Pregnancy & Physical Therapy 101- Week 3

Based on these previously mentioned tips, here is first-hand experience from anew mommy, and her road back to running! Her story tells it all…

As a new Mom and runner, I was excited and anxious to get back to running. I knew I was in no physical shape to compete after giving birth to my son but I was anxious to use running as an outlet to have some “Mommy” time alone. I can vividly remember my first run. I knew it was not going to be pretty and only set my goal to complete two miles. Little did I know that that was a lofty goal! I made it half way and was ready for a walking “break.” Since my first run postpartum, I have gradually increased my mileage.

Here are some of her helpful tips that have helped her back out on the road (and treadmill)! You’re missing the road, the trail, the exhilaration and the freedom of going for a run. You’ve spent several months off from this activity due to your pregnancy and delivery. It’s time to return to running but where do you start?

  • First thing first, get your physician’s permission. Typically, you will follow up with your doctor 6-8 weeks postpartum. At this visit, ask your physician if it is okay to begin running again.
  • Start slow, run a short distance, and remember… it is okay to walk! Did you run or workout during your pregnancy? If you did, you may have a better base than someone who did not, but you should still take it slow as your body has gone through several changes. It only takes 48-hours of inactivity or decreased activity to start losing muscle so you most likely have lost muscle mass, strength, and cardiovascular endurance. Walking is ok! You can also do 1-minute on/off of run/walk. Cycle through 5-10 times based on how you are feeling.
  • Your body will feel different. While pregnant your body produced increased hormones: estrogen, progesterone, relaxin along with several others, which lead to ligament laxity. And if you breast feed you may continue to experience increased ligament laxity due to increased levels of progesterone. This laxity creates more mobility in the joints, especially in the pelvis, which may lead to pain in the lower back, glutes, pelvis, or pubic bones. Physical therapy can help you through these dysfunctions should they arise.
  • Once you begin running you may experience urinary incontinence or leaking. Do not be afraid to talk to your physician or physical therapist about this! While this is very common among new Moms it is not normal and can be addressed with exercise and/or physical therapy. Kegel exercises are a good place to start to strengthen the pelvic floor muscles to address the incontinence (see last week for detailed instructions on how to do this).
  • Talk to your pediatrician about running with your little one in a jogging stroller. Generally, you are able to start jogging with your little one when they have good head control, which is anytime between 4-6 months. Try to stay on a smooth surface and minimize bumps as your baby’s head control is still developing.
  • Remember to hydrate! Hydration is very important, especially if you are breastfeeding your little one. Many jogging strollers have a place for you to put a water bottle or if you don’t carry one then plan your route so there is a water fountain available.
  • Last but not least, enjoy this time!

Pregnancy & Physical Therapy 101 – Week 2

As promised, this week’s pregnancy blog focuses on exercises that are safe to perform while pregnant, and the week’s following the birth of your little gem. **Please check with your doctor before performing these exercises!

Regular exercise after having a baby can help decrease stress levels, increase energy, and improve quality of sleep. The American Congress of Obstetricians and Gynecologists recommends 150 minutes of moderate intensity exercise weekly.

Most physicians and physical therapists recommend waiting six weeks before starting a formal exercise program if you had an uncomplicated vaginal delivery, or eight weeks if you had a C-section.

Over the course of pregnancy, abdominal muscles and the surrounding connective tissue stretch to accommodate your growing baby. Unfortunately, they don’t magically snap back into shape a few weeks after you give birth. In fact, it can take months to recover and you may need some guidance along the way.

Abdominal rehab is a type of physical therapy to strengthen and tone weak stomach and pelvic muscles to help postpartum women regain core strength and return to their pre-pregnancy body.

The following are a group of exercises you can perform in the comfort of your own home:

Kegels

  • Contract your pelvic floor muscles (those that you would use to stop urinating) by pulling them in. Act is if you were sitting on a cold block of ice pull your pelvic muscles away from it.
  • This is a subtle motion so keep all other muscles relaxed, including your buttocks, legs, and abdominal muscles
  • Don’t forget to keep breathing
  • Practice short, quick contractions as well as longer, sustained contractions
  • As you feel more comfortable try doing kegels in different positions such as sitting/standing and eventually walking/hiking.

