postpartum – kaylee may

04
Aug
2015

Pelvic floor exercise progression: How to strengthen your Kegels

First, make sure you know how to take care of you Kegel muscles daily!! If you feel ready to strengthen your Kegels at home, read below!

kegels, kegel muscles, pelvic floor muscles, physical therapy, postpartum, pregnancy

Kegel muscles, or pelvic floor muscles, are just like any other muscle in your body in a sense that contracting them against gravity is a greater chore than using gravity to your advantage. This is important to remember when you decide how to go about strengthening your kegels.

SIDELYING

kegels, kegel exercises, sleeping position, women's health, pelvic floor, pregnancy, postpartum

The position that is most helpful in contracting your Kegels is the sidelying position. Lie on your side with your top leg supported on pillows so that your hip is in a neutral position. Tighten your Kegel muscles as though you are stopping the flow of urine. I often cue people to imagine the pelvic floor is an elevator. Imagine ropes attached to your ribs. As you contract, the ropes are pulling the elevator (pelvic floor) toward your rib cage. Exhale as you are contracting.

If you are holding your breath, the opposite will happen–your pelvic floor will expand toward your feet (eek!) just like a parachute expands when it meets air resistance. This stretches the pelvic floor, making it hard to contract and can weaken it over time. Hold each contraction 5-10 seconds. Repeat 10-20 times.

(side note: If you feel like you can’t contract your pelvic floor in this position, please see a physical therapist! To see one, ask your doctor–possibly your obgyn–for an order to see a physical therapist who specializes in women’s health….even if you are male! They are the gurus of the pelvic floor. You can also see a PT through direct access.)

QUADRUPED

kegels, kegel muscles, pelvic floor muscles, physical therapy, postpartum, pregnancy

Another position that is “gravity-lessened” for the Kegel muscles is the quadruped position. On your hands and knees with your knees directly below your hips and your hands below your shoulders, contract your pelvic floor as described above while exhaling. Make sure your back is flat.

In this position, I also encourage you to contract your abdominal muscles as you contract your kegels. Do this by pulling your belly button toward your spine. Again, if you are holding your breath and/or bearing down, your stomach expands, and the increased volume actually stretches your pelvic floor and abdominals like a parachute stretches when it meets air resistance (aka don’t do that). Hold 5-10 seconds and repeat 10-20 times.

SITTING

kegels, kegel muscles, pelvic floor muscles, physical therapy, postpartum, pregnancy

It may take a few weeks, but once you are able to complete the above positions correctly, you can move to a sitting position for your Kegel work out. 😉 In this position, you are lifting your Kegels against gravity, so it is much more challenging. Contract your pelvic floor muscles by thinking of lifting them up toward your rib cage as described above. Hold 5-10 seconds and repeat 10-20 times.

STANDING

Next, try to contract your Kegels in standing. Think of raising your pelvic floor up toward your ribs with the elevator ropes as described above as you exhale.

The most challenging way to contract and exercise your Kegels is to perform contractions during your normal movements, such as arising from a chair. Start by contracting the muscles in sitting and keeping them contracted as you move to stand.

If you are active in fitness and exercise, keep these tips in mind as you lift weights and move through your exercise routine. Remember, if you hold your breath, you are expanding your pelvic floor (like when a parachute meets air resistance) and stretching them out which can weaken the muscles over time.

(Feel free to leave a comment below (you can leave one anonymously!) or send an email to kayleemayblog at gmail dot com with any questions. If I get enough questions throughout this series, I will post a Q&A post to conclude it)

***The content of http://www.kayleemay.com is for informational purposes only. The information presented is not to be taken as professional medical advice, diagnosis, or treatment. If you are having pain, or seeking medical advice, talk to your health care provider. Do not delay in seeking treatment because of information you have read on http://www.kayleemay.com. Taking recommendations presented on http://www.kayleemay.com is solely at your own risk***

30
Jul
2015

How to take care of your Kegels daily

categories: Health, Pregnancy

Kegel muscles are functionally and medically important for everyone (men and women!), so if you’re wondering if you should take care of your Kegels, the answer is YES.

