Wednesday, November 30, 2011

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.  Accessed by Cheryl Lynn Rudd. November 30, 2011.  Accessed by Cheryl Lynn Rudd. November 30, 2011.  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.

Tuesday, November 29, 2011

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.
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.

Special Topics in Pregnancy and Postpartum. Chicago, Illinois. The Rehabilitation Institute of Chicago. November 11-13, 2011.;_ylt=A2KJkIfgKdVOMlkAIrqJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?
Accessed by Cheryl Lynn Rudd November 29, 2011

Tuesday, October 25, 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.

Wednesday, October 19, 2011

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 -
For Our Patients -

 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.

Monday, October 17, 2011

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.

Friday, October 14, 2011

Who is Treating You?

Great email questions and comments. Thank you.

Credentialing. Yes. I have been told so many things about the letters behind a health care provider’s name. I use to just use PT (physical therapist) but then was told to honor my Doctor (DPT). Then to display all my credentials only to hear “what does that mean?” and “too many letters”.

Some therapists I know have expressed that all those letters are just to boast. Guess I never thought of it that way and it never bothered me. I knew their training; I knew my training, and how we both practiced. So why do those letters matter?

It matters because regardless of the letters, or how many, the consumer needs to know who is providing their treatment. I would rather have someone ask me what ACE (American Council on Exercise) means, rather than not to ask any questions about my experience. It has become the time in which the consumer (patient) needs to educate themselves on their healthcare and choice of treatment. At least ask. I enjoy that part of my practice. Talking. Discussing. Educating. Teaching.

Here is our governing organization’s, American Physical Therapy Association, policy regarding our designations:

The first letter’s should be the health care providers license to practice in their given State, and most important, regardless of their training.  Using PT is the regulatory designation of a physical therapy. PTA the preferred designation of a physical therapist assistant.

  1. PT/PTA
  2. Highest earned physical therapy-related degree
  3. Other earned academic degree(s)
  4. Specialist certification credentials in alphabetical order (specific to the American Board of Physical Therapy Specialties)
  5. Other credentials external to APTA
  6. Other certifications or professional honors

Thank you again for all your questions and comments.  Accessed by Cheryl Lynn Rudd on October 14, 2011.  Accessed by Cheryl Lynn Rudd on October 14, 2011.

Wednesday, October 12, 2011

What Defines Women’s Health Physical Therapy

Physical therapy in general is a specialized profession that focuses on the bones, muscles and connective tissues (ligaments, tendons, fascia) of the body. Where physical therapy excels from any other health care profession is our expertise of the body in motion. Our Director at Eastern Washington University would always remind us that we are health care experts of movement. This fact has never been truer when describing the dynamic nature of the female musculoskeletal system.

There are many stages of change that happen over the course of a female’s life; pre-pubescent, starting menses, maternal, menopausal, and older adult. My focus is to describe those changes, and how these changes directly affect the musculoskeletal system. Add disease, trauma, sedentary lifestyles and emotions, it creates a complicated web of pain, problems and concerns for the body and mind. Physical therapy can be the answer for many of those concerns.

Physical therapy for women was originally called the section on Obstetrics and Gynecology. In 1977, Elizabeth Noble formed The Section on Women’s Health of the American Physical Therapy Association. This section was originally created to address the musculoskeletal concerns of pregnancy and postpartum females. It became apparent that treating women that are pregnant was more that “low back pain with a bump”. Traumatic childbirths often lead to several issues that also needed to be addressed. And childbirth in of itself is trauma: bleeding, cutting, tearing, pain, stitches, etc.

Physical therapy in women’s health has matured since 1977 and now incorporates many obstetric, gynecological and musculoskeletal concerns. In my personal practice, I have treated females with a variety of different issues. Here is a brief list of my personal experiences: lymphedema, collegiate athletes, the pregnant athlete, post mastectomy, breast enlargement/reduction, low back pain, sacroiliac pain, fibromyalgia, wellness, exercise pre-gastroplasty, fecal incontinence, urinary incontinence, pelvic pain, pain with intercourse, osteoporosis, obesity, post hernia repair, and cesarean section pain/scar tissue mobilization.

I will continue to describe women’s health in physical therapy through specific posts. I will leave it to my readers, mentors and my own inspiration to further elaborate on those topics. As a note, I highly respect gender and sexual identification. I am attempting to address my topics with anatomical references; any advice is greatly appreciated. Accessed by Cheryl Lynn Rudd on October 12, 2011  Accessed by Cheryl Lynn Rudd on October 12, 2011.

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

Tuesday, October 11, 2011

What It's All About

I have struggled for several years on how to balance my writing interests and my life. As a single Mom, healthcare provider, group fitness professional and friend to many, bound by HIPAA privacy (much of my knowledge is learned during my practice), time constraints, and the ups and downs of my personal life, I thought I would never be able to get where I am today. Dramatic changes have recently pushed me forward to focus more on myself, and that is what this blog is about; my personal joy in helping others, especially women.

The information I share is from my own personal experiences and knowledge, and from my women's health mentor that has over 30 years of experience in the field. Some knowledge I share has been gained from my practice, based on outcomes from several patient successes and how I have seen evidence based practice applied. Never will my information be from a single patient or case (HIPAA, HIPAA, HIPAA).

I am not a medical practitioner. I do, however, have a vast amount of knowledge in pharmacy, psychology, urology and internal medicine.  This knowledge has been gained though the 11 years of course work in exercise physiology, physical therapy and rehabilitation, continuing education, pre-med classes, 20+ years experience in the fitness industry, and 5 years of close relations with specialized physicians in women's health, obstetrics, urology and gynecology.

This blog more than likely will contain sexual information, but nothing that is gross, crude or unruly. This is what defines women’s health; the difference in sexual anatomy from men. I have more experience in heterosexuality, but that is due to the fact I primarily treat pregnant women in heterosexual relationships. I have limited experience, but have been successful in treating all of my patients, and that is due to fact all “women” basically have the same anatomy; it’s just that non heterosexual and other identifiers use different tools to express their sexuality.

This blog is also a gathering of thoughts for my dissertation that will be in the field of either sports or health psychology. My career pursuit was halted due to the fact I enjoy treating people and being a clinical practitioner.  The ground work has been laid for research and my PhD, but have not absolutely decided yet if I want to “publish or perish”. I have also looked at several professional and paid avenues for blogging, but again, want to enjoy the knowledge and research I share and have the freedom to write what fascinates me.

That is what it's all about. My next blog will be defining what is involved in women’s health in physical therapy. I am always happy to receive any and all comments, questions, criticism, concerns or critiques. My ambition for blogging is due to the need to focus my own personal growth, and any feedback is greatly appreciated.