Strong Moms Restoring Strength and Health After Baby

Shari Berthold, DPT

Victoria Hurwitz, DPT, WCS

Amy Vandermark, DPT

Objectives • Discuss changes your body goes through during

pregnancy and the postpartum period.

• Define diastasis rectus abdominis, perform a self-test, and safely progress core strengthening

• Describe the pelvic floor, possible problems after birth, and how to exercise the muscles.

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Why Are We Here? • Low back and pelvic

girdle pain is estimated to occur in 56 – 72% of women who are pregnant.

• 1/3 have persistent low back pain after delivery

Clinton S, et al. Pelvic Pain in the Antepartum Population. 2016. http://www.drdauber.com/wp-content/uploads/2014/07/Dauber-website-pregnancy-pain.jpg Ostgaard HC. Postpartum low back pain. Spine. 1992. Jan 17(1)53-55.

Why Are We Here? • Over 25 million

Americans experience urinary incontinence.

• 1/3 experience urinary incontinence after delivery. www.nacf.org Huebner, M. The impact of pregnancy and delivery on urinary incontinence. International Journal of Gynecology and Obstetrics. 2010, Sept Vol 110(3);249-51.

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Why Are We Here? • HALF of all women have

at least one pelvic floor disorder.

Nygaard I, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA, 300(11), Sept. 2008

Postural Changes During Pregnancy

Fabmoms.in

Changes After Delivery • Loose connective tissue

– Neck/shoulder pain – Low back and pelvic

girdle pain – Leg and foot pain

• Stretched or separated abdominal wall

• Loose joints • Stretched pelvic floor, tissue

damage to pelvic floor (episiotomy, tears, bruises)

• Postural changes

• Hormone fluctuations

• Weight Changes

• Breast Changes

• Surgical Scars

• Proper posture and body mechanics

• Protect your joints

• Recover abdominal wall

• Recover pelvic floor strength

• Get help early if struggling

Recovery After Delivery

Postural Correction

Correct standing posture Proper baby-holding

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Body Mechanics with Baby Care

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Wikihow.com

Gettyimages.com

• Your core muscles include:

– Lower abdominals

– Deep back muscles

– Pelvic floor muscles

• A strong core helps:

– Posture

– Prevent back pain

– Prevent incontinence or pelvic organ prolapse

Your Core

Cordmama.com

Diastasis Rectus Abdominis

Anatomy Testing Position

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Functions of the Pelvic Floor • Support: your organs including your bladder, uterus,

and rectum

• Sphincter: assist in stopping and starting the flow of urine and passage of gas and stool

• Sexual: help with your sexual response and orgasm

• Stabilize: provide stability to the spine and pelvis

Pittsburgpelvichealth.wordpress.com

Pelvic Floor Problems • Weakness

– Urinary Incontinence

– Fecal Incontinence

– Pelvic Organ Prolapse

– Pelvic and Back Pain

– Difficulty achieving orgasm

• Nerve Damage

– Pain

– Weakness

– Lack of sensation

• Tears or episiotomy

– Painful intercourse

Risk Factors in Childbirth for Pelvic Floor Problems

• Vaginal Delivery

• Instrumental Delivery

• Abnormal Presentation

• Prolonged active second stage (>1hr)

• Birth weight over 8 pounds

• Higher maternal age at first baby (>35)

• 3 or 4 births, more than 2 C-section

• Weaker collagen

• Third degree tear

• Episiotomy

• Pre-pregnancy obesity

Proper contraction of pelvic floor

• Squeeze and lift • Pick up a marble with your vagina • Imagine that you are in a

crowded room and you are trying to hold back gas

• Suck water up a straw into your bladder through your vagina

• Stop your urine flow

Pelvic Floor Contraction

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Power

Endurance

Timing

Quick Hold Knack

Pelvic Floor Exercise Progression

• Pelvic inversion (bridge, wedge)

• Supine

• Sit

• Stand

• Dynamic and functional

Bracing Options

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4mdmedical.com Medco-athletic.com Luckyfeetshoes.com

Scar management

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Picture from: Navina.ca Picture from: Bodypoets.wordpress.com

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Physical Therapy Can Help!

• Posture and body mechanics training

• Manual therapy (joint alignment, massage, scar mobilization)

• Exercise

• Pelvic floor rehabilitation

UPMC Susquehanna Rehab Locations

• Costello Center Physical Therapy

– Shari Berthold, DPT

• Williamsport Hospital

– Victoria Hurwitz, DPT, WCS

• Muncy Valley Hospital

– Amy Vandermark, DPT

*Contact your physician for a referral*

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