Dr. Jessica Gingerich // #ICEPelvic // www.ptonice.com
In today’s episode of the PT on ICE Daily Show, #ICEPelvic faculty member Jessica Gingerich discusses how to return to loading the core during the first 12 weeks of the postpartum period. Take a listen to learn how to better serve this population of patients & athletes.
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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 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.
01:27 DR. JESSICA GINGERICH, PT, DPT
Good morning PT on ICE Daily Show. It is rainy and humid here in South Carolina, so I am already sweating this morning. My name is Dr. Jessica Gingerich and I am on faculty with the pelvic division here at ICE. Dr. Alexis Morgan and Dr. Ellison Melrose and myself are coming off a fun webinar with the CrossFit Affiliate Southeast team where we were talking about coaching the pregnant and postpartum athlete, trying to keep those athletes in the gym as long as we can throughout their pregnancy and get them back in the gym as early as we can in that postpartum timeframe. I wanted to take this opportunity to continue the conversation more specifically around the benefits of training the core during the first 12 weeks postpartum. As always, we want to just highlight some wonderful opportunities to learn. We are coming your way. Go ahead and head over to ptonice.com to see when we are close to you for our two day live course. That is where we take the internal exam and we bridge it with return to sport, return to endurance training, return to strength, gymnastics and so much more. We also have an eight week online course. That is wonderful. We have an online course for eight weeks. So if that is something that you want to hop on, if that’s easier for you to get to, head over to PT on ICE.com to snag your spot. So we are in a really exciting time within that pregnant community. We are starting to see women push boundaries and challenge the norms around exercise. However, the question always continues about returning postpartum. When to do it? We often hear what is safe and unsafe. Here at ICE we like to not use those words because it is more so about what you are ready for and what you are able to do in that snapshot of time. So we know that every pregnancy, birth, prior fitness level and so many other factors vary per person. However, we also know that returning to exercise postpartum has massive mental and physical health benefits. So what I want to do is I want to define that fourth trimester. So this is the time period between zero and 12 weeks postpartum where those physical, mental and emotional changes are huge. They’re huge in so many ways and exercise can be such a massive benefit to mom. And so we want to make sure that we’re doing them justice. So as we make recommendations for core training, we need to respect certain factors. So that’s going to be tissue healing timeframes, pain levels, the amount of help someone has at home, maybe sleep, how much sleep they’re getting, how they’re eating, what they’re eating, are they trying to get their breakfast in as soon as baby starts to cry and they’re getting their lunch in as soon as baby cries and moms are really good at putting themselves first, right? But most importantly, we have to respect function. As hard as we fight for maternity rights, for example, longer maternity leave, mom still has a job at home. She’s caring for a newborn, potentially other children are at home and likely has physical demands of a job waiting for her eight to 12 weeks later, which means she needs to strengthen her core and she really needs it now. Too often the recommendation is taking that six to eight weeks off after birth, which encourages a significant amount of deconditioning, making motherhood, return to work and a whole lot of other things a lot harder. So here at ICE, we love encouraging physical therapy to begin at two weeks postpartum. With this recommendation comes some exceptions, like how is mom adjusting to motherhood or adjusting to adding another baby to the family? Does it give her anxiety to leave the house, which virtual sessions are great for that? Does she need sleep when her appointment time is? You know, that’s a big deal. We want to encourage sleep. Or are the baby’s appointments just adding up and it’s making it hard for her to add this appointment on top of that? So during the first visit, we addressed several things, but core is absolutely one of them. That is looking at diastasis, that is looking at her ability to sit up, a full sit up. We’re going to talk through three planes of motion acting on the spine. You all probably know these from school, but we have the frontal plane, transverse plane, and the sagittal plane. There are a lot of exercises to be utilized in these planes of motion that are important throughout the plan of care for improving strength and function. But where do we start? We love teaching a transverse abdominal contraction along with the pelvic floor contraction, but it never stops there and it usually is something that we move on from fairly quickly. So we do those in supine, we do them in standing, we do them in hanging quadruped, we do them in a trunk extended position, but then we add all of those wonderful layers. So our top three exercises to begin and to start with are the Paloff Press, the Supported Sit Up. This is such a great movement, right? It encourages that full range of motion. Mom is having to sit up out of bed multiple times in the night to feed. And then the Unilateral Farmhouse Carry. I always get a kick out of moms coming into the clinic holding the carrier. That thing is heavy. I’ve carried it out for a couple of moms just to kind of get an idea of how much it weighs with baby inside. It’s heavy and they are having to carry that immediately postpartum to appointments because they can’t leave baby at home. So here we had all three planes of motion with an isometric type of load aside from the Supported Sit Up. There’s plenty of room to progress range, length, load, and then time under tension. As well as these movements mimic those physical demands of life. So again, holding the carrier, rolling out of bed, sitting up for feedings. We often get asked the question, but what about diastasis? So we are assessing that in that first visit. But the goal around diastasis is to coach points of performance. So if you are seeing coning or doming in the midline with a certain movement, can we take a step back, coach those points of performance, and then modify if your client is unable to maintain those points of performance. If they are unable to, you adjust. We need to get the core stronger. And if they have a diastasis, we have to get the core stronger. And we have research on this. So first of all, 57% of people have a gap greater than 2 centimeters. And this is not just in the pregnant or postpartum population. Therefore, we really don’t even have an accurate definition of what constitutes a diastasis. Furthermore, Hills et al. found that diastasis recti was associated with decreased sit up strength and decreased torque generating capacity. A literal weakness issue. So to recap, the fourth trimester is defined as weeks 0 to 12 postpartum. Early core intervention can and should begin at two weeks postpartum per the mom in front of you. Begin with isometrics, then build range, length, and load. As always, we monitor symptoms of leakage, heaviness, pressure, bulging in the vagina, pain, and an increase in bleeding. So with that, I hope you guys have a great Monday and I will see you next time.
10:27 OUTRO
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