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Back Pain After Baby – The Missing Link

Thursday, April 5th, 2007

When I was 5 months pregnant with my son, I started having terrible back pain. It came on suddenly and was with me long after my beautiful baby was born. As a physical therapist, you would think I would have been able to treat myself back to a pain-free state. Despite even several tries by my colleagues, the pain persisted long after my son’s first birthday. It wasn’t until one of my colleagues, a woman’s health specialist, tested my abdominals for something called a “diastasis recti” that I was finally able to successfully treat my back pain.

Diastasis Recti Defined

A diastasis recti is a separation of the rectus abdominus muscle (the 6-pack abdominal muscle). It generally occurs during the 2nd or 3rd trimester of pregnancy and can cause moderate to severe low back symptoms.

How To Test Yourself For a Diastasis Recti

It is always best to have a trained health professional, such as a physical therapist, check you for a possible diastasis. Here is a general way to check for yourself though.

  • Lie on your back with your knees bent
  • Place one hand behind your head and, with the other hand, place two fingers just above your belly button.
  • Do an abdominal crunch by lifting your head and shoulders off the floor
  • Feel if there is more than a two-finger separation of the abdominals during the mini-crunch movement.
  • Do the same separation test 2 inches above and 2 inches below the belly button.
  • Anything over 2 fingers-width separation is considered a diastasis recti and should be treated.

Treating a Diastasis Recti

The good news is that a diastasis recti is easily treatable (there are a few severe cases that require surgery, but most are treatable with one exercise).

The exercise is simple:

  • Place a towel (folded lengthwise) on a mat and lie down on the towel so that the towel wraps around your middle (at the umbilicus level).
  • Cross your arms and grab each end of the towel
  • As you do a mini-crunch, exhale and pull each end of the towel. Because your arms are crossed, this will have the effect of squeezing the towel tightly around you and essentially encouraging the rectus abdominus muscle to close completely.
  • Hold that position for 2 seconds then lower your head and shoulders back down to the mat.
  • Repeat 20 times at least once a day.

I began doing the “diastasis towel exercise” and had improvements in my back pain within 4 weeks. In 6 weeks, my three-finger-width separation had been reduced to a one finger-width separation. Now, if I feel the pain returning, I do the exercise for several weeks and the pain disappears completely.

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A great way to Ice

Wednesday, January 24th, 2007

Now that I have covered when to ice an injury, here is a tip on how to ice. You can always use a bag full of ice cubes, but they tend to be too bulky to contour any given body part. Frozen peas work a little better, but here is a recipe that works the best (and is much cheaper than the professional gel packs you can buy).

  1. Fill a large Ziploc baggie with 3 cups of water and 1 cup of rubbing alcohol.
  2. Before sealing the bag, release any excess air. Shake the contents together and place in the freezer for three hours. (It is best to double bag in case of leaks).
  3. When you are ready for your ice treatment, place a towel or washcloth between your skin and the baggie.
  4. When you are finished icing (after 10 minutes), place back in the freezer to re-freeze and use it again when needed.

I found this “recipe” in the August 2004 edition of runnersworld.com and tell my patients about it all the time.

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To Heat or to Ice?

Sunday, January 21st, 2007

As soon as people find out that I am a physical therapist, they inevitably start telling me about their aches and pains AND they ask me the BIG question: “When should I use ice and when should I use heat?” It makes for great cocktail conversation!

Here is the skinny…

Ice should be used immediately after an injury and for the 48-hour period following an injury. It should only be applied for 10 minutes at a time. Ice will help to decrease inflammation.

Heat should be used for more chronic problems and can be applied for up to 20 minutes at a time. Heat will help to minimize muscle tightness and spasms.

Now, here is where things get a little more complicated. If you are having an exacerbation of a chronic problem, then ice is appropriate. If you have any orthopedic problem ending in “itis” then ice is best, especially after you participate in any activity that makes your “itis” unhappy. For example, If you have shoulder bursitis or knee (patellar tendon) tendonitis and you have just finished playing tennis, ice that knee and shoulder after your game.

Another exemption to the rules: If you are using those “THERMAcare” heat packs that you can get at any drug store nowadays, you can heat for longer than 20 minutes. These packs are great to use while you’re sleeping and will stay warm for up to 6-8 hours. I often recommend these disposable heat packs to patients with chronic neck or back pain.

Now that you are up on the heat/ice issue, if we ever meet at a cocktail party you won’t have to ask me about that. But I would be more than happy to hear all about those aches and pain! As long as I can tell you about mine too!

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Knee Pain and Weight Loss

Tuesday, January 16th, 2007

It is a “Catch 22”; lose weight and your knees will feel better, but to lose weight you must exercise and that makes your knees ache. The heavier you are, the more stress is placed on the knee joints as you move. But move you must to solve the weight problem.

The best solution?

