Pelvic PT after baby; the individualized program.

Having practiced orthopedics, sports medicine, manual therapy, and pelvic floor therapy in Kansas City for 23 years there is one patient question that resonates with me as a tripping up point for new patients. I will give you an example: Recently a patient came for an evaluation after delivering her second baby to establish a baseline and develop a rehabilitation program for her. Main problem issues were diastasis and pelvic organ prolapse. We made a plan to get her back to exercise safely and to address the DRA and prolapse. She cancelled all recommended therapy sessions after her first evaluation once I explained what issues she had that needed work. I suppose she planned to undertake a do-it-yourself program. She emailed me later and wanted to know if Pilates was a good program for her, given her findings from the evaluation. The not-so-quick-and-easy answer to this will illustrate why sticking with the program outlined for you, under skilled guidance by a good pelvic PT, is important in your quest for health and fitness.

The answer is always longer and more complicated than just a simple “yes” or “no”.

For a good, strong, pelvic floor you need good breathing patterns that coordinate with your deep core and pelvic floor. You also need adequate power of the pelvic floor muscles, and good core control from the lower extremities up through the entire trunk. We train that in PT starting with the basics. In the first visits, we check those basics and start you working on them at home. Every patient responds differently to different cues or training tools. At your PT visits in clinic, we will make sure you are targeting the right muscles and patterns. In subsequent visits, we work on transitioning these newly learned basics to higher levels, and how to use them in daily function and with your chosen sport, or activity.

Over time we work on transitioning these movements and recruitment patterns to more challenging activities and planes of motion. Typically our days are spent doing movements in a forward – backward plane of motion. This is also where we start our training in PT- think pushing/pulling, lifting and picking up things such as, well, our babies. If you have not had training, or aren’t able to exhibit good muscle recruitment with twisting or side to side motions (like a crawl in swimming, or the single limb loading challenges of a low impact pilates) these have the potential to cause discomfort and slow your progress. It even has the potential to make a diastasis or prolapse worse if you cannot transition the breathing, pelvic floor, and deep core control to these new activities. This can happen no matter how low impact and overall friendly they are to the average consumer. Many women use unconscious substitution patterns, even for these low impact activities. These substitution patterns have the potential to make your prolapse or your diastasis worse.

In general, these activities (swimming, pilates, yoga) are good for the body, but if you have had big or sudden changes to your body (I am looking at you, new moms and people with a history of surgery, pain or injury) as well as a diastasis or a pelvic organ prolapse, you could be driving more issues to show up. At the very least, you may get stuck and not make your desired progress.

It is hard to say what activities are safe, without seeing you in the clinic, to progress you and challenge you in a similar way to the activity you want to undertake. Your pelvic floor PT will work with you individually and make sure that you are using the correct movement patterns and the right muscles to do the job. They will allow you time and repetition to “catch up” with the weaker muscles that are out of balance, to allow you to take on the challenges of daily life and enjoy your activities. This is why in physical therapy there are several sessions over time, and it is essential to come in to the clinic and stick to the plan that has been set for you. You can see why it is hard for to answer in an email or phone, questions about GENERAL exercises to address a birth injury or other pelvic floor issue. What is good for the common public is not necessarily safe if you’ve have a baby, surgery, pain or other pelvic issues. Those need some specific guidance from a therapist to rehabilitate and return you safely to those activities.

In short, it is not one-size-fits-all, we need to see you, and assess your progress to get you to the next step. We are with you to support you and give you real feedback on what is holding you back or could cause a possible setback later on. Your health and wellness are worth the time, effort and expense. You will not be sorry you took the care to rehabilitate and return to your activities safely.

Call or click here to schedule with one of our pelvic floor therapists today!

• Marla Jacquinot, MPT, FAAOMPT