Pelvic Tilts

  • Lie on your back with both legs bent, feet flat on the floor, and tighten your stomach. Tilt your pelvis backwards to flatten your back on the floor. Repeat sets of 10 repetitions.
  • When this feels easy, advance by performing the tilt, then slowly lifting one foot a few inches off the ground, place your foot back down and repeat with the other leg, maintaining the pelvic tilt
  • Further advance by straightening one leg, sliding along the table and slowly returning to your staring position, repeat with the other leg, maintaining pelvic tilt.

Bridging

  • Begin lying on your back, both knees bent, feet flat on the floor
  • Contract your glutes, lifting your hips off the floor towards the ceiling
  • Hold for 5 seconds, slowly lower hips back down to the floor
  • Repeat 10 times, perform 2-3 sets

Side Planks

  • Start lying on your side with your body in a straight line.
  • Prop up on your elbow, lifting your hips, so that you maintain a straight line from your nose to your toes.
  • Hold 30 seconds, repeat 2-3 sets each side

Chest Press

  • Start lying on your back, both knees bent, feet flat on the floor.
  • Hold your baby right above your chest, elbows bent
  • Contract your abdominals, performing the pelvic tilt from above, slowly straighten your arms, lifting baby up toward the ceiling and slowly lower back down to starting position
  • Repeat 10 repetitions for 2-3 sets.

Shoulder Press

  • Start standing with feet about shoulder width apart, hold your baby so you are face to face.
  • Contract your stomach and lift your baby up toward the ceiling, pause and slowly lower back down to starting position
  • Repeat 10 repetitions for 2-3 sets.

Squats

  • Start: standing with feet shoulder width apart, wearing your baby in their favorite carrier.
  • Lower your hips down and back, like you are sitting in a chair, making sure to push your knees out so that they stay aligned over your feet.
  • Tip: perform these in front of a mirror to make sure your knees are in alignment.
  • Repeat 10 repetitions for 2-3 sets.
  • Variation: Wall Squats – squat to 90 degree knee bend with your back against the wall and hold 3 x 30 seconds.

Lunges

  • Stand up tall, wearing your baby in his/her favorite carrier
  • Step one foot forward, bending both knees
  • Make sure your front knee doesn’t go forward past your toes, ideally both knees will be at 90 degrees
  • Return to your starting position
  • Repeat 10 times, perform 2-3 sets each leg

Walking

  • Often overlooked, walking can by a simple yet effective form of exercise.
  • Take your baby with you in the stroller starting with 10-15 minutes and gradually increasing.

Exercises to avoid – forward planks, crunches/sit-ups, leg lifts

Crunches won’t fix the problem and will likely make it worse.

Why don’t crunches help?

Traditional sit-ups and crunches target the rectus abdominis (6-pack muscle). But after pregnancy, the connective tissue between these bands of muscle is stretched out, causing each side to pull apart and no longer support your core. Doing regular crunches tends to make the muscles tighter, pushing them further apart and stretching the connective tissue even more so that it grows thinner and weaker.

It may be beneficial for you to see a professional prior to starting exercise. Dysfunctions that may develop and require treatment after pregnancy/delivery include:

  • Diastasis Recti – As mentioned above, the rectus abdominis gets stretched out during pregnancy. If it stretches enough the muscle may separate, leaving a vertical gap that allows your belly to sag through.
  • Low back/Pelvic Pain – Experts estimate that anywhere from 24% to 90% of women experience low back or pelvic-region pain when they are pregnant. Many women find that this pain goes away when the baby is born. However, more than a third of women still have pain 1 year after giving birth.

Damage to the pelvic floor muscles during pregnancy or delivery may cause:

  • Pelvic Organ Prolapse – This occurs when the organs of the pelvis are not well supported against gravity and cushioned against pressure, causing them to literally begin to drop.
  • Dyspareunia – or pain with intercourse. This can occur when the pelvic floor muscles spasm and/or if scar tissue is present following an episiotomy.
  • Incontinence – difficulty evacuating or retaining the contents of the bladder or bowel. This occurs if the superficial sphincter muscles grow weak or are impaired by labor and delivery.

