Tag: pelvic PT

How to relax your pelvic floor muscles

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Whenever I teach coursework to pelvic PTs, a common theme tends to come up. While teaching someone to contract their pelvic floor muscles can be challenging, teaching someone to relax and lengthen? So much harder! And teaching someone to actually bear down (the way you need to move your muscles to have a bowel movement)? Way way harder! So, I wanted to take some time today to talk about how to relax and lengthen your pelvic floor muscles. This is super helpful for anyone experiencing pelvic floor overactivity– which often includes people with pelvic pain conditions, constipation, painful sex, and urinary urgency/frequency. And if you’re a rehab professional, this post will also give you tips to help train your patients to lengthen.

As an aside, if you’re a rehab professional and new to pelvic floor therapy, check out my facebook group, built just for you: Pelvic PT Newbies! This group was born after teaching so many new clinicians who just lack the support they need to grow into the incredible practitioners they can be! So, come join us! And, if you’re a more seasoned clinician who loves supporting newbies, you are welcome as well!

Back to the topic at hand, how do you learn to relax and lengthen your pelvic floor muscles? Let’s get started!

1. Locate and find your pelvic floor muscles

It’s tough to let go of tension in a part of your body you don’t really know. So, step one is locating these awesome muscles. The pelvic floor muscles are inside your pelvis like a hammock and run from your tailbone to your pubic bone. They support your organs, stabilize your pelvis and spine, control your sphincters, allow for sexual appreciation, and act as a sump pump to pump blood and lymphatic fluid in and out of your pelvis (Yep, those are the 5 S’s we teach at H&W). They are also super important for breathing–coordinating with your respiratory diaphragm, and play a big role in postural stability and movement. So, locate those muscles in your mind, and see what you know. Can you use those muscles and contract as if you were holding back gas or cutting off a urine stream? If you aren’t sure you’re doing it, grab a mirror, and take a look at your perineum. Do you see the anus pull in (like it’s winking) away from you and the perineal body (between the vulva/penis/scrotum and the anus) lift in? Or do you see the anus bulge out? If you have a vulva, you will also see a small amount of lift there and you will see the clitoris do a really tiny little nod of approval (that’s because the pelvic floor muscles superficially attach to the hood over the clitoris). If you have a penis, you’ll see the penis move as you contract.

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Once you connect with your pelvic floor muscles, the opening and lengthening can begin.

2. Pelvic Floor “Drops” with Diaphragmatic Breathing

This is my standby, go-to, exercise for encouraging lengthening and opening of the pelvic floor muscles. To perform this exercise, bring your mind back to your pelvic floor muscles. Then, aim to let go of the muscles and lengthen, as if you are starting a urine stream. Note– this does NOT mean bear down and push out. Urination actually should not require ANY pushing. This is simply opening, letting go, and lengthening. Another tip to help visualize this is to think about a straw in one of your orifices, then imagine that straw is in a cup of water, and you’re trying to gently blow bubbles in the water (believe me, I’m full of weird visual analogies!) After you drop and lengthen your muscles, let’s do slow, diaphragmatic breathing. Breathing well means allowing your chest, ribcage, and belly to expand as you inhale– Yes, this is NOT just belly breathing! Belly breathing really does not harness the diaphragm the same way! So, perform slow breathing inhaling, allowing your ribs to open, chest to lift, belly to expand AND pelvic floor muscles to open, then exhale gently. Repeat this slow breathing for 2-3 breaths. Then, check in with your pelvic floor muscles, drop them again, and repeat! If it is challenging to know if your muscles are opening or not, you can perform a very small (like 10-20%) activation of the pelvic floor muscles before letting them lengthen and open. That being said, if you have significant overactivity, even a small contraction can irritate the muscles– so pay attention to what you feel!

3. The Elevator Let-Go 

This is another visualization that can sometimes help you leg go all of the way of your pelvic floor muscles. To do this, visualize an elevator sitting in your pelvis. This is your main floor, and your building has 10 floors, and a basement. Now, use your muscles to gently lift that elevator to the first floor. Then, drop the elevator to the main floor. Take a deep breath while you visualize the elevator dropping all the way to the basement. Keep the elevator there while you gently take 2-3 breaths. NOTE: This also should not require much effort– we’re aiming to gently relax and lengthen. 

