One Breath for You, One Breath for Baby - Correct Breathing for Pregnancy and Postpartum

Our very life depends on breathing. Joseph H. Pilates stated that “it is tragically deplorable to contemplate that millions and millions who have never learned to master the art of correct breathing”. It is estimated that we complete 23,000 respiratory cycles a day and it effects our overall body fluids and circulation. Every part of our body moves with breathing. Chest and belly breathing has been linked to a number of health issues.

During the later stages of pregnancy, breathing may become difficult due to the baby’s pressure on the diaphragm. You may find your breathing becoming labored at times, especially during physical activity.  As breast tissue increases, posture may also inhibit proper breathing.

Getting a good breath is important during pregnancy because your breathing assists the lymphatic and venous system to produce a pressure gradient to return lymph and blood to the heart. Some of the reasons for increased swelling during pregnancy may be due to improper breathing.

It is important to practice good diaphragmatic breathing during and after pregnancy. More importantly, after pregnancy, as our muscles have adapted to the breathing performed during pregnancy.

Find a comfortable position with good posture, shoulders back, lumbar spine supported in a chair. Or lying down at a > 45 degree angle to keep pressure off the inferior vena cava.

Place your hands on the bottom of your rib cage under your beasts.

Start slowly by taking deeper and deeper breaths. Do not try taking deep breaths right away or you may become dizzy or fatigued.

Begin to notice how your hands are moving; they should be rising with each breath in and lowering with each breath out.

If your hands are not moving, try to take a breath and focus on your hands to make them rise and fall with each breath.

During and after pregnancy, try to practice breathing for at least 5 minutes a day.

Learning to breathe properly is better for you and your baby’s health, can assist with sleep and swelling in the body. If there is any pain with breathing, or you can’t seem to get your hands to rise and fall with your breath, talk to your OB/GYN. There is also skilled pregnancy/postpartum physical therapists that specialty trained in pregnancy for breathing and rib problems.

Chaitow, Leon N.D., D.O. Breathing Patter Disorders, 2002 Churchill Livington

Women's Works

A happy and amazing 2012 to all my followers!

It has been a very busy, productive and exciting new year for Women’s Health in Physical Therapy. Over the past few months, I have continued specializing my training in pelvic dysfunctions as well as obstetric physical therapy, developing women’s health physical therapy programs in the State of Washington, working with our hospital in developing our BirthPlace Physical Therapy and Massage program, becoming more active in the American Physical Therapy Association interviewing for the Pelvic Task Force, and assisting our hospital in introducing our da Vinci robotic-assisted surgical system. My most recent exciting work has been assisting our therapy and health services on the upcoming convention in April.

Pullman Regional Hospital will be hosting “Women’s Works”, which is an exclusive event celebrating women’s health and wellness. This educational event will include special presentations on gynecological conditions and treatments by our local da Vinci trained surgeons, tours of our BirthPlace suites and services, and presentations from acupuncture, audiology, physical therapy, health psychology, massage therapy, and genetic counseling.

Our participants will be enjoying complimentary appetizers, chair massages, and pampering from our local day spas. In addition, there will be drawings, prizes and celebrating the many aspects our area has to offer for improving women’s health and wellness.
http://www.pullmanregional.org/womens-works


Look forward to future blogs on our event and the da Vinci robotic-assisted surgical system for gynecological conditions and treatments.
http://www.davincisurgery.com/?id=ycc

 

 

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Returning to Athletic Activity Postpartum

Resuming an exercise program after having a baby has its challenges.  Prioritizing activity is difficult in the midst of long days with sleepless nights, diaper changes, nursing, and in many cases, taking care of other children and one’s partner.  Then add on the woman's consciousness of the weight that was gained during the pregnancy and pain form labor and delivery. Exercise may be the last thing on one's postpartums mind.

The athletic women who may be recreational, competitive, collegiate or pro, has her own set of complications when returning to activity.  Decreased income from not being able to compete adds extra stress to the postpartum period. The recreational athlete may feel frustrated about her body and how long it will take to get “back into shape”.  The athletic woman may have increased mental frustration in waiting for her body to heal so she can return to her previous exercise training.

Regardless of the previous activity level before pregnancy, returning to some form of activity is very important postpartum.  A physical therapist specialized in women’s health can in many ways help overcome the challenges with initiating or returning to an exercise program.  One study concluded that “a physical therapy exercise and health education program is effective in improving postnatal well-being” and “may reduce longer-term problems such as postnatal depression”.