In many cases, insurance will cover the cost of evaluation and treatment for these dysfunctions. Check with your insurance provider to see if you need a physician’s referral to visit a physical therapist.

Pregnancy & Physical Therapy 101 – Week 1

Our next blog series has been inspired by one of our former bada$$ employees! She decided to start a family, which many of you may remember, because she worked through much of her pregnancy!

Carolyn brings an amazing perspective because she understands the physical therapy side and can bring that knowledge, as well as personal experience, to these entries. We hope you find these as informative and helpful as many other pregnant and new moms have!

From Carolyn: 10 months ago I did not feel like I would ever get my abs back. I had diastasis recti, separation of the abdominal wall. After having two babies so close together, my stomach still looked pregnant months after giving birth. Finally it is going away because I modified my workouts. If you have diastasis recti make sure that you do NOT do traditional sit-ups or planks as they will make it worse. You need to strengthen your core from the inside out.

There is a test you can do to check to see if you have it so you can heal yourself without doing any further damage. The test is: Lie on your back with your knees bent, and the soles of your feet on the floor. Place one hand behind your head and the other hand on your abdomen, with your fingertips across your midline – parallel with your waistline – at the level of your belly button. With your abdominal wall relaxed, gently press your fingertips into your abdomen. Roll your upper body off the floor into a “crunch”, making sure that your ribcage moves closer to your pelvis.

Move your fingertips back and forth across your midline, feeling for the right and left sides of your rectus abdominis muscle. Test for separation at, above, and below your belly button.

If you suspect that you have it, come talk to us at TOPS to see how to best manage this situation. You can also talk to your health care provider on how to proceed further.

Take care of yourself first!!!

Next week we will be posting about safe exercises to perform, and in the future, we will post on a safe return-to-run program.

*For more information and constant updates/inspiration, please follow Carolyn Frye on Facebook. Also check back in with our blog, as we will be doing a series of information regarding this topic!

**Disclaimer: these posts are meant to be informative, but not diagnostic. If you have any further concerns, you can reach out to us, or to your medical provider. We will do our best to help.

25 Questions To Get To Know Chad

25 Questions to get to know our staff

  1. Who is your personal hero? My dad.
  2. What are you most grateful for? My family.
  3. Why did you choose your profession? I started working with an outreach ATC in high school.
  4. If you could travel anywhere in the world, where would it be? Turks and Caicos.
  5. What is your favorite color? Blue.
  6. What is your favorite sport? Football.
  7. If you could master one skill you don’t have right now, what would it be? Playing Guitar.
  8. What would be your “perfect” day? On a beach with a beer.
  9. What is your dream car? GMC Sierra Denali.
  10. What is your fondest childhood memory? Family trip to Alexandria, MN.
  11. What is your favorite food? Pizza.
  12. What is your favorite state or city that you have either lived in or visited? South Dakota, the motherland.
  13. If you could have one superpower, what would it be and how would you use it? MRI eyes.
  14. What’s your favorite holiday and why? Christmas, because of family time.
  15. What is your favorite movie? Dumb and Dumber.
  16. What is your greatest achievement and how has it shaped you? My wife and children, they have taught me to be unselfish.
  17. What is your favorite song? Record Year – Eric Church.
  18. What fad do you wish would come back? Rolling your jeans.
  19. Who has influenced you the most in your life? My parents.
  20. If you could take only three items with you to a deserted island, what would they be?
    1. My wife
    2. My son Colter
    3. My daughter Raegan
  21. If you could be one musician, who would it be and why? Sam Hunt.
  22. If you could live in a book, TV Show or Movie, what would it be? Dumb and Dumber.
  23. What animal best represents you and why? An ostrich, I am built like one.
  24. In what ways are you the same as your childhood self? I sometimes lack patience.
  25. What is your favorite clothing item? A good pair of Under Armour underwear.