4. Happy Baby Breathing 

This is one of my favorite positions to encourage lengthening of the pelvic floor muscles. For this exercise, you’ll lie on your back and bring your knees up toward your chest, then open your knees and reach through to grab your ankles or your toes (whatever is comfortable and allows you to relax). In this position, take deep long breaths, focusing your breath into your abdomen and pelvis.

Hopefully this helps you get started! Believe me, lengthening the pelvic floor muscles can be challenging, so try not to get too frustrated if you find this difficult at first! If you’re struggling, reach out to a pelvic PT. We’re happy to help you figure this out, and have more tools available if these ones don’t resonate with you!

~ Jessica

Pelvic Floor PT: Soooo IN right now!

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I don’t know if you’ve realized it– but the pelvic floor has become crazy popular! This article by The Guardian was published 2 months ago. 3 different patients and a few friends forwarded it to me, as it highlights just how popular pelvic floor rehabilitation has become. And I’m not surprised. When I first started treating pelvic floor disorders, nearly every patient who came in the door had never heard of the pelvic floor, let alone, a physical therapist who treated the pelvic floor. They would look at me with a perplexed and nervous gaze as I would do my best to explain the anatomy and why there really was a GREAT reason that their doctor had recommended them to come see me. This situation repeated itself again, and again, and again.

But now, it’s actually a much more foreign experience. For the most part, my patients have some level of knowledge about the pelvic floor muscles. The internet and social media has allowed people more access to knowledge– including experts who make informative Tik-tok videos, infographics and blog posts 🙂 on their diagnoses and treatment options. This has created more informed consumers who are learning more about their health, care about their wellness, and are seeking to find the best answers for their care.

In fact, it now very rare for for someone to come in and tell me they’ve never heard of pelvic floor rehabilitation. And that is AMAZING my friend.

When I first moved to Atlanta in 2014, I could count the number of pelvic PTs in the area on one hand. Now?? The last time I counted, there were more than 30 of us. I’m sure that number is closer 50 or even more (I know this because nearly every level 1 pelvic floor course I teach has at least a few Atlanta based people in it!!). And while, again, this is amazing– it’s only barely scratching the surface of what is actually needed!

The reality is that pelvic floor problems are super common, and people dealing with pelvic floor problems are often struggling to find care! Look at some of these numbers:

Chronic pelvic pain effects at least 5-23% of women and 2-16% of men

Approximately 36% of female athletes leak urine

33% of individuals postpartum experience bladder leakage

Approximately 22% of older men experience bladder leakage

35% of people postpartum experience pain during sex

Vaginismus (painful vaginal insertion due to muscle spasm) occurs in 5-17%

20% of people experience constipation

Approximately 10% of people experience fecal incontinence

So… while we are serving so so many more people than we used to, we are just scratching the surface! If you are new to this blog, and want to read a little bit more to start learning about the pelvic floor, check out some of these posts:

Meet the Obturator Internus

FAQ: Isn’t Everyone’s Pelvic Floor A Little Bit Tender?

Head, Shoulders, Knees…And Pelvic Floor?

Yes, Men Can Have Pelvic Pain Too.

Also, if this is resonating with you, and you’re feeling like you may need some help, reach out and let us know!! You don’t need to be one of those statistics– you can get relief, you can feel better! And if you’re not ready to see someone in person, check out some of our mini-courses online on pelvic floor topics!

Do you leak when you run? Try this!

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I love running. To be honest, I’ve been out of a good running routine since Mary was born. She’s one now. I would like to change that. I’m scheduled (yes, my husband and I literally have to schedule everything with our crazy work weeks!) for a run this week and I’m thrilled.

