Debra Goodman, MSPT

Postpartum rehabilitation is an aspect of prenatal care that is extremely neglected. It is generally something that is discussed briefly at best during routine pre/postnatal visits.  Women are rarely given any instruction on rehab exercises and tips for postpartum recovery.  Women are generally given vague instructions from their doctors and midwives to “take it easy” for six weeks when in fact, women should be doing gentle core stability exercises as soon as possible. Women are rarely referred to physical therapy for postpartum consultation.  Information following a cesarean section is no different. Little advice is offered on how to properly rehab their bodies even after this major abdominal surgery. The obstetric community has essentially overlooked an extremely important element in women’s prenatal/postpartum care. 

It is obvious to most fitness professionals, that following pregnancy, women are going to need some very specific nurturing and guidance to help them slowly and safely regain their strength as well as to deal with the physical demands of caring for a newborn. It is outside the scope of practice for doctors and midwives to understand all the orthopedic implications of pregnancy, birth, and the postpartum body. However, this population greatly needs this information and unfortunately only those women who seek it out will get it. Following a cesarean section surgery, women need postpartum rehab guidelines even more and they rarely receive it. The CDC has reported that in 2009, in the United States, 32.9% of pregnant women received a cesarean section which is an all-time high for this country. Therefore, many women are undergoing this surgery, and few are receiving good advice on rehab. Helping women strengthen after cesarean section requires a thorough understanding of how pregnancy impacts the musculoskeletal system, knowledge of the musculoskeletal rehab needs of postpartum women, as well as a basic understanding of what occurs during a cesarean section surgery. 

The Surgery

Below outlines the basic process of the cesarean section surgery birth:

1.  The surgeon makes a horizontal incision in the lower abdomen above the public bone through the abdominal fascia.

2. The abdominal muscles are separated along the midline and a vertical incision is made in the peritoneum.

3. The bladder is dissected from the uterus.

4. An incision is made in the uterus.

5. Fetal head is delivered through the uterine incision.

6. Placenta is delivered through the uterine incision.

7. The uterus is exteriorized (taken outside of the abdomen).

8. The uterus is checked carefully for debris often being turned inside out.

9. The uterus is sutured and returned to its position in the abdomen.

10. The peritoneum and abdominal muscles are sutured.

(Mothering Magazine, Sept-Oct 2007)

The surgery does not actually sever the abdominal muscles, but it creates a great deal of scar tissue, and the scar tissue can create problems if it is not mobilized properly. In orthopedics, the benefits of early scar mobilization are well known in preventing adhesions, expediting healing, and restoring normal biomechanics. The obstetric community does not seem to understand the importance of scar mobility work, and the majority of women never get any information on how to massage their scars. In fact, most obstetric practitioners evaluate whether a scar has healed “well” by the outward appearance of the scar. It is highly unusual for an OB provider to actually touch the scar after it has healed to assess for tenderness, restriction, or skin mobility.  The problems from the scar tissue can present in a multitude of different ways. Below is a list of different symptoms that women will complain about that may point to a scar tissue cause:

1.    Pain or tenderness with palpation of the scar

2.    Pain or tenderness with abdominal muscle activation

3.    Decreased or abnormal sensation in the lower abdomen

4.    Abdominal muscle weakness that does not improve with strengthening

5.    Stiffness of the skin and muscles near the scar

6.    Vaginal pain including pain with intercourse

9.    Abdominal pain

10.  Hip pain

11.  Headaches (occurring years later)

12.  Global myofascial pain (occurring years later)

In the orthopedic field, after a patient has an orthopedic surgery of any kind, they are often referred to physical therapy where they are initially given gentle strengthening and stretching exercises, and they are typically taught scar mobility techniques to practice on a regular basis.   It is common knowledge now that early intervention following a surgery results in a faster recovery. This means that doing gentle exercises to strengthen the muscles and working on scar mobility as the body is healing generally results in a faster and easier recovery. Post c-section patients are rarely if ever referred for physical therapy, and most women are often afraid to touch the scar. 

This is where Pilates instructors can be very helpful to this population. It is important to inform women about the importance of scar mobilization as they are working on regaining their strength as well as to find resources where women can seek treatment for the scar from an experienced physical therapist or massage therapist trained in scar tissue mobilization.  Below are some simple ways that women can work on their scars at home:

 1. Scar work can begin as soon as the scar is fully healed. Sometimes the scar can be extremely sensitive and some women initially are afraid to touch the scar. Women can begin by applying a heating pad for 10-15 minutes and then gently placing their hands on the scar and applying gentle pressure. Just touching the scar can help to desensitize it. Then she can work up to a light stroking motion. If the scar is very sensitive, women may have to work up to applying a deeper pressure or she may need help from a therapist trained in scar work if she feels unable to get past the extreme sensitivity on her own.

2. Once women are comfortable touching the scar, then deeper pressure can be applied. Women can apply lotion if desired and massage across the length of the scar from right to left and then from left to right. Women should press into the scar and work on softening thickened areas. Many scars often feel like a very thick strand of bumpy spaghetti. Over time, the scar should change to where it feels like regular skin. It should be able to slide and glide in all directions over the underlying muscles. It should not pucker inwards or “bunch up” as pressure is applied.

