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Aug 7, 2023

Dr. Jess Gingerich // #ICEPelvic // www.ptonice.com 

In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Jess Gingerich discusses considerations for postpartum exercise include the type of birth, birth trauma, sleep deprivation, and nutrition. It is important to take into account the impact of the birth on the postpartum exercise plan, especially if it was traumatic physically or emotionally. Respecting the individual's experience is crucial. Additionally, sleep deprivation and nutrition should be considered. If a mother is struggling to get proper nutrition due to the demands of caring for a newborn, adjustments may need to be made to the exercise plan. It is also important to consider specific goals when designing a postpartum exercise plan.

The episode highlights three recommended exercises to initiate postpartum impact: heel drops, alternating hops, and jump rope exercises. Heel drops involve going up onto your toes and dropping your heels down. Alternating hops are done by moving side to side and can be performed with or without a jump rope. Using a jump rope adds an extra challenge and requires coordination. The third exercise is small hops with both feet. These exercises are ideal for postpartum women who want to regain strength and fitness after giving birth. However, it is crucial to consider the type of birth, any birth trauma, sleep deprivation, and nutrition when starting these exercises. Monitoring for symptoms such as leakage, pressure, pain, and bleeding is also important during the progression into impact exercises. Breastfeeding moms should be advised to wear a supportive bra during exercise for added comfort.

Jess emphasizes the importance of utilizing progressive overload principles when starting with small impact movements and gradually increasing intensity. She stresses the significance of meeting the individual where they are and understanding that progressive overload is a natural part of the process. This means that as the individual progresses and adapts to the small impact movements, they should gradually increase the intensity of their exercises to continue challenging their pelvic floor muscles and promoting strength and function. Jess also highlights the importance of speaking positively about exercise and the pelvic floor, as it encourages individuals to stay active and avoid deconditioning. By incorporating progressive overload principles, individuals can safely and effectively strengthen their pelvic floor muscles while minimizing the risk of injury or negative symptoms.

Take a listen to learn how to better serve this population of patients & athletes.

If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.

EPISODE TRANSCRIPTION

00:00 INTRO

What's up everybody? We are back with another episode of the PT on Ice Daily Show. Before we jump in, let's chat about Jane for a moment as they are our sure sponsor and they make this thing possible. The team at Jane understands that payment processing can be complex, so they built in an integrated payment solution called Jane Payments to help make things as simple as possible so you can get paid. If you're looking for an easy way to navigate payments, here's what we recommend. Head over to jane.app slash payments, book a one-on-one demo with a member of Jane's support team. This can give you a better sense of how Jane Payments can integrate with your practice and you can browse through several other popular features that Jane Payments supports, like memberships with the option to automatically invoice and process your membership payments online. If you know you're ready to get started, you can sign up for Jane and make sure when you do, you use the code ICEPT1MO as that gives you a one-month grace period while you settle in. Once you're in your new Jane account, you can flip the switch for Jane Payments at any time. Let the Jane team know if you need a hand with anything. They offer unlimited support and are always happy to jump in. Thanks everybody. Enjoy today's PT on Ice Daily Show.

01:25 JESSICA GINGERICH

Good morning PT on Ice podcast. My name is Dr. Jessica Gingrich and I am on faculty with the pelvic division here at ICE. So we just finished up a wonderful weekend of the CrossFit Games. We have a huge congratulations to extend to Dr. Kelly Benfey. She is on faculty with the CMFA division. Her team took 16th place this weekend and boy was that fun to watch her compete. So I was on virtual ice last Tuesday and what I want to do today is talk a little bit about that virtual ice. So I've been on here the last couple times talking about the benefits of certain things early in the early postpartum period. So within that first 12 weeks postpartum. So I wanted to continue that and just what a wonderful time to do it as we did have a mom on the podium this year. So Ariel Loewen took third place. She has a child as she's a mom and she's just out here crushing the fitness space. So before we dive into that we're going to talk about early impact which is going to be really fun. We're going to start to reframe that a little bit but we do have courses coming your way. So hop on the website PT on Ice dot com to check that out. We have two courses here with the pelvic division. We have an eight week online course that bridges everything from gymnastics and barbell lifting to handstand push-ups to everything with the pelvic space with using the internal exam to help get people back to where they need to go. And then we have a two day live course and that one is just really fun. We get moving a lot. So if that is something that's on your list go ahead and head over there to secure your spot.

03:45 THE FOURTH TRIMESTER

So we are going to talk about that early impact in the fourth trimester. So the fourth trimester is the first 12 weeks postpartum. There's a lot of things that matter here but I want to start to reconceptualize the phrase of this or certain things put a lot of pressure on your pelvic floor. So we know that growing a fetus is going to put more demand on the anterior abdominal wall as well as the pelvic floor as well as a lot of other systems in the body. So does a sneeze. Like when we sneeze it puts a lot of pressure on the pelvic floor. When we lift weights it puts a lot of pressure on the pelvic floor. When we lift our child that then wiggles around it's going to put a lot of pressure on the pelvic floor. The phrase this puts a lot of pressure on your pelvic floor we want to maybe refrain from doing that can be a very fearful message. And also one that's just incorrect at this point. We want to do it in a way that is going to allow the pelvic floor to succeed. We don't want to blast through symptoms of leakage or heaviness or pain but we need to start reconceptualizing this especially speaking to our clients. So now before we jump in, no pun intended there, impact, we want to understand the demands placed on the pelvic floor in the day to day. So number one when you have a baby whether it's a c-section or a vaginal delivery we do have a healing process. So with a vaginal birth if there is no tissue trauma, so this is a vaginal birth with no tearing, no episiotomy and episiotomy is where they would cut to allow more room. We know that the tissues stretch approximately three times, 300 times their original length. So right then and there we can put that as tissue trauma, right? That is tissue trauma without any disruption to the sarcomeres or the skin or the connective tissue. Patients will need about four to six weeks for healing but this doesn't mean that we can't do nothing for four to six weeks. Now there's going to be probably a lot of questions that come with this because everyone is different, right? So we need to understand that and set the expectation early can be super helpful. So in educating our patients I love to give a timeline. So I usually say between six and twelve weeks, sometimes six and eight weeks depending on where that person is. And that's kind of nice because then when they get back to doing impact things that's now something where they're like oh I was kind of anticipating twelve weeks instead of now, right? And so that gap is pretty big but at least it allows them to be like okay I have this set date or timeframe if you will where we're going to start working back to that.