Some things to consider before starting or resuming an exercise program postpartum:  Give yourself at least 2 – 3 months to allow tissues to heal and develop a routine for you and your family.  See your primary care physician and ask if it is okay to start or resume your activity. After 2 – 3 months, do not attempt to resume the activity you were doing pre-pregnancy; cut the routine by half and start with 2 to 3 days a week to see how your body fatigues under the new stresses of motherhood.  Feel free at any time to contact your women’s health physical therapist to answer questions and assist in returning you to your healthy, active lifestyle.
http://www.womenshealthapta.org/find-a-physical-therapist/index.cfm

http://www.blackcelebkids.com/wp-content/uploads/2009/03/candanceespencover.jpg  Accessed by Cheryl Lynn Rudd. November 30, 2011.

http://candaceparker.com/  Accessed by Cheryl Lynn Rudd. November 30, 2011.

http://www.articlesbase.com/basketball-articles/wnba-candace-parker-returns-to-wnba-after-pregnancy-1028822.html  Accessed by Cheryl Lynn Rudd. November 30, 2011.

Special Topics in Pregnancy and Postpartum. Chicago, Illinois. The Rehabilitation Institute of Chicago. November 11-13, 2011.

Norman E, Margaret S, Richard HO, Galea M. An Exercise and Education Program Improves Well-Being of New Mothers: A Randomized Controlled Trial. Phys Ther. 2010;90:348-355.

Tailbone Pain: Can Be More Than Just a Pain In the Butt

Tailbone (coccyx) pain, also known as coccydynia/coccygalgia/coccygeal, presents as severe localized pain in the tailbone/coccyx area.  Pain is usually associated with the sitting position, defecation, coughing, standing, walking, bending forward, and the movement from sit to stand.  Pain begins or increases after a long bout of sitting, direct injury from a fall or sport’s trauma, and after pregnancy, labor and delivery.

There can be many other causes for pain felt in the tailbone area.  The low back and the sacroiliac joint can be involved in or the cause of pain in the tailbone. Also factures, tumors, infection, inflammation in the pelvis can be associated with tailbone pain.  Certain psychosomatic disorders can cause pain in the pelvis or buttock muscles.

If experiencing these symptoms, first see a primary care physician to rule out medical issues, such as infection/inflammation, tumors, and fractures.  Afterwards you can ask for a physical therapy referral.  A physical therapist will want to first rule out if the pain is caused by the low back, pelvis or hips.  A physical therapist specialized in coccydynia can use several techniques to decrease pain, improve sitting posture and address muscle weakness or imbalances.
http://www.womenshealthapta.org/find-a-physical-therapist/index.cfm

There are a couple things you can try on your own that may help your pain before seeing a physician or physical therapist. First, DO NOT use a hemorrhoid/ring pillow; this can make the pain worse. You can use ice around the area, with couple towels between the ice and you to protect the skin; do not use ice for more than 10 minutes at a time.  Place a low back pillow or support in a chair and sit with good posture and positioning, and try not to sit for more than 30 minutes continuously.  These techniques can be used to minimize symptoms, but if the pain continues to persist, be sure to contact your physician or a local physical therapist.
http://www.apta.org/apta/findapt/index.aspx?navID=10737422525



Special Topics in Pregnancy and Postpartum. Chicago, Illinois. The Rehabilitation Institute of Chicago. November 11-13, 2011.

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Accessed by Cheryl Lynn Rudd November 29, 2011

Pain with Intercourse After Child Birth

Pain with intercourse after a vaginal child birth is not uncommon. Most medical physicians suggest no intercourse for 8 weeks after vaginal child birth and even after some caesarean sections. Most importantly, this allows the cervix to return to pre-pregnancy dilation to prevent bacteria from entering the uterus.  This also allows the pelvis, pelvic floor and vaginal tissues to heal from trauma, open wounds and the stretching.  The pelvic floor stretches three times its length during the birthing process (imagine taking your bicep muscle and stretching it 3 times its length; these muscles are going to be sore for a while).

Pregnancy hormones progesterone and estrogen increase the laxity in the tissues to prepare for the belly to enlarge and the pelvis to allow the baby’s head to pass through during birth. These hormones remain at elevated levels after pregnancy and through the time the mother is breast feeding. Pain can be felt in the pelvis and thighs due to the instability caused by these hormones after birth.  Having to “spread” the legs during intercourse can cause pain in the hips, pelvis and low back if these structures are unstable.

So how does a couple return to healthy intercourses after pregnancy?