25 Questions To Get To Know Amy

25 Questions to get to know our staff

  1. Who is your personal hero? My parents
  2. What are you most grateful for? Everyone who has supported me in my life and, more recently, my dream and passion.
  3. Why did you choose your profession? My mother and I both had ACL surgeries that I was able to participate in the PT. I was inspired by their work and I also felt a natural affinity for their work.
  4. If you could travel anywhere in the world, where would it be? All of those places you see on Facebook of “Top 20 places in the world to travel”! I want to go to them all!!
  5. What is your favorite color? Teal.
  6. What is your favorite sport? I like to watch football, but I like to play softball. Competitively only.
  7. If you could master one skill you don’t have right now, what would it be? I’d love to be able to run as fast as the wind! Since that’s not happening…maybe learn another language while I’m sleeeeeeping!
  8. What would be your “perfect” day? Wake up to a gorgeous sunrise on the beach, run on the beach, make a delicious breakfast…then boogie board, snorkel, jet pack, jet ski, whale watch, etc all day. A gorgeous sunset walk on the beach. An early dinner…and early to bed! haha.
  9. What is your dream car? A luxury SUV.
  10. What is your fondest childhood memory? All of our fun family get togethers and vacations. I also love the beach (if you don’t already know that) and Raging Waters!
  11. What is your favorite food? Mexican for sure.
  12. What is your favorite state or city that you have either lived in or visited? I love me some good ole Cali-for-nia! And appreciate it now, more than when I lived there!
  13. If you could have one superpower, what would it be and how would you use it? To be invincible on command! Ummmm…using it goes without saying…this could be super beneficial on many levels! Lol. I would LOVE to have that pill in Limitless…that would also be utilized to it’s fullest extent!
  14. What’s your favorite holiday and why? I looooove 4th of July; Christmas is a close second though!
  15. What is your favorite movie? Eh……don’t really care for movies that much to have a favorite one. I guess since I referenced Limitless, I’d have to say I like that one. Otherwise, I like a good non-fiction movie. Preferably a war movie.
  16. What is your favorite song? I just love me some good ole 90’s R&B baby!
  17. What fad do you wish would come back? Hypercolor! Or fanny packs!
  18. Who has influenced you the most in your life? My parents.
  19. If you could take only three items with you to a deserted island, what would they be? Welllllll, we all know I’d die if I had to live off of the land, so probably some type of energy bar, a friend to help entertain me and build stuff, and…hmmmm…a survival kit!
  20. If you could be one musician, who would it be and why? Huh? I want to be a rich anonymous person! I don’t want all of that attention…so of course, I don’t know which musician that is…since they are poorly known, but highly paid!
  21. If you could live in a book, TV show, or movie, what would it be? There are too many questions about TV, Movies and books…I don’t know… I want to live inside the Magic School Bus stories…cuz that’s all I can think about right now.
  22. What animal best represents you and why? A lion…roar! Cuz I’m a Leo…and my hair is crazy.
  23. In what ways are you the same as your childhood self? Have you seen me?? I darn near look the same…pictures prove it! And I still really don’t like to sit still much…squirrel!
  24. How do you want to be remembered? A kind person who helped those who were looking for guidance to help improve themselves.
  25. What is your favorite clothing item? SHOES!!!

If the Shoe Fits: What Your Running Shoes Would Tell You If They Could Talk

At T.O.P.S. Physical Therapy and Osteopractics, we pride ourselves in our “shoe game” as we strive to put together the best outfits in the business. HOWEVER, there is so much more to a running shoe than the visual aesthetics, and we are reminded all too often of the implications from wearing the coolest looking kicks day in and day out instead of opting for comfort. We have come up with some helpful advice and tips about choosing the appropriate shoe to fit your training needs.

Take them out on a test run:
The right running shoes offer more than just comfort. Stores that specialize in running often have treadmills, so ask a salesperson to watch you run and recommend sneakers based on your running form and foot posture.

One shoe is not fit for every workout:
Running shoes are designed for forward motion. They lack the ankle support provided by cross-trainers, which are better suited for activities with lateral movement, like tennis and boot camp classes at the gym. To help avoid injury, save running kicks for the road or the treadmill.

Make sure the shoe fits:
Generally, your running shoes shoulder be a half size larger than your normal size to give your feet room to shift without jamming your toes. While standing, you should have half a thumb’s width of space between your longest toe and the shoe’s tip.

Hand-wash those bad boys:
For dirty sneakers, remove the insoles and spot-clean the outsides with warm water, soap, and an old toothbrush. Stuff newspaper inside the shoes and let them air-dry. Avoid putting your shoes in the dryer at all costs: direct heat can ruin the shape and adhesive on the shoes.