As a pelvic physical therapist, my goal is always to help my support my patients in whatever exercise or fitness routine they enjoy. Sometimes, pelvic floor problems get in the way. I can’t tell you how many times I’ve heard things like: “I used to run all the time, but ever since I had a baby, I just can’t” or “I tried just wearing a pad while I was running, but I can’t get over the feeling that I’m making everything worse” or “I can run if I go first thing in the morning, empty my bladder before I leave, and then stop at the park on the way to go again.” Bladder leakage during running is ANNOYING. It can be so impacting to people, and for many, it can lead them to stop a movement or activity they enjoy, for the long-term.

5 years ago (has it really been that long!?!) I wrote on the topic, “Is running bad for the pelvic floor?” after receiving that question several times. Spoiler alert: There are times when it may be appropriate for someone to stop running for a period of time to retrain their body and regain their pressure modulating system optimization– however, running can be an excellent way for someone to exercise and move! There are no “Bad” exercises, just bodies that sometimes aren’t quite ready for them.

So, if you’re struggling with leaking every time you hit the pavement, what can you do?

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Let’s consider what happens during running, from a pelvic floor standpoint. Several studies in the past few years have demonstrated that the pelvic floor muscles are active during running. This study from 2017 used EMG electrodes at the pelvic floor muscles, and found that there was increased activation of the pelvic floor prior to heel strike and reflexive activation after heel strike during running. This is in line with what we know about the pelvic floor muscles. They play a crucial role in anticipating movement, preactivating, then have modulating force during movement based on the task at hand. And, this is protective. We would want the muscles to have varying levels of activation so that we can support ourselves during movement, support around the urethra, not leak.

What happens then when someone is leaking with running? We of course, want to say that this reflexive thing is not happening. This review did show some alterations in the way that those who leak contract vs. those who do not leak. However, this study found that the reflexive action was the same in those who leaked and those who didn’t. This one also found that patterns of engagement were the same. So, it is likely that there are sometimes differences, but sometimes not. And this seems in line with what we know about leaking. Leaking during running is a pressure system problem. So, to help it improve, we have to address the whole system– which includes the pelvic floor muscles, but not only the pelvic floor muscles. It makes sense that sometimes the issue is stemming from these muscles not activating at the right time, with the right force–but sometimes, the pressure problem is from something else.

How can we address the pressure modulation system?

First, we need to evaluate the system to see how the structures are functioning, and this includes looking at you– the full person– to see how you control pressure through your pelvis. So, we need to look at how you move from head to toe, then evaluate your running mechanics, then look more closely at your breathing pattern, your abdominal wall, and your pelvic floor muscles. Once we do this, we often have a clear idea of what is happening and can make a strategy to get this better.

So, my big Tip #1– Go see a pelvic floor PT–but make sure it’s someone who is trained at looking at the whole person and can really evaluate you well.

If you’re nervous about doing this, I feel you. It can be hard to talk to someone about very private things. And I totally understand that the idea of having an internal examination can be a barrier for some people. BUT, know that those of us living in the pelvic floor world talk about this stuff ALL THE TIME. You won’t surprise us. Seriously, we hear this stuff all day. And, if you don’t think you’re ready for an internal exam, that’s cool. Honestly, we don’t mind. There is SO much that can be done to help the pelvic floor and bladder leaks that can be done without an internal exam! If you want to learn more, give us a call. One of our doctors of physical therapy will be happy to do a virtual consult with you and get you started!

Ok, off my soap box… What else can you do to impact the pressure modulation system and decrease leakage?

Tip #2: Breathe!

This seems so simple. I know, you’re thinking, “Of course I’m breathing!” But, are you? Or are you going through a series of breath holds? Next time you run, pay attention, and keep your breath flowing in and out as you run. The diaphragm is the major pressure regulator of the body. So, we need to keep your breath moving so pressure is spread out!

Tip #3: Let your ribcage move!

Many people tend to run with stiffness, locking down their ribcage. This can funnel pressure downward toward the pelvic floor muscles leading to increased load, and potential leaking. Instead, relax your ribcage, let your arms swing and allow your trunk to rotate. This will actually turn on more of the muscles around your core improving the synergistic activation of your pressure modulating system.

