Our thyroid is a VITAL hormone gland in our body. It is a big player in regulating our metabolism, heart and digestive function, muscle control, brain development, mood, and bone health. Whoa, that’s a big job! Hypothyroidism is defined as a condition in which your thyroid hormone is not producing enough thyroid hormone to support your body’s needs. Interestingly, menopause and hypothyroidism share many symptoms. In some women, menopause triggers changes in thyroid balance, leading to changes in TSH (Thyroid Stimulating Hormone). However, perimenopausal women, even children, can develop hypothyroidism as well. In a routine blood test, TSH is checked to see how much of this hormone is being produced in the body. More detailed testing (typically not routine) can offer more information on how thyroid is being utilized in the body, also helping in making an accurate diagnosis of this condition. Uncontrolled thyroid conditions in combination with high impact exercise programs can pose risk to our fitness clients, such as adding to further depressed metabolism, increased/decreased heart rate, and even abdominal weight gain. Once controlled, progressing with exercise should be gradual and monitored. If you are experiencing symptoms of thyroid dysfunction, consider following up with your naturopath or primary doc to get a baseline on thyroid gland function!
Diastasis recti occurs in the last trimester of pregnancy and commonly presents in post partum moms. During pregnancy, the connective tissue (linea alba) between the two rectus abdominis muscle bellies (aka “six pack”) stretches to accommodate the growing fetus. Following pregnancy, the linea alba gradually resumes normal position and the rectus abdominis muscles return to pre-pregnancy tension. Unfortunately, 33% of post partum women maintain a significant gap between the rectus muscles even a year after delivery that can lead to disappointing results with tummy toning exercises. More importantly, in some women, diastasis recti may contribute to symptoms such as back pain, poor balance, abdominal discomfort, and incontinence. Performing traditional abdominal exercises such as plank, crunches, and bicycle can be ineffective and can even make symptoms worseL
So, if not traditional abdominal strengthening exercises, what CAN help diastasis? Anytime we are dealing with symptoms in the body that relate to length/tension relationship between muscle and connective tissue, it is important to assess MOVEMENT. Diastasis recti is not a condition neatly contained to one little structure or even one little region of our body. Rather, it is a symptom of poor movement patterns throughout the body that further result in poor intra-abdominal pressure management throughout the midsection. The goals of treatment are to improve upon poor movement patterns which can be a result of muscle weakness, ROM restriction, joint or muscle pain, connective tissue issues, impaired muscle coordination, poor posture, preferred and/or restricted breath patterns….and more. It is not uncommon to see several of these issues presenting at once in women following pregnancy. Each women’s post partum healing experience is different, which is why a thorough assessment performed by a movement specialist (aka physical therapist!) is essential in getting started.
There are thousands of Google hits out there on “the DO’s and DON’T’S of exercise“ for diastasis recti. I tell my new mom’s to “proceed cautiously” with these recommendations. Certainly, it is good to have guidelines, but each women’s post partum recovery experience is unique. The “do’s” can create frustration of movement (FROMO), while the “dont’s” can trigger fear of movement (FOMO). For example, it is common for women to be cleared by her doctor to return to all pre-pregnancy activities about 6-8 weeks after delivery. However, due to a detected or undetected diastasis, she may have difficulty lifting her 8# infant out of the car seat or off the floor. This seems like such a simple task, yet is commonly challenging for women with abdominal dysfunction. This can lead to self-doubt in performing day to day tasks and without treatment, can greatly affect her self-confidence in performing higher level activities in the future. Meanwhile, restricting movement without proper assessment may create unnecessary fear of movement. Some women with a gap, especially if evaluated and taught proper strategies for managing intra-abdominal pressure, may be able to perform a crunch or plank with good tension and technique. For these women, this may create fear in a movement they can perform successfully which can last a lifetime.
Diastasis recti is a condition that is often treatable and can greatly improve a women’s level of success in performing day to day activities and achieving recreational or high level fitness goals. Connecting with a physical therapist specially trained in working with women with this condition is the first step in establishing an effective program. Setting and discussing reasonable goals, receiving a baseline movement performance assessment, creating and implementing individualized treatment programs, and patient education are key in getting mom’s back on the right track on their road to healing diastasis recti.
H.I.I.T. workouts are THE bomb, right? They’re fast-paced, challenging and downright addictive! They have definitely gained in popularity, especially among women, and have been touted as a good option for those looking to sweat and burn off a few calories! However, high intensity and high impact exercise is not always the best fit for everyone, especially the post partum population. Whether mom is 6 weeks, 6 months, or 6 years since having baby, here’s why just jumping back into high impact training after baby may not initially be mom’s best choice of exercise.
Pregnancy is an exciting time in a woman’s life, characterized by so many physical and emotional changes. It has been accurately described as a marathon event on the body yet many women rush through the recovery phase without paying much attention to changes that have occurred. The truth is that no matter how much of a “child birthing rock star” mom might be, pelvic and/or abdominal injury occurs during labor and delivery. Pelvic muscles can tear, ligaments often overstretch, and connective tissue is stressed. When trauma occurs to any other joint in our body, we immediately kick into protective mode. We know almost instinctively to rest, and, over time, resume load on the injured area. Through the healing process, we periodically re-assess our symptoms and scale our movements based on lingering symptoms until our problem resolves. Sometimes we even engage in specific exercise programs to build back strength, coordination, or motion. Rarely, however, do we implement these same strategies to our pelvic or abdominal region when recovering from pregnancy.