Do not exceed the ‘expiration’ date:
The best indicator of when to retire a pair of running shoes is mileage – between 300 and 500 – which you can track manually or with apps like MapMyRun or the Nike Running Club. Creases in the midsole (the squishy part of the shoe between the shoe’s bottom and the sneaker itself) are a better clue of overuse than worn treads are.

For more tips and tricks to keep you on T.O.P.S. of your competitors AND your shoe game, visit us at T.O.P.S. Physical Therapy and Osteopractics! Be sure to check out a few of these local retailers when you are looking to buy your next pair of running shoes.

What Is Osteopractic?

With healthcare, patients are more informed and knowledgeable than ever before. As with everything else in today’s world, they want things performed a certain way, done as quickly as possible, and they will use the internet to find the best place where they can get that service. These individuals want results, and they will shop around until they can find the provider that can effectively provide that in a shorter length of time.

As healthcare evolves, manual therapy is becoming increasingly important as it (1) provides results in a shorter time than traditional methods, and (2) it does so in a more personal, one-on-one manner. A Physical Therapist may find him or herself readily compared to massage therapists, chiropractors, or even craniosacral therapists, as patients are looking for just the right person to get them pain free. We Physical Therapists are the most qualified to return patients to a healthy lifestyle as we offer a broad scope of practice ranging from therapeutic exercise to pain management to, yes, manual therapy.

Hands-on treatment of soft tissue mobilization, joint mobilization, and dry needling therapy, among others, are rising to prominence in the field. With this, the newest form of PT is that of an Osteopractor, and our own Amy Brannon holds a diploma in Osteopractic Physical Therapy. The word ‘Osteopractor’ translates to ‘bone practitioner’ and they are therapists trained in diagnosing and treating neuro-muscluo-skeletal disorders. This diploma is given to a doctor or physical therapist who has completed an intense course of study that includes Certificates in Spinal Manipulation and Dry Needling, as well as IASTM (Instrument Assisted Soft Tissue Mobilization) and Extremity Manipulative Therapy. These techniques are proven to heal tissue, reduce joint impairment, and lessen pain.

An Osteopractor is a highly skilled, hands-on manual therapist who graduated through the Spinal Manipulation Institute. Dr. Brannon is one of a select and minimal group in the world to earn this title. If you are struggling with joint or muscle pain, and you’re searching for a solution…look no further than T.O.P.S. Physical Therapy.

Lesson About Health Insurance

This is a quick 5 minute read that is important for all consumers to understand when getting medical services from an office! This is a simple lesson on health insurance and medicine…

Now that it’s the New Year, PT offices, and many other medical offices have to reset all of their insurance information. With that said, Ron Pavkovich gave a great summary of this fiasco, from the point of view of a PT front office…great read, not only for PT offices, but ANY medical office!

For those who don’t know, you, the patient, is ultimately responsible for knowing and understanding your benefits for medical care. The patient has the responsibility of knowing their plan, what is, and is not covered. As a courtesy, physical therapy and medical offices verify your benefits and explain them to you in a “language” that you can better understand. This courtesy of checking benefits is a relatively COST CONSIMUING gesture on their part. It is also ALWAYS an estimate. With that said, it is your choice and responsibility to either check your own benefits or know your plan. If your insurance does not pay for the services or care you received, it is still your responsibility at the end of the day. This is why you sign you initial paperwork advising that you understand and agree to pay for the services provided, in the scenario that your insurance does not pay.

If you have had a service performed, it is not the PT or MD office’s fault that your insurance did not pay. Therefore, you cannot, and should not, expect that office to not collect for services rendered and treat you for free.

This is a simple education lesson on health insurance and medicine. Please do not blame your provider for you not knowing what your plan does and does not cover. Your provider’s office is simply the messenger and doing you a courtesy by trying to help you understand the type of coverage you have. At the end of the day, your provider does not make these insurance policies nor do they have a say in what is paid for. Also, please keep in mind that your provider is likely only getting reimbursed about 40% of what they bill your insurance carrier. Insurance carriers are killing medicine!