Tip #4: Lean into the hills! 

When going up or down hills, it is easy to lean back to try to control the movement. This can alter the position of your ribcage over your pelvis which will impact your pressure control. Instead of doing this, lean into the hill as if you have a strong wind blowing against you (I love this visual I got from my friend & colleague, Julie Wiebe!). When going downhill, lean into the downhill and let yourself pick up a little speed instead of leaning back to slow down. Relax into the hill. Many of my patients find that doing this actually reduces the pressure they feel and can decrease leakage.

Tip #5: Get a running evaluation!

Running form matters, it really does! So, go see someone and have them take a look at your running form to offer you guidance on how you can optimize it! Be sure you’re using the best type of shoes for your foot as well! This can make a big difference! Awesome running stores in your area should be able to help you with this!

I hope this is helpful! What questions do you have about running and the pelvic floor? Ask away! We are here to help!

Have a great week!

~ Jessica

 

Virtual Pelvic Floor Physical Therapy

~ jesspreale ~ 2 Comments

We are in an unusual time. Like many of you, I have been reading way too many articles and watched way too many news stories. COVID-19 is sweeping the world, and all of us have this immense responsibility to act, where we are, to do what we can to prevent the spread of this virus. Everyone is impacted, and everyone (hopefully) is trying to make the best decisions for themselves, their families, and society at large.

Healthcare is also seeing a shift—away from in-person care and toward virtual platforms. Right now, this is essential for so many reasons. The interesting thing is that at Southern Pelvic Health, virtual sessions have always been a part of what we do. And now, more than ever, we are working to be sure this service is available for anyone who needs it. Because, the reality is, pelvic floor problems don’t stop during a pandemic. In fact, for many, they can be exacerbated. Social distancing also offers the opportunity to stop and care for yourself, your health (along with your family & the community by flattening that curve!).

So, what is virtual pelvic floor physical therapy and what can it do for you?

The initial visit starts the same as an in-person session. We spend time discussing what is bothering you, in likely more detail than you thought we’d be discussing. We talk about your history, what happened when all of this started, what changed along the way, what is happening now. We discuss any pain or orthopedic problems you are having, your bladder health, bowel movements and sexual function. And most importantly, we discuss your goals—what you want to achieve how you hope to feel.

Next, we provide an exam. Now, here’s the difference in the virtual session. The components of the exam during which your PT would palpate your muscles or feel you move—we can’t do that. So, the exam takes on a different flare. We still watch you move from head to toe to identify how your body is working for or against itself. We may ask you to do different self-tests, feel different areas and see if you have soreness/sensitivity. We will give you additional information to see if you can activate certain muscles. And, from here, we can actually glean quite a bit of information. You see, the pelvic floor does not work in isolation. So, watching a person move alone can give us so much information about your function. I’ve written about this before, and here are a few that address this:

Head, Shoulders, Knees and Pelvic Floor!

6 Reasons Why the Diaphragm May Be the Coolest Muscle in the Body

Pelvic Floor Problems in the Adult Athlete

Next, just like in-person sessions, we start you on a plan to address the problem areas we have identified. This likely includes specific exercises for you to get started on, and some educational pieces to start improving your habits. We will also make a plan for the future—which could include virtual sessions only, recommendations for in-person consultations, or perhaps a hybrid! At our practice, we already have much of our content and exercises in a digital format. Any exercises we recommend will be given to you via video instruction in your patient portal. Behavioral education and other pieces like that will be provided for you both in our virtual session, but also via handouts e-mailed to you after.

Already an established patient?

This is even better. We have already done a comprehensive exam (or perhaps, another PT has already done this exam!), so we will have a complete picture of your situation.  We will be able to discuss your progress, modify and progress your exercises, continue providing specific education, and help you continue to move forward to improve your function.

Live out of state?

