Specializing in Women's Health in Denver

Physical Therapy for Women's Health

What is Women's Health Physical Therapy?

As the physical therapy scope of practice expands, the specialized field of women's health continues to develop with great need. Women's health encompasses a wide variety of diagnoses, with everything from urinary incontinence to pelvic pain, to promote and advance health in women of all ages and populations. Physical therapists with specialized knowledge and skills can address the unique health problems of women by providing assessment of the pelvic floor and low back/sacral musculature to determine musculature strength, endurance and tonicity. Working with a patient specific program of neuromuscular reeducation, soft tissue work, joint mobilization, biofeedback, stabilization, kegels, and neural mobilization, we address the entire pelvic and lumbosacral system as a whole to ensure success for our patients. Short and long term goals, patient home program and education are established and completed from the first day of care. Facilitating independence is our primary goal, allowing our patients to take a more active role in managing their health.

Women's health physical therapy can help minimize or even relieve the symptoms associated with the following conditions that a woman may experience at some time in her life:

• General
• Musculoskeletal low back/pelvic and hip dysfunction
• Stress, urge incontinence or overactive bladders
• Pelvic pain/dysfunction
• Interstitial Cystitis (IC)
• Prenatal/Postpartum
• Back Pain
• Weak Abdominals (possible muscle separation)
• Urine Leakage with coughing or sneezing
• Pelvic Floor Dysfunction
• Sacral iliac joint dysfunction
• Stress, urge incontinence or overactive bladders
• Pelvic pain/dysfunction
• Sensory Changes/Leg pain
• Postural Changes
   

Postpartum Exercise- A Safe Program for Postpartum Women

The benefits of exercising within 6 weeks of giving birth:

• Improved mood and feeling of normalcy in your body
• Decreased urinary urge or stress incontinence
• Decreased low back and sacral pain
• Increased energy and return to favorite activities more quickly
• Improvement of diastasis recti (separation of the abdominals in the center at the belly symptoms and problems

 Background:

A majority of the literature you read will provide very vague guideline in regards to resumption of physical activity post-partum.  The American College of Obstetricians and Gynecologists states that “pre-pregnancy exercise routines should be resumed gradually, based on a woman’s physical capability.”  Dr. John Clapp, in his book, “Exercising Through Your Pregnancy,” states that after extensive research, he now recommends that any new mom start exercising early and increase the level and amount gradually, avoiding any pain or heavy bleeding.

 Once you have received the consent of your physician/healthcare professional, it is highly recommended that you begin working on your core musculature to offset the effects that pregnancy has on your posture, childbirth has on your pelvic floor musculature, and the overall effects on your basic center of gravity. The core musculature consists of the Transversus Abdominus, the Multifidus, the Diaphragm and the Pelvic Floor muscles. Your transversus abdominus muscle lies inferior to your belly button deep to your rectus abdominus, or 6 pack abdominals.  Your multifidus lie segmentally along your spine and coordinate with your Tranversus abdominus to support your low back and pelvis.  Your diaphragm sits under your lungs along the rib cage and your pelvic floor supports your pelvis, sitting as a bowl to attach your sacrum and pubic bones, as well as to support your sphincter.

 This entire area serves as your core musculature to work synergistically to provide support and stability for the lumbar spine and pelvis. Please keep in mind that it is important to not jump out of the gates by resuming sit ups and leg lifts. Instead, we recommend first working on the deep core muscles (as described above) to provide proper coordination and support for your low back and pelvis. As this area improves in function, then resumption of higher level activity will be appropriate.

