Exercise after Pregnancy

There are a few things a woman should take into consideration when resuming exercise after pregnancy: Pelvic floor strength and her abdominal muscles. Restoration and strengthening of the Pelvic Floor muscles is very important and should begin in the early days and continue weeks after delivery. Whether her delivery was vaginal or C-section, special attention needs to be paid to the post-partum woman’s abdominal wall. A widening of the gap between the two bands of the Rectus Abdominus muscle, known as Diastasis Recti, may not resolve spontaneously after pregnancy.

Pregnancy and childbirth puts a woman’s body through one of her life’s most strenuous events. Laxity in the ligaments, an increase abdominal girth, an exaggerated forward tilt of the pelvis can alter the center of gravity, affecting dynamic stability of the spine and pelvis. Combined with the load of carrying a new baby and breastfeeding, these added stresses to the spine can lead to postural fatigue and discomfort. Physiotherapists are experts at analyzing posture and alignment and can prescribe postural exercises and advice on body mechanics.

Kegel exercises are an important part of pre-natal health. The Pelvic Floor muscles (PFM) lie at the base of the pelvis, and run from behind the pubic bone to the tailbone. Differentiate a PFM contraction from the buttock muscles. To avoid increasing intra-abdominal pressure, don’t hold your breath and push. Instead, think of pulling the two side walls of the vagina toward midline, and lift up inside. Hold this contraction for 10 seconds, without holding your breath.
Immediately after a vaginal delivery, many women find it hard to feel a contraction in their pelvic floor muscles. It works much easier if “muscle memory” exists from previous practice.
If you’re having difficulty with this, an internal examination by a women’s health physiotherapist can determine the extent of the problem. Other concerns, such as uncomfortable scarring after an episiotomy, can also be addressed.

We have 3 layers of abdominal muscles. 100% of women have some degree of Diastasis Recti, or abdominal separation in their third trimester of pregnancy. At 8 weeks post-partum, if the gap is marked (greater than 2 fingers width), if untreated it will likely still be a problem after a year. Diastasis Recti can aggravate low back problems and result in a midline “doming” of the abdomen under load. The underlying cause is an abnormal increase in intra-abdominal pressure during exertion, not the pregnancy itself.

If you suspect you have a Diastasis, try to avoid activities that strain on the abdominal wall. This would include sit-ups, especially over a large ball, heavy lifting, yoga postures that include back bends, Pilates “100’s”. This is until you have learned to contract the inner Transversus Abdominus (TrA) muscle to support the wall.

Two thirds of women with Diastasis Recti have some level of Pelvic floor dysfunction. The Pelvic Floor muscles and TrA work synergistically to support the pelvic organs, especially during exertion. Good tone in these muscles helps to prevent and treat prolapse and stress incontinence, which can show up in mid-life.

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Sun City Physiotherapy Locations

Skiing and Snowboarding

Sports

Physiotherapy » Posts by Sun City Physiotherapy (Page 8)

Skiing and Snowboarding

Ski and snowboard season is here!

I’m sure many of you skiers out there have already started to dust off your equipment, check the daily snow report and maybe even head to the mountain for some early season skiing.

We are fortunate in Kelowna to have so many great ski resorts nearby. Skiing and snowboarding are great ways to get some fresh air and exercise when it can be a challenge to stay active in Kelowna through the fall and winter. This is especially true lately when it has been so wet, cold and dark outside. Since most outdoor activities have wrapped up for the summer, I think that this is the perfect time of year to start conditioning your body in preparation for the upcoming ski season, if you are not already doing so. A good exercise program which addresses core and hip stability, balance, flexibility, muscle endurance and aerobic conditioning will go a long way to help improve your endurance and technique on the mountain to help you get the most out of your season.

If you are currently recovering from an injury or if you have just been sedentary for some time and are noticing a lack of strength, balance, range of motion or overall conditioning, it can be very useful to engage in a progressive rehabilitation exercise program prior to doing something more demanding on your body, like hitting the slopes for the day.