So, what’s the big deal? Why is the post-partum recovery phase so important for women? Most women seem “fine” after pregnancy, right? We hear it all the time: “Wow, she bounced back in no time!”, or “She’s killing it at the gym just 6 weeks after having a baby!” Unfortunately, mom’s apparent function does not always correlate with her actual function.
Did you know that women…
These are significant numbers and can create huge issues for women if not addressed early and properly. Clearly, these are not easy things to talk about and, understandably, most moms don’t sit around chatting about pain, prolapse, and peeing after (and way after) pregnancy. In fact, many women feel it’s normal to pee, have pain, or separated abs and just carry on with activity in spite of their symptoms. Sadly, these symptoms are red flags of core dysfunction and will likely progress if not addressed.
Most women are in the dark as to how to resume exercise after pregnancy. Very few are educated on post partum exercise progression, with most told to “take it easy and do Kegels”. At 6-8 weeks, moms are often “cleared” by their physicians to exercise and jump back into activities such as H.I.I.T. jogging, biking, and yoga, super anxious to lose their baby weight and feel strong again. Here’s the thing, though. Normal core function is dependent on mom’s ability to manage intra-abdominal pressure when she moves. In a healthy core, this is pretty much an automatic response that we don’t have to think about. However, many, MANY women are lacking the ability to control intra-abdominal pressure changes properly due to muscle, joint, or ligament damage that occurs during delivery. (HINT: that’s why some women pee when they jump!) And, the higher the impact or change in extreme movements for mom, the more control is needed. Repetitive movement with a poorly balanced system inevitably leads to greater dysfunction.
The good news is that there are postural strategies, exercises, and behavior modifications that can help safely restore the core to help ensure stabilization of the trunk and pelvis with exercise and movement. The abdominal muscles involved in the initial post partum recovery phase include the diaphragm, pelvic floor, transverse abdominis, and multifidus and are considered our “deep core” muscles. Most people have never even heard of these muscles! Proper function of the deep core system requires collaboration and coordination of all four of these muscles. In other words, just doing Kegel’s is NOT enough! Re-training these muscles requires exercises and movement strategies that are very different than the core exercises we all know and love (i.e. planks and crunches). In some cases, the traditional ab exercises can actually trigger dysfunction or progress an existing dysfunction.
I don’t believe most women are intentionally returning to activity or sport pre-maturely. I feel in most cases, moms are following the current standard of care before resuming exercise, and are not aware that core re-training programs are even available. Leaking is NEVER normal, pelvic organ prolapse is treatable, and the sooner low back, hip, or pelvic pain is addressed, the better the outcome.
As fitness professionals, we need to do a better job educating and screening moms before they return to sport or activity after baby. As moms, we have to do a better job speaking up and asking questions, and seeking help if we experience symptoms. Pelvic health PT’s are excellent resources for women with pelvic dysfunction and are highly trained to make appropriate exercise recommendations. In a perfect health care world, all women would be screened for core dysfunction after pregnancy. But for now, educating women on safe fitness options, encouraging them to seek help if symptoms persist, and supporting them in their decision to heal prior to returning to high impact training is a good start!
For more information on specialized post partum recovery classes, please visit www.epochphysicaltherapy.com. New A.B.C. After Baby classes starting in November!
Post by Julie Yunaska, MPT, CPT
Physical therapists can be a valuable resource for women before, during, and after pregnancy. Aside from the hormonal shifts in the body, women experience many musculoskeletal and neuromuscular changes as well that can lead to both acute and potentially chronic discomfort and dysfunction. Below are three benefits of skilled physical therapy intervention for mom during this transitional time!
Pain Management– It is common, but not normal, to experience low back pain, hip and leg pain, and pubic pain during pregnancy. Pregnancy alters normal body alignment due to the changes in weight distribution of the trunk as baby grows. Compensatory habits can develop that can lead to muscle weakness, joint tightness, and pain. Women’s health physical therapists are trained in assessing these conditions and utilizing manual techniques, individualized exercise prescription, and other recommendations to help alleviate symptoms.
Pelvic Floor Muscle Training and Education – Proper pelvic floor muscle activation and coordination is an important component of deep core function in the pre partum, labor, delivery, and post partum phase. Women’s health PT’s are trained in effective techniques that teach proper strengthening and sequencing strategies to better prepare the body for the demands of pregnancy and delivery and help prevent common conditions such as incontinence, prolapse, and pelvic pain. Determining whether the muscle is weak, tight, or poorly coordinated is important in developing and prescribing each individualized program.
Learn Strategies for Labor and Delivery – Although labor and delivery is often not perfectly predictable, women’s health physical therapists are skilled in providing strategies for comfortable birthing positions, proper breathing techniques to protect the pelvic floor during labor and delivery, and post partum recommendations to allow for a full recovery following pregnancy. (HINT: It’s time to rethink “pushing” during delivery!”)
If you or someone you care about is pregnant or has recently had a baby, consider a visit with a women’s health PT! We work to provide you with tools for better self-care during pregnancy and offer the expertise for effective intervention for optimal healing after baby.
By Julie Yunaska, MPT, CPT 7/17