Kegel muscles are associated with incontinence, back pain, pelvic organ prolapse, hip pain, and even your sexual performance.

When I am treating a patient in the clinic, I make sure to talk about daily positions and movements that affect their condition before educating them on exercises. The reason is that the positions and movements we perform repetitively each day will affect our bodies more than spending 15-30 minutes a day exercising. It’s incredibly important to treat our bodies well by first integrating good posture and movements into our daily habits.

kegels, kegel muscles, pelvic floor muscles, physical therapy, postpartum, pregnancy, women's health

First, I will address sleeping position because it’s one of the most important positions our bodies assumes that determines which muscles are stiff and which ones are too flexible. A sleeping position is like holding a stretch for hours at a time. It might seem like Kegels wouldn’t be impacted by our sleeping position, but if our hips are internally rotated and/or adducted (knee rolled inward and past midline), the pelvic floor muscles are stretched out because they actually attach to the hip bone itself (by way of the fascia of the obturator internus). So when the hip moves “inward” it pulls on the pelvic floor muscles. This happens when we lay on our side without the top leg supported. If you are a side sleeper, I recommend putting one to two pillows between your knees and feet to support your top leg in neutral.

kegels, kegel exercises, sleeping position, women's health, pelvic floor, pregnancy, postpartum

(I promise I don’t sleep on tile floors)

Second, I will address our sitting position. I don’t care who you are–you sit a lot. If you sit in bad positions like this

kegels, kegel exercises, pelvic floor, women's health, pregnancy, postpartum

or this

kegels, kegel exercises, pelvic floor, women's health, pregnancy, postpartum

or this

kegels, kegel exercises, pelvic floor, women's health, pregnancy, postpartum

..let me just go ahead and buy you some of these.

Okay, bad joke.

Again, if our legs assume an “inward” position, our Kegel muscles are pulled taut, therefore stretched. You know how little kids look when they have to pee? They pull their knees in. That’s because that pulls the muscles taut. Over time, that position stretches the muscles, making them harder to contract. It is best to sit in a neutral position. I encourage you to modify your desk set up to make sure you are treating your Kegels well when at work!

kegels, kegel muscles, pelvic floor muscles, physical therapy, postpartum, pregnancy

Lastly, our standing position can impact our Kegel muscles. Standing with your hip hiked and legs crossed puts your muscles in an asymmetrical position (ahem MOMS who let a kid sit on one hip all the time). Not only will it lead to back pain, hip and back muscle asymmetries, but can weaken the pelvic floor over time.

Another bad position for your pelvic floor muscles in standing your “tail” curled under too much. Yoga and pilates classes stress tucking your tail bone (which can be a good cue to get those abs and gluts to contract) BUT this places the pelvic floor directly under the torso nice and flat so that ALL the pressure from your internal organs rests on it, weakening it over time when it’s a habit. (yes, I know you don’t FEEL heavy pressure just standing there…but there is a such thing as gravity, folks)

So don’t stand like this

kegels, kegel muscles, sway back, postpartum, pregnancy, pelvic floor, physical therapy

or this

kegels, kegel muscles, pelvic floor muscles, physical therapy, postpartum, pregnancy

or this

kegels, kegel muscles, pelvic floor muscles, physical therapy, postpartum, pregnancy

or this

kegels, kegel muscles, pelvic floor muscles, physical therapy, postpartum, pregnancy

Stand in a neutral position like this:

This may seem like nit-picky advice and may even seem unreasonable to do (especially ALL THE TIME), but try to start incorporating good posture and movements into your daily routine to take care of your body.

