tailored exercises to regain the strength, endurance, coordination and proper timing of contraction and relaxation of the pelvic floor muscles for proper function in isolation and with the other deep trunk muscles.

The Diaphragm, back muscles (multifidus), stomach muscles (Transversus abdominis) and muscles of the pelvic floor all work in a synergistic way to provide stability, strength and controlled movement.

Please contact a Pelvic Floor therapists in your area. If you are in the Richmond, Virginia area, you may contact Women’s Health Physical Therapy for more information about Postpartum Strong – from the Inside Out!

Why Didn’t I Know . . . that I could help prevent prolapse and incontinence?

As a specialized pelvic health physical therapist in the United States for the last twenty years, I have heard this comment so many times. The clinical evidence from research is now published in journals for urogynecologists, physical therapists, urologists, as well as for obstetricians and gynecologists, supporting the need for assisted pelvic floor recovery after childbirth. Just recently Dr. Ingrid Nygaard, a urogynecologist at the University of Utah, wrote an editorial in the March 2015 Journal of Obstetrics and Gynecology describing pelvic organ prolapse (POP), which does not typically develop to end stage until decades after vaginal birth. This morphological change can be affected by performing exercises to facilitate closing of the pelvis and regaining more stiffness of the muscles and connective tissue.

In order to understand how pelvic organs descend, a woman needs to understand the remarkable pelvic floor muscles and connective tissues that form a trampoline-like mat in the lower pelvic region. This tissue offers a certain level of stiffness to hold up the pelvic organs so they can function optimally, and accommodates varying degrees of intra-abdominal pressure when laughing, coughing, sneezing, or exercising. Holding your breath, known as performing a valsalva, places pressure on the pelvic floor which can initially create hypertonus,(too much contraction), or pelvic floor relaxation from fatigue. A certain degree of stiffness of the tissue must be achieved otherwise the load from above due to increased pressure in abdomen when having a bowel movement, delivering a baby, excessive weight gain, or exercise can cause a descent of the pelvic organs. When a pelvic organ descends, women often complain of a bulge in their vagina or a deep lower pelvic pressure.

The structure of the pelvis also changes during pregnancy due to pregnancy hormones. During the 21-38 weeks of pregnancy, the pelvis opens in preparation for birth. For some people whether due to genetics or an easy non-stressful birth the body snaps back. But for 27% at six weeks the tissue was not recovered, and at 6 months 15% had a larger opening than the normal of 25cm2. An analogy would be a woven cane chair that no longer offer good support when someone sits upon it, but that it sags in the middle. As we examine our physical bodies, it is possible that women have muscle variations and differ in mechanical stretch that their connective tissue can withstand. Previous research illuminates for us that torn muscles can heal.

The call to action to help prevent prolapse is to rehabilitate the pelvic floor muscles during the postpartum period. Most muscles significantly change in six weeks, but depending on how stretched the muscles became or trauma from decreased blood supply, a longer period might be required. The body is magnificent in changing during the childbearing year. Just like recovery from a strained muscle in sport, pelvic floor muscles appear to respond well to rehabilitation post birth in an effort to regain form, and isolated function as well as coordinated and proper timing of function with the other deep trunk muscles like the back extensors and transverse abdominus, while coupled with exhalation. With the research that is now being published there is no reason why a woman should not know what happens to their pelvic floor during birth and how they can regain the best function possible.

To learn more, you may visit our website: obgyn-physicaltherapy.com

or call to set up an appointment: 804-379-3002

Every woman who has a child deserves to be postpartum strong from the inside out!

Did you know that current research reveals……. 1 in 3 women will have bladder leakage, 36% of postpartum women will discover they have separation of the their abdominal muscles, and 30-50% of postpartum women will experience a heavy feeling that could be descent of the pelvic organs?

Become postpartum strong so you do YOU DO NOT HAVE TO LIVE WITH ANY OF THESE CONDITIONS!

Did you know that a physical therapist, who has advanced training in the women’s health specialty, can perform a musculoskeletal assessment to determine if you present with one or more of these postpartum dysfunctions.

Why Didn’t I Know?

Take a minute to answer this 5 question check list . . .