In the clinic, it is not uncommon to see overuse or traumatic injuries pop up as a result of unresolved muscle weakness, due to injury or sedentary behaviour, followed by more demanding or intense exercise. This excessive demand could come from lifting very heavy weights, running too fast or too far, attending an advanced exercise class or participating in a full day of winter activities. While the above examples may very well be a realistic long term goal, you may be putting your body at an increased risk of injury if you engage in an activity that your body is not adequately prepared for.

Exercise needs to be consistent and frequent, rather than all or none. Set a goal to exercise small amounts each day. An exercise program should include a combination of core stability, strengthening, stretching, balance training and aerobic conditioning.

If you are currently recovering from an injury or if you have been inactive for some time and are not sure where to begin, a physiotherapist can help get you on the right track, by developing a safe and effective individualized home exercise program based on your specific goals and current ability.

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Snowmobiling aches and pains

Sports

On February 2, the groundhog told us that spring will arrive soon. But don’t fear – the sledding days are not yet over. If you are looking to maximize your snowmobiling adventures or to try the activity for the first time before the snow disappears, then this is for you.

Like any other activity, it is important to understand the risks and how to prevent injury. In this case I’m not talking about injuries from accidents, although that is still very important to take precautions to avoid. My focus is instead on the aches and pains you may experience throughout your body.

Snowmobiles have come a long way from the original 20 ton machine that was first designed for log hauling, with most modern machines weighing over 500 lbs and able to reach speeds of 110 mph (Heisler 2010). With prolonged time on the machine you are exposed to awkward positions for your upper body, long periods of sitting with a forward bent posture, and vibration stresses. Not to mention the heavy lifting, pulling, and pushing when you need to get out of a jam. Common aches and pains from riding are the low back, neck, shoulder and the occurrence of white-finger syndrome (Heisler 2010).

I’m not suggesting you quit your sport! There are certain factors that can be modified to prevent you from injury, and to keep you more comfortable.

A factor to the aches and strains is the ergonomics of a snowmobile. One of the most important parts to adjust is the steering bar (Rehn et al. 2005). Ideally it should be close enough to your body and have the grips oriented in a way so that your wrists aren’t bent, your shoulders aren’t hiked up and you do not have to reach so far forward. This will put you in a more comfortable posture for your upper limbs and your lower back, as well as lowering the grip force you need to use. Specific positions are to have your wrists neutral, elbows bent 60-70 degrees and if you have a seat back, for it to be tilted back 45 degrees (Heisler 2010). Grips should ideally be about 1.5” in diameter to lessen the grip strength required to steer (Heisler 2010). When looking at buying a snowmobile, also consider its seat suspension. Whole-body vibration, which will occur even on groomed trails, puts the discs in your back at risk for injury (Bovenzi and Hulshof 1999).

There are other factors to consider beyond just the ergonomics of your sled. Here are things you can do to prevent injuries:
Avoid sitting too long in poor posture: When you sit, you lose the normal curve in your low back. This is made worse by bending forward. The posture in combination with the machine’s vibration puts the discs at risk of injury. When possible, alter how you sit so that you back isn’t arched so much.
Wear appropriately warm mitts: Vibration of the upper limb, along with cold exposure, can contribute to the occurrence of “white-finger syndrome” which increases the chances of frostbite. It will also affect your ability to grip properly (Heisler 2010). To minimize this risk, stay warm!
Keep strong: Think of sledding as you would another sport – one that requires strength and endurance. Keep your body fit, and flexible, during the week to prepare you for the weekend adventures.
Listen to your body: If you’re getting fatigued, it’s time for a break. That is when you have a greater chance of adopting poor postures, or hurting yourself with the sudden jolts and turns.

And of course, listen to your body if you’re experiencing pain. Delayed onset of muscle soreness, DOMS, has been reported to last about 1-3 days after snowmobiling (Heisler 2010), but if it extends beyond that, or if you’re finding you’re getting weak (a loss of grip strength is commonly reported) – seek out care from a health professional.

Enjoy the rest of the sledding season, have fun, and stay injury-free!

