Pregnancy & Physical Therapy 101 – Week 5

Over the past 4 weeks, we have presented you with some basic information for pregnancy and return to activity after pregnancy. Every person is going to be different, and this is purely based on research and experience. Today we are completing this series with more technical information and with some of our resources.

If you would like more information, please contact us, so we can help you individually.

Pelvic floor research:

The overall pelvic floor muscle group has 4 primary functions:

  1. They are supportive and hold your organs up,
  2. They include sphincter muscles to prevent urinary and fecal incontinence,
  3. They contribute to sexual arousal and performance,
  4. And they assist in lumbopelvic stability

Pregnancy and delivery can lead to pelvic floor dysfunction

Think of what can happen if the pelvic floor no longer performs its vital functions well. If the organs of the pelvis are not well supported against gravity and cushioned against pressure, they literally begin to drop. This is known as pelvic organ prolapse.

  • Pelvic Organ Prolapse
    • Parity increases risk (Buchsbaum et al. Obstet Gynecol. 2006)
    • Found in 44% of parous women aged 20-59 (Samuelsson et al. Am J Obstet Gynecol. 1999)
    • Urinary incontinence
    • 4% greater in primiparous women (MacLennan, et al. Br J Obstet Gynecol. 2000)
    • 5-6 times more likely with vaginal delivery (Altman et al. Obstet Gynecol. 2006)
    • Reported by 25-75% women postpartum (Gregory, & Nygaard. Clininal Obstet Gynecol. 2004)
  • Dyspareunia
    • Pelvic floor muscle spasm and/or scar tissue following an episiotomy (MacLennan et al. Br J Obstet Gynecol. 2000)

If the superficial sphincter muscles grow weak or are impaired by labor and delivery, women may experience difficulty with evacuating and/ or retaining the contents of their bladder or bowel. This is known as incontinence.

If the pelvic floor muscles that power sexual activity grow weak or are impaired, sexual activity may become painful. This is known as dypareunia. This is not an end-all, be-all symptom. This is something that can be helped!

There is an abundance of information that has been provided over these past few weeks…ultimately, if you are unsure, please contact us, as we would love to help you with your individual needs!

And ultimately, congratulations on your new baby!!

Pregnancy & Physical Therapy 101 – Week 4

Don’t just take our word for it! Here are some success stories from new mommies who have utilized our services and have had improved symptoms, both during and after pregnancy. If you are feeling pain, discomfort, or are afraid to start working out, please do not hesitate to reach out to us! We are here to help 🙂

Pregnancy PT recommendation – I’ve been going to TOPS since its inception, the staff and I have been through a few surgeries, This time we took on pregnancy. Having had 2 shoulders, double mastectomy with reconstruction and a back surgery, I knew my body would need help on this 9 month journey. I didn’t want to do any damage to my joints or have undue stress on my back. As an avid swimmer gaining 30 plus pounds is a whole change and shock to my body. I would go in 1-2 times per week for maintenance therapy. As my weight increased and belly grew my pain and tightening of muscles would shift too. Amy and Chad were able to keep my pelvis in alignment, and break up my tightening fascia to allow me to continue to exercise at a high level. They also had programs designed to adjust with my progress. A very strong core and pelvic floor is key to a healthy pregnancy. I wanted to maintain these key muscle groups to reduce unnecessary stress on my low back, shoulders, and hips. Furthermore, pregnancy is full of leg cramps! Add working out on top and you are primed for the worst cramps of your life. As a pharmacist, I was taking my full vitamin regimen with extra calcium and magnesium to help with these cramps. You also can’t do too much salt when pregnant or you will swell. Again, my weekly PT sessions worked on my legs and the cramping was reduced. I can’t say enough about the staff at TOPS. I love them!

-Lindsey B.

At the beginning of my second trimester I started to have pain in my back and hips. Thinking this was normal pregnancy pain I just dealt with it for a few months. Finally, it got to the point where my belly brace was no longer helping and I went to see Amy at TOPS. She did a few manipulations, re-positioned my hips, and showed me some stretches which my husband could help with at home. This one appointment saved me lots of pain throughout my third trimester and I wish I would have gone in sooner. They even helped me after my C-section, with some strengthening moves, to build my core and pelvic floor back up. I defiantly recommend them to all of my pregnant friends now!!

-Ruth P.

To all of the new and soon-to-be-moms, hope this article helps! I’ve been working with my therapist to strengthen my core postpartum, but have been surprised that many women just jump into a workout routine without any help. Who knew crunches can be bad postpartum?? I didn’t, until I spoke with my therapist. Here is another article that supports and breaks down the benefits of physical therapy for new moms!

-Jenny B.

Abdominal Rehab article from Baby Center:

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:


  • 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.


  • 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.


  • 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.


  • 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


  • 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.