First, allow for 8 weeks to pass for the tissues and structures of the body to heal, and the cervix and uterus to contract to their pre-pregnancy size.  Then attempt slow, controlled intercourse with an ample supply of lubricant.  If at any time there is pain or discomfort, stop, and try again another time.  For women, intercourse with vaginal penetration is the most vulnerable, intimate act a woman can engage in. If there is pain or discomfort, it can dramatically mentally and physically damage later acts of intimacy for women.

If several attempts were performed without success, be sure to see a medical physician to diagnosis possible medical issues, such as a pelvic infection.  Ask for a physical therapy referral if all is cleared medically.  A physical therapist specialized in women's wealth has many techniques and skills that can help a couple address pain, musculoskeletal issues, and return both partners to a healthy, fulfilling sexual experience.

Neille C. High Risk Pregnancy and Postpartum Physical Therapy. Chicago, Illinois. The Rehabilitation Institute of Chicago. May 21-23, 2010.

Pain with Intercourse

Took a couple days to organize my thoughts and was not quite sure where to start. So as I do with each one of my patients, I will start at the beginning and with the basics.

Decided to answer most of your emails emphasizing - pain is not normal. Pain is the body saying there is something wrong. See your physician.  I welcome direct questions before a physician’s visit, but there are lots of simple tests that can be performed and medical information you can ask your primary health care provider. Most insurances require you to do it anyway before you can ask or get a physical therapy referral.  Then you can proceed to look for a physical therapist.

Women's Health Physical Therapist Locator - http://www.womenshealthapta.org/find-a-physical-therapist/index.cfm
For Our Patients - http://www.womenshealthapta.org/plp/index.cfm

 Once medically cleared, a physical therapist can assess the skin, fascia, connective tissues, muscles and bones. Therapists are also able to analyze the proper positioning of these structures and diagnose movement dysfunctions.  Some therapists specialize in biofeedback for the pelvic floor and have additional training in pelvic physical therapy. A physical therapist can also examine referring pain; this where where the problem area is different than the where the body is presenting with pain.

Once problems (usually more than one) are identified, a physical therapist can assist in decreasing pain and improving the experience of intercourse.  Therapy can include exercise, hands on techniques, education, biofeedback, and desensitization. Health psychology is also used in the women’s physical therapy practice.

Pelvic physical therapy requires patience, patience, patience, trust and adherence to “homework”.  This is also true for the patient’s partner. I can not stress how more successful intercourse is with a partner that is encouraging, honest, open, trustful and involved in pelvic physical therapy. Not like they have to be at any of the appointments, but to realize with patience, persistence, and delicate work, both partners can return to having incredible, wonderful sex.

Will elaborate on your topics as well as treatment options soon. Thank you for your questions.

Pregnancy Discomfort vs. Pain

The musculoskeletal system goes through many changes with pregnancy. One of these changes is the increase levels of progesterone and relaxin the body.  The increase in these hormones causes the connective tissues (ligaments and tendons) to soften and to allow for the belly to expand and the pelvis to prepare for the child birthing process.

If a woman has been hyper-mobile, or highly flexible, throughout her life span, then these hormones may cause instability. Instability causes a painful back, pelvis, sacroiliac joint, knees, ankles and other parts of the body.

So what are normal discomforts of pregnancy vs. pain?  Usually discomforts do not limit women in functional mobility, meaning, they are able to perform their daily activities normally with minimal interruptions. Pain is what limits a woman from sleep, performing her job, taking care of herself and her family.

If there is pain that prevents a pregnant woman from performing her daily activities, and sleeping at night, a physical therapist can help in several ways. Exercise, belting, soft tissue mobilization (therapeutic massage) are skills of a physical therapist.  An obstetric physical therapist has specialty training for the pregnant body such as bracing, myofascial release, muscle energy techniques, biofeedback, taping, pressure points and trigger point therapy.

I have heard many say that pain with pregnancy is normal. This is not true. Pain is not normal. Pain is the body’s message that something is wrong. A physical therapist, specialized in women’s health can analyze the body to find what is unstable and painful.

I have been fortune in my practice to have many resources.  Our clinic has a private therapeutic pool, acupuncture and pregnancy massage specialists. My credentials include certification in biofeedback for pelvic floor dysfunction and physical therapy credentials in obstetrics. The women I have treated have become pain free in their pregnancies, and actually improve as they progress, which leads to a healthier child birthing process.

Thank you for all your emails comments and topics. Attempting to respond personally to specific questions and post to the most popular.