(Feel free to leave a comment below (you can leave one anonymously!) or send an email to kayleemayblog at gmail dot com with any questions. If I get enough questions throughout this series, I will post a Q&A post to conclude it)

***The content of http://www.kayleemay.com is for informational purposes only. The information presented is not to be taken as professional medical advice, diagnosis, or treatment. If you are having pain, or seeking medical advice, talk to your health care provider. Do not delay in seeking treatment because of information you have read on http://www.kayleemay.com. Taking recommendations presented on http://www.kayleemay.com is solely at your own risk***

29
Jul
2015

The lowdown on Kegel muscles

categories: Health, Pregnancy

I first heard about Kegel muscles in college. My roommate with a deep southern accented read us an article about Kegel muscles out loud from a magazine. Due to her strong accent, we all thought she was saying “giggle” muscles. Based on what she was reading, that seemed like an appropriate name for those particular muscles. 😉

kegels, kegel muscles, pelvic floor, pregnancy, postpartum, women's health

Fast forward about four years to physical therapy school, and I ended up learning a lot more about Kegel muscles than what could be read in a magazine. For example, did you know…

Kegel muscles are the pelvic floor muscles, or the base/foundation of our torsos that support our uterus, rectum, small intestine, and bladder.

Kegel muscles are relaxed when we urinate or defecate and are contracted when we are not urinating or defecating.

Kegel muscles can be stressed if we are obese, pregnant, coughing, sneezing, or move in faulty patterns that overstretch the muscles.

Kegel muscles are associated with incontinence, or leaking urine or fecal matter.

Kegel muscles are muscles that EVERY PERSON has, men and women. (i.e. men can leak urine as well! They just don’t talk about it as much)

Kegel muscles can be strengthened to prevent problems with incontinence…or even help achieve orgasm.

Kegel muscles work with synergistically with abdominal muscles.

Since these small muscles hold up our organs, function as the base and foundation of our bodies, and are so closely associated with frustrating medical conditions like incontinence, I thought it would be a good idea to do a series on the Kegel muscles.

Stay tuned to learn if you need to strengthen your Kegel muscles and how to go about doing that!

(Feel free to leave a comment below (you can leave one anonymously if you want!) or send an email to kayleemayblog at gmail dot com with any questions. If I get enough questions throughout this series, I will post a Q&A post to conclude it)

***The content of http://www.kayleemay.com is for informational purposes only. The information presented is not to be taken as professional medical advice, diagnosis, or treatment. If you are having pain, or seeking medical advice, talk to your health care provider. Do not delay in seeking treatment because of information you have read on http://www.kayleemay.com. Taking recommendations presented on http://www.kayleemay.com is solely at your own risk***

19
Jun
2015

Diastasis Recti | Dealing with a common postpartum condition

categories: Exercise, Health, Pregnancy

diastasis recti, pregnancy, pregnancy abs,

Diastasis recti, a separation of your abdominal muscles, is a common condition during and after pregnancy.

The linea alba is a line of fibrous tissue between two sides of the rectus abdominis that runs vertically. When this muscle is stretched throughout pregnancy, there can be a physical separation or widening between the two sides of the abdominal muscle.

rectus abdomis, diastasis recti, linea alba, postpartum, pregnancy,

As outlined in previous posts, the abdominals act as a natural back brace for us. If there is weakness or separation in our natural back brace, a number of pain conditions arise. Unfortunately, diastasis recti is not always recognized early, and I see mothers of all ages in the clinic for hip pain, back pain, knee pain (etc, etc, etc) that arose from weak abdominals. (side note: Obgyns should just start referring women to physical therapists after any type of birth, right?)

I searched the web to find a quick video of how to tell if a diastasis recti is present. I found this video you can use to assess for the presence of this condition:

Let’s all freak out for a minute because we all just realized we have diastasis recti…

ok, I’m still freaking out…

still freaking out…

ok, now I am desperate to fix this!

How convenient there is a post right here about postpartum abdominal strengthening!

There is one thing to add to this strengthening program if you find that you have diastasis recti. Use your hands (or a brace, etc) to physically pull your abdominals together as you perform the exercises. In other words, push your abs together.

diastasis recti, pregnancy, pregnancy abs,

I want to note a few things you should most definitely NOT do if diastasis recti is present:

1. SIT UPS. Like, never. Never, ever do sit ups.

2. PILATES before you do this program.

3. YOGA positions where you are pushing your stomach out (aka abdominal breathing, dead bug, to name a few), yoga positions that STRETCH the abs (cobra), or anything on your hands and knees with poor abdominal control (cat, cow, sunbird).