Another point made is that often the PT or MD offices are responsible for pre-certifications. If the office is “in-network”, the office is obligated to write off some procedures, which are oftentimes beneficial.
Furthermore, if you provide insurance information that has lapsed after the first of the month, that carrier isn’t liable for payment! Good luck collecting or getting backdated approval from whatever carrier, if any, succeeds the lapsed carrier. And TPA’s will not backdate authorizations until you can prove they were wrong with processing it the first time. So in other words, they can allow for their mistakes, but never yours.

This becomes particularly frustrating for small private practices. They bill everyone the same, yet they generally are not able to negotiate with insurance companies, as they have no leverage. Thus, they have to either take what they pay (usually around $0.40 of every $1 billed) or not participate as in-network. They then approve the full rate, but pass it to the patient as an out-of-network cost. Most small private practices will offer anyone who pays day of service, a discount (and if insurance paid day of service, they would get it too). So anyone is welcome to see the prices, but insurances can change what they pay on a whim, so that is more difficult to keep up with.

This is an issue in our health care system that tends to be heated and followed with a lot controversy. Some responses we have had about this topic are:

  • Insurance anymore is only catastrophic Insurance at best. The deductibles are crazy and your 100% right about it killing medicine.
  • The mouse print on our patient delivery confirmation is extensive and has expanded to include all these points. Most folks have no clue how their insurance works. I have to explain regularly that office visits to their doctor and prescriptions don’t generally apply to deductibles.
  • I agree and fully understand your point. When will I be able to pay my doctors the same price for a service that they accept from insurance companies?
  • I agree the patient is ultimately responsible to know their benefits but we all live in the real world and that usually never happens. Protect yourselves and document, document and document some more!

MRI… Friend Or Foe?

There is always a question as to whether or not an MRI is needed, desired or unnecessary… which is what we address with each of our patients individually. If you talk to the experienced health care provider, the answer is probably “no” more than “yes”. However, if you talk to the patient, they oftentimes swear they need one, or will gain more confidence in getting one.

Here is some insight on why experienced health care providers shy away from getting an MRI until it is absolutely necessary!

Thank you to Adam Meakins for eloquently stating this information:

Do you think an MRI for that patient with persistent back pain will give you the answer?

This is an interesting study that highlights one issue with medical imaging.

1 patient with persistent low back pain had 10 MRIs in 10 different settings interpreted by 10 different radiologists.

49 possible pathologies where identified on the reports in total, but none, that’s NONE were reported consistently by all 10 radiologists.

Just how confusing is that for you as a clinician and the patient?

When it comes to medical imaging remember the 2 golden rules…

  1. Is there a high risk/suspicion of sinister life threatening pathology?
  2. Will the information gained from a scan change my management plan?

If no to both then DO NOT scan!

It will only hinder not help you or your patient!

For more information, visit: https://www.thespinejournalonline.com/article/S1529-9430(16)31093-2/abstract.

After Your Physical Therapy Visit: Short-Term Soreness Equals Long-Term Health

If you’ve suffered an injury, you most certainly wish that you could just click your fingers and have the pain be gone the next day. Of course, the body’s healing process doesn’t function that way and it takes time and proper care to get you back to feeling 100%. Oftentimes, physical therapy is an element to your recovery, stretching and activating muscles and other parts of our body that potentially haven’t been used or fully functional in quite a while. This movement will come as a slight surprise to that area of your body, as it may have been used to it’s new habit. While activity is necessary to get you back to your old self. this movement will cause resistance, and with this resistance will come soreness. So how can you deal with soreness after a physical therapy session? These three tips can help alleviate some of your discomfort:

  1. Ice the area >> Soreness typically means that the tissue of the body part is inflammed. Ice will work to cool and soothe the area – just as inflammation is a typical part of the healing process, ice should be a typical response to that inflammation. Apply ice for 20 minutes at a time, applying as often as you feel necessary.
  2. Drink water >> Soreness after a physical therapy session may be related to local inflammation, which produces waste products the body needs to eliminate. Drinking water throughout the day after a session will enable your body to process any toxins that had released into your blood stream.
  3. Take notes >> It’s your body, and your soreness, so write down where you feel the discomfort, how (if at all) the feeling has changed, and even how you feel following a physical therapy session. Any feedback you provide your therapist can act as a guide for future sessions.