Start with the knee exercises and stretches that I recommend on this site. They won’t help you lose weight, but they will help to balance the muscles around the knees and will, ultimately, allow you to participate in any cardiovascular type of exercise (which will help you lose weight).

Try aerobic exercises that don’t place stress on the knees. Try swimming or water aerobics to start. Then move to a stationary bike (just make sure to position your seat up high enough so that your knees are relatively straight as they complete each cycle.) The Elliptical machine is a good next step as it affords a great workout with little pounding or stress on the knee joints. And by this time, you have probably lost enough weight that walking or even running on a treadmill won’t aggravate your knees.

Remember that for every 11 lbs. you lose, your knee symptoms will be 50% better! So find a low impact form of activity that works best for you and keep on moving!

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Fit America Contest

Thursday, January 4th, 2007

Happy New Year Everyone!

For those of you who are looking for a great way to get healthy in 2007, check out www.myfitnesstrainer.com. Annette Hudson has created a great website that helps you track your calories and fiber consumption and gives you daily strengthening exercises to perform. She has just started a contest called “Fit America” and yours truly has joined her forum as part of the support system available to participants. I will be helping contestants with any physical problems they may be having that is hindering their participation is the exercise program.

It should be lots of fun. If you need to lose weight and/or get healthy, come on and join the fun. I will be there to help you along the way!

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Pilates or Yoga?

Thursday, November 16th, 2006

This should be a short blog. The answer is BOTH. The trunk, hip and pelvic strengthening of Pilates and the general stretching of Yoga make for a perfect combination of exercises. There are pros and cons to both. Pilates equipment sessions are expensive and Pilates mat classes can be overly challenging. Yoga is much more affordable, but the classes can be too large for proper supervision and correction of technique. My advice is to take several Pilates classes and incorporate the core strengthening into Yoga. Also, make sure you choose small Yoga classes if possible so you don’t get lost in the crowd. For Pilates buffs, I recommend learning some of the basic/traditional Yoga stretches and adding them to your Pilates warm-up or cool-down.

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Young, Female and Susceptible

Thursday, November 2nd, 2006

This blog goes out to all of my friends and patients with daughters who play sports. There is a higher rate of ACL injuries in girls who play soccer and basketball compared to boys. The ACL is an important ligament in the knee that stabilizes the leg during rotational movements. One theory as to why females are more susceptible to ACL injuries than males is based on hormones. Estrogen and relaxin increase the laxity of the knee ligaments and place teenage girls at a disadvantage on the field or court. There is some disagreement as to when during the menstrual cycle girls are most susceptible. One study found that injuries occurred during the menstrual phase of the cycle, while another study found that, during ovulation, females were three times more likely to injure the ACL. Either way, coaches can help prevent these types of debilitating injuries by training their female athletes properly.

Here are the top three things that coaches can do:

1. Work on strength training for the hamstring muscles. These muscles imitate the ACL action of keeping the tibia (lower leg) from shifting too far forward over the femur (upper leg).

2. Teach proper landing techniques and cutting maneuvers. Girls should be taught to bend at the hips and knees as they land and to maintain proper alignment of the knee cap over the second toe.

3. Do balance training (proprioceptive training). Check out This Site for more information and great training ideas.

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Quit To Be Fit

Monday, October 16th, 2006

My girlfriend is trying to quit smoking. Not because she is worried about wrinkles or because she is afraid of emphysema. My girlfriend is quitting because she has neck pain and her orthopaedic doctor has told her that a nicotine addiction could explain some of her physical symptoms. Here is an eye opening statistic: People who smoke are 2.7 times more likely to develop low back pain than people who don’t smoke. Smoking effects the muscles, bones and ligaments in the body by decrease their available oxygen. Research has shown that this reduction in blood flow occurs because nicotine causes a thickening of the blood vessel walls. So, if you smoke, you have weaker bones, weaker muscles and weaker ligaments – the perfect recipe for low back pain, neck pain, fractures and poor recovery after surgery. What cannot be said about smoking is that it will automatically cause degenerative changes in the neck. A study published this year by Spine looked at 200 asymptomatic men and woman (half smokers and half non-smokers). The researchers found no differences in cervical joint health between the two groups. Will I be telling my girlfriend about that study? Probably not. That particular study looked at people with no pain symptoms. We can think of them as “lucky smokers.” My girlfriend has not been so lucky. The combination of a grueling desk job and a long history of smoking, has set her up for severe neck pain. I am holding my breath that she will have enough willpower to quit; not only because I think it will give her neck a fighting chance at recovery, but also because second hand smoke weakens MY muscles too.

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Welcome to Body Blog

Saturday, October 7th, 2006

I am constantly struggling with my own physical aches and pains. Everybody does. Even with my background in physical therapy, I still don’t have all the answers. In fact, the more I know, the more questions I have. The body is, after all, a complicated beast. This blog is about my process in dealing with my own physical problems. It is also about my successes and failures in helping others heal. What works. What doesn’t.

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