04:16 PRESSURE ON THE PELVIC FLOOR

Number two, we need to start talking about toileting. We need to teach people how to poop. We need to teach people how to pee. If we are not asking that question, are you burying down when you go to the bathroom? Are you pushing your pee out? You're going to be missing a big mark here. Your pelvic floor is reflexive. So as pressure gets put down on it, it should be turning on. So if you're going to the bathroom and you're burying down, we're putting a lot of pressure on the organs if you will. However, we're also putting pressure on the pelvic floor that's likely kicking it on and if it's not, it's just pushing it downward. So we need to be asking about that. We need to be encouraging a squatty potty. We need to be encouraging fluid, water intake, fiber intake and really the time spent on the toilet and this goes for males too. So spending a lot of time on the toilet just isn't what you want to do. If they are the person that takes their phone in with them, you could even tell them hey let's try not taking your phone in to see if you get off the toilet sooner.

08:12 BLADDER IRRITANTS

So number three, we do have oral intake. So we talked about water intake just a second ago, but just recognizing that beverages like carbonation, alcohol, artificial sweeteners, they could be bladder irritants. And so I went to the gym this morning and I did one of the CrossFit Games workouts today called Halina, which is a three rounds of 400 meter run, 12 bar muscle ups and then 21 dumbbell snatches. I went at 7.15 so I had coffee and I had to go to the bathroom probably three times before I went and did the workout because that is a bladder irritant for me. So when we talk about bladder irritants, we are not saying stop having these things. It's just saying hey this may be a trigger and so if this is happening to you, that's okay. Just recognize that if you have double unders or running or something, box jumps, that may be we try to have the coffee after the workout or maybe you have one cup instead of two or can we sandwich that coffee with some water to dilute the urine a bit. That's one of the big things is not necessarily taking those things away but just telling them hey this could just be a bladder irritant for you. It looks different for everyone. Number four and probably one of the biggest ones is the symptom threshold. Helping your client find their symptom threshold is going to mean that they're going to be reaching their symptoms. They are going to likely be leaking. They're going to likely be maybe feeling like they're going to leak and that can be a very daunting thing but it's going to give us a lot of feedback, a lot of them feedback and it's going to give them a lot of freedom when they're in the gym. If you reach this threshold, take a second, pause, take a breath. Maybe we do a little bit of jumping and then we back off and we do the bike and get a sprint in. Or we do another option for jumping. I'm going to talk about some options here in a second. Speaking positively about exercise and their pelvic floor is huge. They are not going to ruin their pelvic floor. I would rather, we would rather have someone stay active in the gym or whatever that looks like for them rather than telling them they're going to ruin something so they stop and then fast forward 30 years later and now they're in a skilled nursing home sooner because they're massively deconditioned or they have a massive injury because of being deconditioned. Now that we have some guidance on the return factors that we want to manipulate and play around with, let's start using pressure rather than, or rather forces if you will, to strengthen the pelvic floor. Now there are considerations we need to keep in mind, like the type of birth, we talked about that earlier. Birth trauma, so this could actually be physical as well as emotional. So if you have someone who is identifying that their birth is pretty traumatic, we're going to respect that. Sleep deprivation, nutrition, if your mom is having a hard time getting protein in and carbs in and good fats in because every time she goes to eat her baby starts to cry, that's something to just talk about and maybe we push that back a little bit and that's okay. And then of course specific goals. So our top three exercises to initiate post-part or impact in that time is going to be heel drops. So that's where you'll go up onto your toes and drop your heels down. Alternating hops is just going to be alternating side to side. You can do that without a jump rope or with a jump rope. Doing it with a jump rope is actually very difficult. It takes a lot of coordination. And then small hops. And that is going to just be small hops with two feet. Something to keep in mind in here are breastfeeding moms that can be very uncomfortable. So just talking to them about wearing a very supportive bra when they come to that visit. As always, we are going to ask about symptoms during your progressions into impact. So the symptoms are going to be leakage, pressure, pain, and then also bleeding. So in that early trimester we want to just keep an eye on bleeding. It is normal to have an uptick in bleeding, but we want it to not be like that they're passing clots after they start upping their intensity. Keeping the conversation positive even if they're hitting symptoms early and we're regressing. All we're doing is we're meeting them where they are and understanding that progressive overload is going to happen. And even talking to them about that is a really fun thing. So to recap, pressure doesn't have to be a bad word when talking about the pelvic floor. Understand other factors that may be influencing the pelvic floor, such as toileting, nutrition, type of birth. And essentially linking that to their symptom threshold. Utilizing small impact movements at first and start to initiate those progressive overload principles. So I'll leave you with that. Have a great Monday and we'll see you next time.

13:40 OUTRO

Hey, thanks for tuning in to the PT On Ice Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review. And be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ICE content on a weekly basis while earning CU's from home, check out our virtual ICE online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

 

 

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