4. LIFTING without engaging your abdominal muscles. This includes lifting your dear little (or big) baby.

5. Did I already say don’t do sit ups? Just don’t. If you want strong abs, do this.

diastasis recti, postpartum, pregnancy, abdominals, rectus abdominis

I strongly encourage you to seek help from a physical therapist if you have a significant diastasis recti. There is nothing like having an expert treat you one on one to prevent and treat pain. I am not speaking of a personal trainer or fitness guru, although they are helpful for many things. A physical therapist is a movement system expert with a physical therapy degree (7 years of post high school education for a doctorate degree) and has been up close and personal with the rectus abdominis and line alba a la cadaver labs. TMI?! I just want to be clear that seeing a personal trainer is NOT the equivalent.

Your health insurance may help you out with the cost of physical therapy. If you don’t want to see a doctor first to get an order for physical therapy, call your local PT clinic and see if they have direct access. If you don’t know what direct access is, please read my explanation here.

Happy abdominal strengthening, ladies!

If you are interested in more pregnancy and postpartum health tips, read my previous posts!

The Do’s and Don’ts of Breastfeeding: How to prevent musculoskeletal pain

Postpartum Abdominal Strengthening

Pregnancy and Back Pain

Top 3 Exercises Every Pregnant Woman Should Do

Return to Running After Pregnancy

***The content of http://www.kayleemay.com is for informational purposes only. The information presented is not to be taken as professional medical advice, diagnosis, or treatment. If you are having pain, or seeking medical advice, talk to your health care provider. Do not delay in seeking treatment because of information you have read on http://www.kayleemay.com. Taking recommendations presented on http://www.kayleemay.com is solely at your own risk***

02
Oct
2014

Return to Running After Pregnancy

categories: Exercise, foot pain, Health, hip pain, knee pain, Low back pain, neck pain, running

Postpartum has been a long road. And not the kind of “oh, what a journey…” road. The first days after Seton’s birth I didn’t so much want to roll over in bed. I was definitely not dreaming of tying up my shoelaces and going for a run. But eventually, albeit after many weeks, I found myself promising the exercise gods that I would never complain about working out again as I watched Netflix count down to the next episode of my TV marathon in utter disbelief that my current state of life existed on a couch. Being restricted from doing something just makes you want to do it, right? I longed for the feeling of my tennis shoes hitting pavement, my heart beating through my chest, and my frequent breath mixing with the fall air.

We may be anxious to return to running after pregnancy, but it’s important to make our comebacks gradual. Lots of changes just happened to our bodies and, as mothers, we now need our bodies to take care of our babies. Being injured isn’t an option.

To prepare for running, I encourage you to strengthen your abdominals and pelvic floor muscles through the abdominal progression and pelvic floor exercise progression I recommend. Having strong abdominals for running can reduce the risk of injury to our backs, hips, knees, ankles, and even should girdles and necks! The abdominals will work to stabilize our backs and pelvis to allow the limbs to generate movement for each step.

I also encourage you to strengthen your gluteals. You should do this the same way I recommended doing it throughout your pregnancy: by performing Hip Abduction with Lateral Rotation (“The Clamshell”). You can read through the steps in my post Top 3 Exercises Every Pregnant Woman Should Do.

When you feel as though your abdominals and pelvic floor muscles are strong enough that you can keep them contracted throughout the course of the day (even when going up/down stairs or getting up for the floor while holding your baby), you are likely ready to begin a running progression. Make sure your doctor has cleared you to exercise!

To begin, start with running and walking at one minute intervals, aka run a minute, walk a minute. Prior to pregnancy, I told my patients to do this for 30-minutes. But, now that I am experiencing the joys of postpartum first-hand, I recommend doing this for as long as you can up to 30-minutes. I started my progression (ahem, last night) and barely made it to 18 minutes. I walked that last 12 minutes telling myself, “whatever, I’m strong…I pushed a human out of my body!” as I somehow heard my heart beating the way you do after an insane workout.

