Have you heard the newest claim? That mom jeans can give you prolapse?
I know, I laughed when I heard it, too.
I’m not denying that some people might feel something like pressure when they wear high-waisted pants, but the why is where we’ve got it wrong.
They would have to be some SERIOUSLY TIGHT pants to actually make your organs squirt out.
Let’s just be honest here. We’re talking like Kim Kardashian Met Gala corset type tight, which is totally different from the jeans you got at The Gap or the leggings you got from LuLu.
If you’re wearing something tight and your brain is getting information and sensation down there, it doesn’t necessarily mean its cause or making a prolapse worse.
What we do know is the grade of prolapse isn’t correlated to the severity of the symptoms.
Some women aren’t even aware they have prolapse and they can literally have an organ hangin out.
It has something to do with the brain’s awareness of what’s going on locally.
Just because you notice something it doesn’t mean it’s progressing symptoms.
These blanket statements are harmful and the fearmongering doesn’t help anyone.
There may be something we need to explore further with those who have more prolapse sensations when they wear these garments. Or maybe they need a sizing chart. Or to check the setting on their dryers, because their pants are shrinking.
What do you think?
Tell me if you think high-waisted pants cause prolapse.
There’s this argument in physical therapy right now comparing the access to care in the United States and the access to care in other parts of the world.
I hear a lot of misinformation getting thrown back and forth, but at the end of the day, what we really need to focus on is WHO gets to make the decisions.
Who decides you need care?
Here’s my theory…
1/3 of women will do just fine postpartum
1/3 of women would benefit from basic postpartum care
1/3 if women need high level expertise for complex issues or won’t respond to basic care
That’s why it’s been challenging for me to hop on the “everybody needs care” train.
We have to acknowledge not every single person who gets injured needs rehab. Not every person who has a baby needs the highest level of PT care.
But what every person does need is better screening, to determine which bucket they belong in.
It gets confusing because you would assume therapy is therapy. But think about any other job. Think about where you work. There are people who do fine and just get by. But there are people you go to when you have a complex problem that has a complex solution, right?
Physical therapy is the same!
Now, when we bring insurance into the mix (and this is where we all get a headache.)
Most people start with “Do they accept my insurance?’ when REALLY we need to start with “What bucket do I fall into?”
Most of the time this idea of “physical therapy doesn’t work” stems from a complex problem getting put in the wrong bucket.
Many large practices are productivity oriented. They focus on revenue generation (ahem, churn & burn) They are busy negotiating contracts with insurance companies. Because the focus is productivity, you usually get the basic stuff that doesn’t work for everyone in every bucket.
We need to be better at triaging up front. That’s why I am so adamant on putting out resources for everyone to access. I’m only one person (still haven’t figured out cloning technology) and my time is a finite resource. And many people are limited by geography. But many people (moms and Pros alike) can learn outside of a one-on-one visit.
All of the stuff I put out is to make sure all the buckets are addressed. But if you’re in that third bucket and you spend 6 months doing that basic stuff, you can get really frustrated.
As patients, we need to be aware there are different levels of care.
In the case you might be in that third bucket and you’ve tried to DIY and you’ve tried the clinic down the street, please know it isn’t your fault. You were just put in the wrong bucket.
The last thing we need to be doing is guiliting more moms.
As medical professionals, we have to step up. If someone isn’t getting better and you don’t have the capabilities to help, you need to know someone who does.
Being able to identify your strengths and where you may be lacking, and then having resources to help in those areas, that’s crucial.
Tell me what you think about this.
If you’re a mom, and you’ve done all you’re supposed to do and still didn’t get better, where did the blame go?
If you’re a pro, where is your wheelhouse? Which bucket do you help most?
You may be asking, what does that have to do with my pelvic floor health?
I picked up this habit doing telehealth when I couldn’t put my hands on someone.
If you did something like ballet, gymnastics, or cheerleading, that tells me a lot about your flexibility and what your stability strategies might be.
If you rowed, you may have movement biases depending on what side of the boat you were on.
If you swam, you may have certain shoulder or spine mobility.