This one is a little tricky. Technically, we are not able to see patients for physical therapy services if they do not live in Georgia. BUT, that does not mean we are not able to help you. We regularly offer virtual consultations and coaching services for people all around the country. This has been an amazing service to provide to play a critical role in helping to guide people to the services they need to get better. Our virtual consultations offer a similar format as our initial telehealth sessions. The difference here is that we would not be able to examine you and progress you in a program. We can offer some general guidance based on your symptoms, and very importantly, we can help you connect with more local practitioners to be on your healing team. We do the legwork for you—we find you resources, skilled practitioners (yes, we help you decide who your best options are!), and coach you along the way.

Are you ready to take the virtual leap? E-mail us today to arrange your first session at Jessica@southernpelvichealth.com!  

Stay healthy my friends! And please, wash your hands!

~Jessica

On Creating Agency as a Patient

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Agency is defined as, “the capacity of individuals to act independently and to make their own free choices.” What does this mean for healthcare? How does the healthcare consumer maintain and create agency while also navigating the complexities of medicine?

A few weeks ago, I traveled to Washington DC to teach a group of 40+ physical therapists and occupational therapists about working with people who are dealing with various types of pelvic pain. Over this 3-day course, we covered topics related to diagnosis, medical management, manual therapies, movement interventions, and much more. On the third day of the course, I gave a lecture on “trauma-informed care.” What is trauma-informed care? Trauma-informed care means the “adoption of principles and practices that promote a culture of safety, empowerment and healing.” While we do focus on how widespread trauma is, the varying ways people experience trauma, and strategies to develop sensitivity, respect and consideration for the needs of our patients, we also strongly emphasize the importance of treating all patients in this way.  One of the key pieces in doing this is helping a person develop a strong sense of agency– the ability to make their own educated decisions and partner alongside their healthcare professionals, instead of being the recipient of directed care.

The idea of agency can seem fairly basic. Shouldn’t every patient feel like they can make their own decisions? Shouldn’t they feel like their healthcare providers are all members of the same team? But, that is often not the case. When a person loses this agency, they can end up in situations where things start happening to them, instead of with them, and this can create difficult and sometimes traumatic experiences. This could be a mother who feels pressured to have a birth intervention she was really not comfortable with having. This could be a person being scolded for not being “compliant” with their recommended home exercise program (as opposed to their clinician understanding what happened and partnering with them to fit exercise in their lives). Or, it could be feeling pressured to continue a painful examination that they otherwise would choose to stop.

There are many reasons why losing one’s agency is detrimental. Remember, the pelvic floor muscles respond to threat. So when a person is in a situation where they feel threat (whether that is due to stress, a difficult situation, or other circumstance), the pelvic floor  will activate. When someone is dealing with something like pelvic pain, sexual pain, and other diagnoses, this can lead to a problem becoming worse. So, how can you maintain your agency as a patient?

  1. Ask Questions. All the Questions. “The only stupid questions are the ones that are not asked.” If you aren’t understanding what is being recommended to you, ask more questions for clarification. Your healthcare provider should always be happy to answer any questions you may have to help you make the best decisions for your care. This also applies to times when you are in the middle of a treatment/procedure/etc. Ask away.  Try saying:
    • “Would you mind explaining my options again?”
    • “Can you clarify what the benefits and risks would be to…”
    • “Are there any risks in not moving forward with that treatment?”
    • “What are the reasons you think I need to…”
    • “I’m sure you have a busy day, but it would really help me if you could answer a few questions.”
  2. Don’t be afraid to slow things down. If your treatment session or medical appointment is going a direction you are uncomfortable with, or if something is happening that you don’t feel like you understand, feel free to take a break. Try saying:
    • “I need some time to think about that.”
    • “I would like to take a few minutes to consider my options.”
    • “I would prefer not to move forward with that today.”
    • “Can you explain _______ to me again?”
    • “I’m not sure I understand all of my options.”
    • “I’d like to go home and think about all of this. I’ll let you know what I think at our next visit.”
  3. Bring a friend. If you know that you tend to get overwhelmed at your appointments and have difficulty expressing your needs or how you feel, consider bringing a friend/partner/spouse who will have your back! Tell them in advance what you want their role to be and how they can help you! This could be stepping in to ask for some time to consider options, asking a provider to slow down and repeat their explanation, or simply being a person to be present with you during a difficult appointment.