Since you are only running one minute at a time, use the minute to focus on running with good form. After pregnancy, our bodies will forget we have abdominals and gluteals, so we will be relying on muscles like the tensor fascia lata (TFL, which is the muscle that controls the infamous IT band) that can lead to injury. Focus on contracting your abdominals. Review my post Improve Your Running Stride Part II: The Gluteals which will help you use your gluteals to improve your stride.

Once you hit this walk/run cycle for 30 minutes, start aiming for running 2-minutes, then walking 1-minute up to 30-minutes.

Add a minute to your running spurts when you feel ready (should be every three to five runs), and so on.

Keep in mind:

Do not push yourself too quickly. Your muscles need time to catch up to what you are asking your body to do.

Do not set time goals until you are confident you can run with good form.

If you’re having unusual aches, pains, or … ahem, dare I say leaking, talk to your physical therapist.

And, lastly, you may want to wear two bras. 🙂

This was my reaction to finally getting the green light from my doctor to exercise:

Hopefully you enjoy you first run back as much as I did.

***The content of www.kayleemay.com is for informational purposes only. The information presented is not to be taken as professional medical advice, diagnosis, or treatment. If you are having pain, or seeking medical advice, talk to your health care provider. Do not delay in seeking treatment because of information you have read on www.kayleemay.com. Taking recommendations presented on www.kayleemay.com is solely at your own risk***

12
Sep
2014

Postpartum Abdominal Strengthening

categories: Exercise, hip pain, knee pain, Low back pain, Pregnancy

*These exercises are based off the Sahrmann Low Abdominal Progression.*

I swore to myself I wouldn’t get that certain post pregnancy “pooch” that stays with me the rest of my life…we all know what I am talking about. Yeah, good for Kate Middleton for going out in public right after giving birth with a pregnancy pooch, but let’s be honest… that kind of thing sticks around a whole lifetime for us normal folk. I thought I would share my postpartum abdominal strengthening program for those in the same position as me.

This post will look very familiar to those of you who read my series on tips for runners. Postpartum abdominal strengthening is very similar to how I recommend my runners strengthen their abdominals with a few key differences.

One difference is that it is important to take it slow and remember that your abs have been stretched to their limits over the course of 9 months. The initial goal of postpartum abdominal exercises is to first be able to contract the muscles. The subsequent goal is to strengthen the abdominals to support your low back, pelvis, and hips. After all, you will be carrying extra weight around (aka the babe and that extremely heavy carseat…grr), and you need your abdominal brace to support your back and hips! Many of my patients’ musculoskeletal problems can be traced back to poor movement patterns due to weak abdominals that they never strengthened after being pregnant. The final goal, for vanity’s sake, is to reduce the chance of the friendly pooch being with us the rest of our life.

One other difference of postpartum abdominal strengthening is that it is necessary to contract your pelvic floor muscles (you’ve heard of Kegels) when you contract your abs. I tell this to my runners as well, but it is especially important after giving birth.

Lastly, and most importantly, ask your doctor and physical therapist before initiating any abdominal strengthening postpartum. It didn’t take me long after giving birth to realize we all have different birth stories (it seemed like everyone else got an epidural because they worked #lies #imnotbitter #yesiam), therefore different rates and amounts of healing required. This goes for any type of birth– Cesarean, water, natural, epidural, in a rain forest like that crazy lady on Youtube (don’t Google it, I warned you)…anything! Your doctor will likely want you to wait a certain amount of time before initiating exercise.

The postpartum abdominal strengthening progression takes you through five abdominal exercises, each progressively more difficult. You will notice that the low back does not move at any point in the exercises. Rather, the abs work to stabilize as the limb movement becomes progressively more challenging. To work through the exercises, you must first successfully perform up to 20 repetitions correctly before progressing to the next exercise. Therefore, you may be on one level for up to 2 weeks before you feel you are ready for the next. If you can not perform an exercise without compensations (arching it away from the floor, pushing into the floor, or allowing your abdominal muscles to “pooch” up toward the ceiling), you must go back down to the previous level.