I’ll also ask about wind instruments and singing, because that plays into breath strategies.
I try to find whatever cue resonates with the person in front of me to get the activation strategy I’m looking for.
We have to remember that women had an entire existence BEFORE they were moms, and how movement patterns were introduced are still relevant to their bodies now.
In understanding our clients holistically, we need to remember it doesn’t start the second they had a baby. No one walks into pregnancy with a clean slate.
Start to ask questions. Start to look for patterns.
There are so many things we learn about movement when aesthetics are involved, like with dance or gymnastics. When you have to look a certain way while you move, I tend to see an overactive pelvic floor.
When you get older, even though you’re not doing those sports anymore, the habits are still there to a degree.
I would love to know, postpartum pros, do you already ask these types of questions?
I was a victim too back when we didn’t know any better.
Now we do.
A story on Good Morning America about Ashley Tisdale began as a story about how hard it is to navigate postpartum & ended with some unfortunately common misinformation about diastasis recti. The advice this doctor was providing was literally out of the year 2000.
Let’s make a few things abundantly clear about diastasis recti:
♦️It’s not painful
♦️It’s not preventable
♦️Sit ups are not damaging
♦️You aren’t broken with DRA
Instead, can we update what we DO know:
🟢All women have DRA in pregnancy
🟢Cat/cows aren’t enough
🟢DRA isn’t a sentence for lifelong inactivity
🟢Pain may mean hernia NOT DRA
🟢Surgery is a LAST resort
🟢Physical Therapy 1st
The second you conceive is the second you lose control. We should be focusing on education instead of prevention because some things are impossible to prevent.
Diastasis recti DOES NOT mean you’re broken! Abdominal separation HAS to happen! You don’t want to prevent that!
Literally, at least once a week, someone comes in saying they need treatment for their diastasis recti. (I’m serious, it’s the gateway drug to postpartum physical therapy). They have leakage, but they won’t come in for that. They will come in because they don’t like the way their abdomen pooches out.
DRA just isn’t that big of a deal. If you have pain, we need to make sure you don’t have an umbilical hernia because that IS a big deal.
Stop telling moms that cat-cow is enough, because it isn’t.
We are not delicate and I will tell you from experience. When my youngest was 3 and I was doing these tiny “strengthening” exercises (because that’s all I thought I could do), I felt so weak.
What do I do now? Whatever the hell I want! I bend, lift, overhead press, snatch. And I’m fine. And I’m strong.
We shouldn’t be afraid and we need to stop scaring moms. What have you been told about DRA?
Does this spark joy? ( I know you know what this means.)
Think back to the beginning of the pandemic when Marie Condo was super popular, many of us got caught up in this question.
The idea was if you pulled out every last thing and placed it in a big pile in the middle of your room, then you’d be forced to deal with it. And I almost feel like this is where we are going with postpartum return to running.
Let’s be honest, until 2019, we weren’t even having these conversations! But this is how the pendulum swings, isn’t it?
The pendulum swing is inevitable, because without it, how do we find out what we don’t know? But through this process, unfortunately, some people will get pulled down.
We’ve gone from no screens at all to full gait screens, screen for pelvic health, screen for impact readiness, and comprehensive musculoskeletal screen.
I’m going to predict that some physical therapist will see these recommendations and revert back to their initial training and get lost in the minutiae of a less-than-optimal foot swing (or whatever).
THEN they will spend precious time trying to rehab something that 1) isn’t that big of a deal and 2) they aren’t really qualified to treat in the first place.
We’re going to have some therapists straight up Marie Condo-ing postpartum return to running.
What things really matter and what things don’t?
Mom just wants to run. But now we’ve given her a huge pile of crap to deal with, most of which may not even matter.
We need to figure out better systems to gather information, figure out what’s relevant, and put the other stuff off to the side.
We don’t have the time or patience to pick up every little thing and ask if it sparks joy.
This isn’t a criticism of the research. The research is important for guidance! But we CANNOT let it pull us into the minutiae.