I hope these tips have been helpful in helping you develop strategies to create agency as a patient. If you are a healthcare provider, I urge you to reflect on your own practices. Do your words and actions support your patients in maintaining autonomy? support agency? Do you unintentionally pressure patients into participating in treatments or exams that they may not feel comfortable with? Do you shame patients when they don’t follow your recommendations? None of us are perfect. I truly believe that most health care providers have the best of intentions. But, we can all do better. Reflect on our own words, habits, body language, and be better partners for our patients!

What other strategies have you found to help you improve your agency as a patient?

~ Jessica

 

 

We’re live and going social!

~ jesspreale

Hi everyone! I’ve been staying up till midnight nearly every night, and no, it’s not because of my baby (she’s an amazing sleeper!). It’s because TODAY is move-in day at Southern Pelvic Health! My garage is packed with furniture, and I can’t wait to get this space ready!

Along with that, I am finally ready to launch my website!! Check out www.southernpelvichealth.com and see what you think!

We are also getting social!! I love blogging here, and I’m excited to bring smaller bits of content, tips, and pelvic floor love to the social media scene! Check out our Instagram and follow @southernpelvichealth! You can also find us on Facebook!

We will begin seeing patients on Monday September 30! If you’d like to set up an appointment, you can register as a new patient online!

Can’t wait to get started! Thank you for the outpouring of love and support as I’m starting this journey!

❤️ Jessica

Early Recovery After Caesarean Birth

~ jesspreale ~ 2 Comments

6 weeks ago, we welcomed our second daughter into the world. Mary Lynn was 6 lbs 10 oz of squishy, adorable, babyness. And she came into the world via a Caesarean birth. And it was amazing. And hard. But good.

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In the recovery room right after Mary’s birth!

C-sections come with challenges, just like vaginal births do, and for me, these challenges included a significant blood loss that led to me fainting on the second day, a super low blood pressure due to a response to the epidural that contributed to the fainting but also meant going off of my epidural pain meds really early, and nerve pain that lasted for about a month after Mary was born. (We’ll y’all more about that another time.)

Since I am living the early postpartum life, I thought it would be fun to do a series of posts on my own rehabilitation journey (since, in many ways, each of my births has been a mini-case study for myself!).

So, let’s talk Cesarean rehab in the first 6 weeks!

Moving well after major abdominal surgery

I love when people imply that birthing via Cesarean section is somehow “the easy way out” compared to birthing via the vagina. Hello people, this is major abdominal surgery! All mommas get birthing badges– let’s support each other in our journeys, right?!

Initially after a Cesarean, movement alone can be challenging. Standing up from a chair. Rolling over in bed. Lying down in bed. But the good news is that with some easy tips, this movement can become much easier. First, as you are moving, bending, standing, etc. remember to “blow before you go.” This easy to remember phrase comes from my friend and colleague, Julie Wiebe. This means, begin to exhale before you initiate a movement. Breathing like this with movement helps to control pressures within the abdomen and pelvis, so it can significantly help you in your movement after having your baby- both in terms of ease but also in protecting your pelvis and abdomen.

When standing up from a chair, remember, nose over toes. Scoot to the edge of the chair first. As you go to stand, lean forward first. This puts your body weight over your legs and helps take the burden away from your core.

When you lie down or get up from lying down, channel your inner log. So, when you lie down, first sit on the edge of the bed. Slowly lift your legs onto the bed, then lower the rest of the body down, using your arms for support. If you need to roll over, bend your knees, then roll your body as a unit- like a log. Reverse these steps for getting up out of bed.