Level 1

Step 1: Lay on back with knees bent and feet flat on floor.
Step 2: Contract abdominals buy pulling navel toward your spine as you exhale. Contract pelvic floor muscles (the muscles you use to stop the flow of urine).
Step 3: Hold 5-10 seconds.
Step 4: Repeat 10-20 times.

Watch out! Do not push your back into the floor or arch it away from the floor. Your stomach should be sinking DOWN, not pushing UP toward the ceiling.

Perform exercise daily until you feel you are able to do 20 repetitions correctly.

Level 2

Step 1: Perform abdominal and pelvic floor contraction as in Level 1.
Step 2: Raise one leg so hip is bent 90 degrees while maintaining abdominal contraction.
Step 3: Place leg back to starting position as in Step 1.
Step 4: Raise contralateral leg so hip is bent 90 degrees while maintaining abdominal contraction.
Step 5: Place leg back to starting position as in Step 1.
Step 6: Repeat 10-20 times.

Watch out! Do not push your back into the floor or arch it away from the floor. Your stomach should be sinking DOWN, not pushing UP toward the ceiling.

Perform exercise daily until you feel you are able to do 20 repetitions correctly.

Level 3

Step 1: Perform abdominal and pelvic floor contraction as in Level 1.
Step 2: Raise one leg so hip is bent 90 degrees while maintaining an abdominal contraction.
Step 3: Maintain position of Step 2 and raise opposite leg so hip is bent 90 degrees.
Step 4: Place one foot back to starting position (keep those abs contracted!)
Step 5: Place the other foot back to the starting position (keep those abs contracted!)
Step 6: Repeat 10-20 times.

Watch out! Do not push your back into the floor or arch it away from the floor. Your stomach should be sinking DOWN, not pushing UP toward the ceiling.

Perform exercise daily until you feel you are able to do 20 repetitions correctly.

Level 4

Step 1: Perform abdominal and pelvic floor contraction as in Level 1.
Step 2: Raise one leg so hip is bent 90 degrees.
Step 3: Raise opposite leg so hip is bent 90 degrees.
Step 4: Straighten out one leg, keeping heel close to the floor.
Step 5: Bring leg back to position in Step 3 (bent 90 degrees).
Step 6: Straighten opposite leg, keeping heel close to the floor.
Step 7: Bring leg back to position in Step 3 (bent 90 degrees).
Step 8: Continue alternating extending each leg (as if running!) while keeping abdominals contracted for 10 -20 repetitions.

Watch out! Do not push your back into the floor or arch it away from the floor. Your stomach should be sinking DOWN, not pushing UP toward the ceiling. If you cannot straighten your leg without moving your back, try sliding your heel on the floor. Progress to being able to straighten your leg with your heel just above the floor.

Perform exercise daily until you feel you are able to do 20 repetitions correctly.

Level 5

Step 1: Perform abdominal contraction as in Level 1.
Step 2: Lift one leg so hip is bent 90 degrees.
Step 3: Lift other leg so hip is bent 90 degrees.
Step 4: While maintaining your abdominal contraction, straighten BOTH legs so heels are just above floor.
Step 5: Bring both legs back up to being bent 90 degrees.
Step 6: Repeat straightening both legs at the same time for 10-20 repetitions.

Watch out! Do not push your back into the floor or arch it away from the floor. Your stomach should be sinking DOWN, not pushing UP toward the ceiling. If you cannot straighten your leg without moving your back, try sliding your heel on the floor. Progress to being able to straighten your leg with your heel just above the floor.

Perform exercise daily.

You also want to integrate the program into your daily life. Be sure to contract your abs when walking, getting up from a chair, carrying your baby (and that carseat…grrr), etc.

For humor, here is what family gatherings look like when you are related to a physical therapist and someone asks how to strengthen their abs:

***The content of www.kayleemay.com is for informational purposes only. The information presented is not to be taken as professional medical advice, diagnosis, or treatment. If you are having pain, or seeking medical advice, talk to your health care provider. Do not delay in seeking treatment because of information you have read on www.kayleemay.com. Taking recommendations presented on www.kayleemay.com is solely at your own risk***

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Tag: postpartum