We took our border terrier, Addie, for her first formal grooming last week. We volunteered her to be a part of a training where the groomers were learning how to hand strip (what you do with wire hair dogs). I stayed with her and was petting her to help her stay calm. But when I started to pet her against the grain, the groomer straight up reprimanded me and said I would damage one of her muscles (I don’t remember which one. Not relevant.)
Here’s the thing, Addie’s breed was bred to pull vermin out of holes. And, now I’m stating the obvious, if a dog goes in the hole, it has to come out of the hole. Which will pull hair against the grain SIGNIFICANTLY harder than I was petting her!
I was telling my friend this story and she said, “Yeah, this is exactly how it is in pelvic PT.”
“DON’T LIFE WITH PROLAPSE!”
“DON’T RUN WITH LEAKAGE!”
“DON’T BREATHE WRONG!”
Give me a break. We are NOT that freaking delicate!
I feel far more confident saying this 23 years into practice, going through this myself, and seeing how the research has changed. We really need to reexamine what we tell our clients.
Or if you’re a client, what someone is telling you!
But it can be so hard because usually when you’re seeking help it;s because you feel like something is wrong and you’re afraid. The fear drives the feeling of fragility.
My dog isn’t delicate and neither are we.
We also have to remember, it’s only recently most of this research is coming out and it’s getting better. That we have pro women athletes that continue to compete postpartum and showing us that we can do these things at a high level.
Women have been doing this stuff for a long time, but we’re finally getting visibility and awareness behind it.
With the lack of evidence, it’s hard to find your way. And I’m saying this as a practitioner AND a mom who’s had every symptom under the sun and experienced that fear that I was too fragile to do the things I loved. But then I realized it was all crap!
That’s why it’s so important for me to dispel this thinking. Because I’ve lived it.
This all goes to say:
We need more research
We have to have conversations
We need to question the advice we are given and what the “evidence” actually means
Question the advice you’re getting. “Tell me more about that.”
Finding the right return to run progression? Where do you even begin?
Invariably, I hear, “What about a couch to 5K program?”
Eh, probably not.
I think that was a simple solution initially because it’s considered basic and for someone who is literally getting off the couch to run a 5k. (Let’s avoid comparing early postpartum running to just getting off the couch, shall we?)
We need to consider…
…if we’ve done a return to run readiness screen
…if we know the mom can tolerate impact
…if we know that balance and strength are descent
…why not undershoot the goal?
Okay, hear me out.
Imagine if you went out for your very first postpartum run, you’re feeling great, but then you finish and realize you have symptoms. What does that feel like when you’ve waited for something for so long and it’s not at all what you expected?
Sadly, I know many moms who have experienced this. Mentally, it’s so challenging to dig yourself out of that hole.
The nice thing about undershooting our goal is you don’t even have to 100% clear the return to run screening, but we can still get an easy win by just getting out there. How much better is it to finish the run and feel good?
Each time out builds confidence and establishes the habit.
Even though these couch to 5k programs are starting with 5 minutes of run/ 5 minutes of walk, that can still be too much. If we undershoot the goal and take a slow progression, we can be back to full running within 5 weeks.
I KNOW it’s hard in the early stages postpartum and 5 weeks can seem like a lifetime, but in a few years looking back, it will barely be a blip on the timeline.
Undershoot your goals. Set yourself up for success, both mentally and physically. Let’s kick the Couch to 5k program to the curb.
We’re going to build CONFIDENCE with these early, easy wins.
A long time ago, breathing wasn’t even a conversation in the pelvic floor therapy game. Aside from relaxation breathing or the valsalva maneuver used in heavy lifting, we didn’t have conversations about any type of breathing in between.
We talk about breath in yoga, sometimes pilates. All of these breath cues are different and none of them are wrong!
Now, when we talk about breath and the postpartum pelvic floor, which of these is right?
Well, (and here comes everyone’s favorite answer), IT DEPENDS!
I use real-time ultrasound to look at the pelvic floor muscles and how they respond to different types of breathing. We can figure out what works for different people in different situations.
And sometimes, I can even tap into breath patterns from childhood. Did your patient play a wind instrument? Have them recall the mouth position they used for the flute or clarinet! Their body remembers!