1) DO YOU LEAK WHEN YOU LAUGH, COUGH, AND/OR SNEEZE? ⃝YES ⃝NO

2) DO YOU HAVE PAIN OR DISCOMFORT WITH INTERCOURSE? ⃝YES ⃝NO

3) DOES YOUR BACK ACHE WITH LIFTING, FEEDING, OR CHANGING YOUR BABY? ⃝YES ⃝NO

4) DO YOU SOMETIMES FEEL “PRESSURE” OR A “BULGE” IN YOUR PELVIS? ⃝YES ⃝NO

5) WHEN PICKING UP YOUR HEAD WHILE LYING ON YOUR BACK, IS THERE A BULGE OR DO YOU

FEEL A SEPARATION IN YOUR STOMACH MUSCLES? ⃝YES ⃝NO

If you answered YES to any of these, you’re definitely not alone! Ask for a musculoskeletal assessment. A physical therapist women’s health specialist can assess pelvic floor muscle function, abdominal separation, and postural alignment, and functional use of your back, abdominal and pelvic floor muscles coupled with proper breathing. Even if you have none of the above, you could benefit from attending a screening and learning how to regain or improve the strength, endurance, and coordination of the deep intrinsic trunk muscles to prevent the above listed concerns.

All insurances will cover physical therapy for muscle disuse and incoordination post delivery. Women across the world who just had a baby with no delivery problems are screened and offered rehab.

“You too deserve the best so that you can give your baby the best!”

Pre-Natal/Post-Partum Care

Pre-Natal/Post-Partum Care

A pregnant woman undergoes a myriad of physiological changes, which in turn results in physical changes. However, an understanding of the pregnant body is crucial to adapt to its changing state.

“DID YOU KNOW?” Most physical discomforts that you will experience during pregnancy can be treated with pelvic floor physical therapy. A very common complaint during pregnancy is lower back pain. This is treatable with physical therapy and will include modalities such as proper body mechanics, relaxation techniques, and strengthening exercises for the pelvic floor and core muscle groups. As most of these common complaints carry over into the post-natal period, it is of utmost important for pregnant women to return for physical therapy for specific postpartum care as well

Pre-Natal Conditions

First Trimester:

Lower Back Pain
“Morning Sickness” – Nausea

Second Trimester:

Diastasis Recti (separation of abdominal muscles)
Lower Back Pain

Third Trimester:

Lower Back Pain
Frequent urination
Low Energy – Fatigue
Constipation/Bowel Issues

Post-Partum Care:

Your body is amazing! And…yes, your body does change after having a baby.

After giving birth, women should seek out a women’s health physical therapist who is trained in the proper exercise, stretching techniques and other modalities. For some women, they will notice changes directly after childbirth that they might not have experienced while being pregnant. It’s great to know that these discomforts can be treated.

Incontinence (leaking urine when laughing, coughing and jumping)
Diastasis recti (separation of abdominal muscles)
Scarring from C-Section, episiotomy, or perineal tear
Pelvic floor weakness
Prolapse (or feeling of a bulge or heaviness in the pelvis)
Pelvic pain and pain during intercourse

Back Pain:

Lower Back Pain is a common discomfort that very often manifests in the sacro-iliac joints, or lumbo-sacral joint. More times than not, the pubic symphysis is also affected. This postural dysfunction can appear in any of the trimesters and may result in sciatica pain and discomfort.

So What Causes This Pain? The discomfort felt in the lower back and pelvic region is due to postural changes to accommodate the growing baby, ligament laxity, chronic weak abdominal wall and hormonal changes, to name a few.

Treatment Options Available: postural evaluation by a pelvic floor physical therapist who will evaluate your body mechanics, deep tissue massage, stretching, strengthening and other modalities such as ultrasound therapy and low-level laser therapy.

Diastasis Recti:

During and/or following childbirth, women may notice a weakness and separation in their abdominal muscles. A Diastasis Recti is the separation of the rectus abdominis muscle. Many women notice this separation when laying down and lifting their head up. A separation of these muscles of 2 cm or greater is considered significant and will need to be treated. Some factors that may contribute to this condition include weak abdominal tone and hormonal changes. This separation may appear in the second trimester and contribute to lower back pain.

Shouldn’t I Just Do More Crunches? NO! If you have a diastasis of your abdominal muscles, going back to your regular exercise routine may actually make the condition worse. Pelvic floor physical therapists are trained in specific abdominal strengthening exercises, coupled with proper breathing. With careful healing of your abdominals, you can get back to your regular routine in no time!

Physical Therapy Treatment Includes:

Soft Tissue Mobilization
Therapeutic Exercise
Myofascial Release
Deep Tissue Massage
Posture, Biomechanics and Proper Breathing
Low-Level Laser Therapy
Ultrasound Therapy