ACL Rehabilitation

Foot and Ankle

There are four main ligaments that provide stability of the knee joint – the medial and lateral collateral ligaments on either side of the knee, and criss-crossing deep inside the joint are the posterior and anterior cruciate ligaments. The anterior cruciate ligament (ACL) is a thick ligament that attaches from the lower surface of the femur (thigh bone) onto the upper surface of the tibia (shin bone) in a way that will resist the tibia from slipping too far forward or rotating too far inwards on the femur. If – as can happen during sports that involve twisting, jumping, or pivoting – the knee twists too far with a lot of force, then part of all of the ACL can be torn.

ACL injuries are one of the most common knee injuries and they are managed in different ways depending on the severity of the injury and the age and activity level of the person.

Non-operative management consists of physiotherapy treatment with focus on reducing the inflammation and working through a strengthening protocol in order for the muscles around the knee to support the knee joint as much as possible. In these cases the surrounding muscle support is crucial as the knee will be lacking some stability if the ACL hasn’t been repaired. A knee brace may also be useful to provide extra support once the person is taking on more activity at the end of the rehab and beyond.

In many cases surgery will be required. The repair is normally made with a graft taken from the persons own hamstring or patellar tendon. Once the surgery is done, the rehab begins immediately. Whereas in the past the knee might have been put in a cast and rested, current protocols involve early weight bearing and range of motion exercises. It is very important to regain the knee range of motion early on otherwise it can be hard to progress and achieve goals further down the line.

A strengthening program, developed by your physiotherapist, will be started post operatively in order to begin to regain some of the knee strength and stability. The strengthening program for ACL reconstruction rehab is quite specific because the exercises need to strengthen all of the important muscles without placing too much stress on the healing ACL graft. A gradual progression of strengthening is done, beginning with simple light exercises and building up until eventually more complex exercises that are specific to your sport can be achieved.

By the end of the rehab the goal is to have sufficient strength in the muscles and ACL graft to give the knee the functional stability it needs to cope with the demands placed on it during activity. A return to sport is typically achieved in around 9-12 months following surgery.

Knee Osteoarthritis

Foot and Ankle

Knee Osteoarthritis

You wake up, the sun is shining, you climb out of bed and realize that your knee feels stiff. Again. After about ten minutes the stiffness eases and you head out for your morning walk. You notice that you can’t walk as fast as you could a couple months ago, and you have started shortening your walking distance due to the pain in your knee. Over the last month you have also noticed weakness in the muscles around the knee, reduced balance and grinding in the knee joint with movement.

Does any of that sound familiar? If so, you may have knee osteoarthritis. Osteoarthritis is a common degenerative condition that often involves the spine, hip and knee joints. When the articular cartilage between two bones breaks down, the underlying bone becomes exposed, which can be painful. An x-ray of the knee can help confirm the diagnosis of osteoarthritis, although symptoms do not always correlate with the degree of degenerative change seen on x-ray.

While it is usually not possible to identify the exact cause of this condition, factors which increase the risk of osteoarthritis include increasing age, a family history of osteoarthritis, obesity, a previous injury that has caused trauma to the joint and a sport or occupation that has involved repetitive stress on the knee joint over an extended period of time.

There are a wide range of physiotherapy treatments that can be quite effective at alleviating pain, reducing stiffness and improving range of motion, flexibility, muscle strength, balance and overall function. These treatments may include education, manual therapy, exercise prescription, modalities and use of a gait aid, such as a cane.

Exercise can be quite beneficial to help reduce symptoms and improve function. Consider your physiotherapist your exercise expert who can put together a home exercise program for you which includes specific exercises for range of motion, stretching, strengthening, aerobic exercise and balance training. As well, swimming and/or cycling are often well tolerated and help improve aerobic conditioning, joint lubrication and can help with weight management.

Manual therapy involves different hands on techniques performed by your physiotherapist which can help reduce stiffness and improve range of motion. We will often measure knee range of motion before and after treatment and between physiotherapy visits to determine how effective the treatment is for you. Modalities, which include heat, cold, electrical stimulation, ultrasound and acupuncture may also help to reduce symptoms. Ultimately, our goal is to reduce pain and improve function and the treatment you choose will depend on your goals, the severity of your symptoms and your current level of function.

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