Ask them if they sing! Where did they find that breath? That transfers over!
The third is what are you doing and what do you actually need? We can’t go around telling people they are breathing wrong because we don’t know their experience with breath. You might be treating a yogi who can get just as much activation on an inhale as an exhale.
We need context. What do they know? What experience do they have? What has worked in the past?
It’s my job to be an investigator. Real-time ultrasound allows me to give a cue and directly watch how the muscles respond to that cue.
With breath, we have to figure out what each person needs.
For those of you working with women, ask a few questions first to learn what they’ve been taught, what they’ve been using, anad what’s worked in the past.
If the breath strategy they’re using isn;t what you want to give them, BUT what they’re using isn’t causing problems, then DON’T WORRY ABOUT IT.
Focus on the changes you can make that will actually improve symptoms for your patient.
Where looking to find the breath that works for that person at that time. End of story.
Moms, were you ever told that your breath was wrong?
Pros, have you ever told anyone their breath was wrong?
Have you heard this gem before? “Oh, you have knee pain? Just stop running for two weeks and try again.”
One of my clients got this “solution” from her primary care doctor.
She went to them because she wanted to know if there was something structurally wrong with her knee. Because she went in with expectations of what she wanted from her provider, she was able to pivot away from the doctor’s solution and find her own.
When I first see new moms, I ask them
“What’s your reality compared to what you expected to happen?
What are you not doing that you thought you would be able to do?
What symptoms are you experiencing that you didn’t expect?”
I was talking with a mom who was used to doing 30-40 minutes yoga sessions and, for many reasons, hadn’t been able to get back to it. She could either keep banging her head against the wall and get frustrated when she didn’t get in her session OR she could aim for a different goal. She could choose to work on re-establishing the habit of getting on the mat by doing a quick 7 minute flow whenever the time became available.
I say this from experience, you can take the advice given but you have to frame it in the CONTEXT of your life.
No one has written a book about YOUR postpartum experience or YOUR kids.
There’s frustration in the fact that the plan isn’t laid out for you, but there’s also freedom in that blank page. YOU get to write your own story..
That can be very scary in the beginning. When you try to get that perfect thing in, you’re often setting yourself up to fail. Really it needs to start by figuring out what you can do to show up for yourself.
Do something that will fill up your cup and we can get to the rest later.
Moral of the story is when you’re working with a provider, take in the recommendations but make sure they fit the context of your life.
You’d think a Google search was a Google search, right?
I sure thought that, and I was SHOCKED when the same search terms pulled up COMPLETELY different results on two different devices.
In the course of preparing a presentation proposal, I decided to do a Google search for “returning to sport postpartum” to see what the average mom is finding when she is looking for advice.
And this led me down the Dr. Google rabbit hole. How are we vetting our resources? How do we get more clinicians paying attention to the literature. Who determines who is a clinical expert.
We need our researchers in this field to start gathering data that helps us triage care and differentiate between, say, an olympic level athlete and a mom who isn’t returning to a sport for her job.
Even evidence and research needs to be vetted. How many times have you heard someone say “Well, the research shows…” when you know damn well they’ve only read the abstract. Or even worse, they read it on a blog.
I hate to break it to you, but the full story isn’t in the abstract.
It’s really hard to be a consumer! As professionals, we do the best we can with the limited amount of research there is about returning to sport postpartum. We have diagnostic and screening tools, but those have mostly been pulled from other types of injuries.
There is something to be said for expert opinion, of course. I do things with my patients that the research simply hasn’t gotten around to yet. Or that a randomized control group study can’t replicate.
On the professional side, we need to be better at explaining what we are doing.
Moms, you need to be aware that the first thing that pops up in your google search may not be the right answer.
If you ever run across something that doesn’t sound quite right, send it to me in my DMs. And if I don’t know, I bet I know someone who does know.
This also comes into play when you are purchasing programs. You want to buy from someone who you like but is also providing sound information.
Moral of the story?
Vet your sources of information…Might want to skip Dr. Google for now