 All of the following exercises are appropriate whether you give birth vaginally or via cesarean section. Of course, ensure you get approval from your physician before resuming any exercise program:

Phase 1 program

(24 hours after giving birth to 4 weeks postpartum):

Diaphragmatic Breathing:

• Lie on your back in neutral spine position with hands resting on your lower rib cage
• Relax jaw, place tongue on roof of mouth, and slightly separate teeth
• Inhale through the nose, flaring the rib cage and drawing the air into the lowest lobes of your lungs
• Exhale through your mouth, funneling the rib cage, hollow the belly and feel the depths of your lungs empty
• Repeat for 30-60 seconds, up to 5 times per day to help with relaxation

Pelvic Floor activation, better known as Kegels:

• Lie on your back, with knees bent and feet hip width apart (we recommend your pelvis be elevated up on 1-2 pillows to allow gravity to help you contract)
• Relax and take a deep diaphragmatic breath
• As you exhale, draw your pelvic floor up and in, and tighten your anal sphincter as if performing an “Anal wink.” Attempt to hold this contraction for up to 10 seconds
• Gradually relax the pelvic floor muscles for 10 seconds
• Repeat up to 10 times, up to 5 times daily, in multiple postures, including hooklying, sitting and standing
• Goal; 30-80 reps/days, 10 times 10 second holds, with functional activity

 Transversus Abdominus contraction exercise:

• Lie on your back with knees bent and feet shoulder width apart
• Maintain a neutral spine (don’t let your back arch too much or let it press into the table) and inhale through your nose
• Exhale, pulling your belly button to spine, as if you are pulling a corset tight against your lower abdominals
• Relax your abdomen as you inhale in feeling an expanse of your rib cage
• Repeat up to 10 times, up to 5 times daily, in multiple postures, including hooklying, sitting and standing

Multifidus exercise:

• Lie on your back with your knees bent, feet shoulder width apart
• Maintain neutral spine by gently drawing the lower abdomen toward the spine
• Swell the lower back muscles on each side of the spine my “thinking of” moving your tailbone and lumbar spine together. Contraction of multifidus should occur without physical motion of extraneous muscle groups, while maintaining your abdominal contraction. Hold up to 10 seconds
• Repeat up to 10 times, up to 5 times daily

 Pelvic tilting exercise:

• Lie on your back, knees bent, feet shoulder width apart
• Inhale gently and the exhale, gently draw your belly button to spine, then squeezing your two sit bones together and flatten your back. Hold 10 seconds
• Repeat up to 10 times, up to 3 times daily

 Gentle Articulated Bridging:

• Lie on your back with knees bent, feet shoulder width apart
• Inhale gently and the exhale, gently draw your belly button to spine, first rocking back into a pelvic tilt.
• Keeping your abdominals engaged as well as your gluts, begin to lift your tailbone off the floor and continuing to lift up one vertebrae at a time, thinking of a strand of pearls lifting off a table.
• Hold at the top before hyperextending the back. Inhale and exhale, then roll gently back to starting position.
• Repeat up to 15 times, up to 3 times daily

 Special Tips for Incontinence Issues:

• Incontinence Recommendations

1. Postpartum Bladder Fitness Goals:

• Go every 3-4 hours – remember this is a goal and may take time to achieve this!
• Goal to go 7 times in every 24 hours
• Avoid constipation
• Increase kegels and goal of orgasm - 1 time per day (try to urinate before and after sex)
• Avoid “Just in case” urination
• Sit down when urge wave comes
• Avoid certain bladder irritants or stacked irritants

 2. Bladder Irritants:

• Alcohol, Beer/wine, carbonated beverages, soft drinks, caffeine, milk/milk products, coffee, tea, citrus fruits and juices, tomatoes, spiced foods, sweets, artificial sweeteners, chocolate
• Food not contributing to irritation grape, apple, cranberry, prunes, plums

 3. Output Recommendations:

• Go for 8 seconds, drink a ton of water, and try not to strain when you go to the bathroom
• Goal is to go every 3-4 hours. This may take time to get to this goal.
• Focus on relaxation and calming when you feel the sense of urgency to use the bathroom
• Sit when you use the bathroom

4.  Exercise Recommendations and External biofeedback tools recommended to assist in exercise performance:

• Elevate your hips on pillows when you perform your kegels. Gravity will assist you in contracting these muscles
• Use a mirror to see yourself when you are doing your kegels to visualize a good contraction and an anal wink. 
• If incontinence, low back pain or irritation to this area is still an issue at your 6 week appointment, please let your doctor know and come see one of us that specialize in women’s health at the Cherry Creek Wellness Center, Inc.
  

Contact Lea Schlipman, MSPT at the Denver office at 303-333-3493.