Abdominal Binders and Compression Underwear? It depends. It may be worth considering  using an abdominal binder for the first few weeks after your birth, progressing to wearing compression underwear or shorts(ie Spanx, SRS recovery shorts, Core shorts). These types of garments provide support to the abdomen and can be incredibly helpful for moving and walking around after your surgery. The flip side with compressing the abdomen is that it can impact how well you can move your ribcage and can influence pressure mechanics within the pelvis. So, if you are already struggling with pelvic organ prolapse or urinary leakage, or if you pushed for a period of time before having a Caesarean birth, it may be worth talking with a pelvic floor PT prior to utilizing this during your recovery. Generally, the compression underwear/shorts provide more support to the pelvic floor and abdomen, so they may be a little better with pressure modulation than the binder. For me personally, the binder and compression undies were amazing! They took away my nerve pain, and helped me move much better. I chose to wear these sporadically during the day (a bit on, a bit off), and practiced breathing well with my diaphragm during the times the binder was off.

Handling your incision

Initially, your main focus here is keeping your incision clean, and monitoring it to make sure it is healing well with no signs of infection. Around 6 weeks, if you are cleared by your physician, you can begin to gently mobilize the tissue around the scar and aim to desensitize the scar. I usually start above and below the scar, before working on the scar itself. You can perform gentle massage to the tissue above and below the scar and gently stretch the skin in all directions above and below the scar. You can also gently desensitize the scar by touching it with your fingers or a wet cloth, and gently rubbing across the scar in all directions. We can mobilize this scar tissue further, but we are going to talk about this in a future post as this post is focusing on the early period of healing.

At this time, you can also begin applying silicone gel or silicone strips to help soften your scar and prevent hypertrophic or keloid scars. Silicone is considered a gold-standard treatment for the prevention or treatment of hypertrophic scars. While most of the research regarding silicone is of poor quality with significant bias, evidence does tend to suggest a positive benefit. My first Caesarean did lead to a hypertrophic scar, so I began applying silicone gel to my scar once cleared by my OB to do so, around 4 weeks after Mary’s birth. I’ll report back on the difference between this new scar and the old one (See, mini case study!).

**I also have to note here that my colleague, Kathe Wallace, has a fantastic book that details some recommendations for scar tissue management after Caesarean. Kathe also offers a free abdominal scar massage guide at her website, which is a fantastic resource!

Exercise in the Early Postpartum Period

If I could give you one piece of advice on this early postpartum period, it would be to relax. Give yourself a break. Allow yourself to recover and heal. I find that so many people want to jump into too much, way too soon, and unfortunately, this can be more harmful than it is helpful. Remember, you just did something incredible. You just had major surgery. You deserve to rest. 

When we think about exercise during this initial period of healing, we are going to start very gently. Here are a few things you can get started on:

  • Walking: I’m not talking about going and walking several miles. During the first few weeks, it’s best to really rest, and give your body time to heal. Getting up, walking around the house as you feel comfortable can be very beneficial.  As you continue to heal, during the next few weeks, you can increase your walking. So, this may include some outings and short periods of walking between 2-4 weeks. Between 4-6 weeks, you can generally consider a leisurely walk in your neighborhood or a longer outing. The key here is to listen to your body. Rest when you need to, but gradually move to increase your endurance. After you see your OB for a postpartum visit around 4-6 weeks, and you are cleaned to do so, you can continue to gradually increase your walking as you are feeling comfortable.  Are you antsy to jump back into running? Zumba? Bootcamp? Pilates? Don’t. We’ll get there. But let’s rest right now.
  • Breathing: You all know I am fairly obsessed with the diaphragm. 4 years after this post was written, I still think it’s one of the coolest muscles in the body. The diaphragm works in coordination with the pelvic floor muscles, deep abdominal muscles and deep low back muscles to provide support to the abdominal organs, modulate pressure in the thorax and pelvis, and provide dynamic stability to our spine and pelvis. Slow breathing, aiming to expand your ribcage and relax your abdomen as you inhale, then slowly exhaling your air can be incredibly beneficial to re-establishing these normal functional relationships.
  • Gentle Pelvic Floor Muscle Activation & Relaxation: First, my biggest recommendation would be to SEE A PELVIC PT before and during your pregnancy so you really know your current function and can have an individualized plan to get the most out of your muscles and your body. I encourage people to discuss their delivery with their OB, and ask about beginning gentle pelvic floor and abdominal exercises. The timeline for starting this will depend on the specifics of your delivery, and we want to be smart when activating muscles that have been cut. When your provider is on-board with you starting, I like to pair gentle pelvic floor and abdominal wall activation with breathing. This looks like this:
    • Inhale, expanding your ribcage, relaxing your abdomen and your pelvic floor muscles.
    • Exhale and gently draw in your pelvic floor muscles, allowing your lower abdominal muscles to also gently draw in. Aim for a “moderate” effort to allow activation of the muscles but not overactivate them.
    • Then, relax your muscles again as you inhale, repeating this cycle.
    • Aim to do this for a minute or two, twice each day.

Stay tuned as we continue this journey over the next few weeks and months! What have been your challenges after childbirth? For my fellow health care professionals, what else do you like people to know immediately after a caesarean birth?

Have a great week!

Jessica

BIG NEWS: I’m opening my own practice!!!

~ jesspreale ~ 14 Comments

Ok, so I have been SO excited to share this with all of you, but needless to say, I’ve been a little busy with nursing, diapers, and keeping a very active toddler happy.

My two little lovebugs!

Over the past 10 years, I’ve had the chance to treat hundreds of patients in a few different job settings. I’ve also helped to educate hundreds of other health care providers as they journey into pelvic health rehabilitation. I have learned so much through these experiences– both about patient care and creating a positive, motivating and enjoyable clinic environment for patients and clinicians alike!

So, I am thrilled to announce that I will be opening my own practice this fall! I have soooo many more details to share, but for now, I can tell you that I will begin seeing clients on October 1st, and will open scheduling in mid August! (If you want to be contacted first when the schedule opens, send me a message now!)

If you have any questions, please feel free to reach out!! Can’t wait to share more details with all of you in the next few weeks/months!!

~Jessica

Interview in Men’s Health Magazine on Chronic Pelvic Pain

~ jesspreale ~ Leave a comment

Good morning!

I was interviewed for an article that was featured this month in Men’s Health! I wanted to share with all of you here! Excited to bring information on male chronic pelvic pain and pelvic floor physical therapy to such a big platform!

In the article, we discussed the scope of the problem, treatment recommendations, and even some details on what good pelvic PT should look like! I hope you all enjoy!

Click here to view the article in Men’s Health on male chronic pelvic pain!

~Jessica

Video Interview with Dr. Ken Sinervo: Internationally- Recognized Endometriosis Expert

~ jesspreale ~ 4 Comments

Happy Endometriosis Awareness Month!

Did you know that Endometriosis affects more people that inflammatory bowel disease?

Did you know that 10-15% of women (and some men too!!) suffer with endometriosis?

Did you know that they often see 7+ physicians before being diagnosed with the condition?

Endometriosis is so common, and often can be a very life-impacting condition. As a pelvic PT, I often treat individuals with endometriosis, helping them with the musculoskeletal and neuromuscular sequelae of the condition. I have also helped many patients navigate the healthcare system to ultimately receive the appropriate care they so desperately have needed.

In honor of Endometriosis Awareness Month, I asked Dr. Ken Sinervo, the medical director for the Center for Endometriosis Care in Atlanta, GA to spend some time with me discussing this important diagnosis. Dr. Sinervo is an expert in treating endometriosis, and I can’t tell you how lucky I am that his office is about 20 minutes from mine! He is also a kind and humble person and a compassionate physician, and I was so excited to interview him for this post!

In the video below, we discuss: 

  • What is endometriosis and where does it occur?
  • What are the current theories on the causes of endo?
  • How can it be treated?
  • Excision vs. Ablation surgery
  • How to find an Endo expert
  • For pelvic PTs: How do you identify patients who may have endo?
  • And, as an extra bonus, cherry on top, Dr. Sinervo describes the research he is involving in trying to identify potential markers to actually test for endometriosis!!

I hope you enjoy the video as much as I enjoyed interviewing him! I apologize in advance if our video cuts out a little bit, but I don’t think it impacts the incredible content (Our weather in Atlanta was a little struggly, so I think my internet had some difficulties!).