3. Women can also practice picking up the scar. The scar should eventually be mobile enough that the scar be pinched and lifted up.

4. Any touching of the scar is good touch. Even if women are not doing a “perfect,” professional scar massage, any manipulation done is helpful. Women do not need to be concerned about doing the massage perfectly. Any nurturing and attention directed to the scar will be beneficial.

5. It is normal to feel sore during and after scar mobility work. Heat is helpful to apply prior to scar massage, and ice may be helpful to apply after scar work.

 Abdominal Muscles

Aside from scar work, post c-section women should begin gentle abdominal strengthening as soon as possible.  The focus should be transversus abdominus contractions and pelvic tilts.  Diastasis recti precautions are still in place in the early postpartum phase, so women should not be doing aggressive rectus abdominus exercises that involve lifting head and shoulders or double legs from a supine position.  Initially women should be focusing on gentle core stability exercises and slowly increasing the exercise load and intensity over the course of the first postpartum year. Following a c-section, activation of the abdominal muscles may be uncomfortable or sore which makes women afraid to contract their abdominal muscles.  However, women greatly benefit by strengthening the abdominal muscles because it helps increase circulation around the wound which promotes healing, and activation of the abdominal muscles pulls through the scar which helps the scar heal with more mobility. Of course, abdominal strengthening also helps women begin the process of shortening the over-lengthened abdominal muscles and contributes to restoration of proper posture. 

Below are examples of excellent postpartum abdominal exercises:

Seated Transverse Abdominal Exercises:

—Seated with body weight centered over pelvis, shoulders back, place hands over belly

• 30 Second Hold: Begin with a diaphragmatic/belly breath, then exhale and contract abdominals by drawing the belly button all the way to the spine.  Imagine you are touching the spine with the belly button.  Hold it here counting out loud for 30 counts.  Recommended: 5 sets per day.
• Repeating Transverse: Same position as above.  This exercise is a pulsed contraction.  Begin exercise with a diaphragmatic/belly breath, then exhale and draw abdominals to the spine. This is the starting position. Hold this contraction for a count, and then release the muscles half way out.  Repeat this back and forth motion. Count out loud for 50 repetitions.  Recommended: 2 sets of 50 reps per day.

****These exercises may also be performed on hands & knees.

       Supine Abdominal Exercise

• Pelvic Tilts: Lying on back, knees bent, small space under lower back (neutral spine).  Begin with a diaphragmatic/belly breath and exhale while drawing the belly button to the spine. Next, engage the lower rectus and obliques and visualize the distance from the pubic bone to belly button shortening and the belly hollowing.  The pelvis will gently rock back towards the floor (posterior tilt).  The abdominals will be scooping backwards. Recommended: 1 set of 10 reps per day

***Can also be performed on hands & knees

Kegels (Pelvic floor contractions)

Imagine you are pulling your pubic bone toward your tailbone shortening the distance between the two bones.

Imagine you are drawing your ischial tuberosities and your pubic bone together.

Remember to relax the pelvic floor completely after the exercise!

Build up to 10 second contractions, 5-10 reps daily

Quick flicks—squeeze and release quickly, 10 reps daily

Pilates instructors are in a great position to educate women about all the possibilities for postpartum healing.  Passing on this information helps to empower women and teaches them the importance of postpartum rehabilitation.  Women will be extremely grateful for this knowledge.

More About Debra
Debra Goodman MSPT, is a licensed manual physical therapist with specialties in women’s health, dance medicine and sports medicine. She has been a physical therapist for Westside Dance Physical Therapy, New York City Ballet and the School of American Ballet. Debbi also had a women’s health/orthopedic-focused private practice in New York City. She now practices in Albany, where she’s lived since 2004. She is one of the few physical therapists trained in internal evaluation and treatment of the pelvic floor muscles. She is skilled in the treatment of pregnancy and postpartum problems including chronic pain, sciatica, cesarean-section recovery, urinary incontinence, and post-delivery scars. Debra is a Pilates instructor and part of the continuing education faculty for Kinected and The Kane School of Core Integration in New York City.

Pilates-Pro wants you to be healthy before you step onto the mat. That’s why we have another article on eating healthy (and colorful) meals.  Enjoy!

It can be hard to maintain a healthy diet. Counting calories, deciphering ingredients – it can all get overwhelming. Well, forget that. We want to share one of the most basic ways to determine a healthy meal – just use your eyes.

See, the natural pigments that give foods like fruits and vegetables their color also have beneficial nutritional properties. By including foods in a variety of colors, you can add nutrition and vitality to any meal. We want you to literally eat a rainbow every day!

So why is it important to eat a rainbow and not just your favorite fruit or veggie? Well, a study in the medical journal, Nutrition states that the variety of vitamins and antioxidants absorbed from a range of sources can, even in small amounts, provide greater health benefits than consuming only a few types of vegetables in large quantities. Here are some good places to start:

Red. Colored by lycopene, red foods like cherries, beets, grapefruit, watermelon and even red potatoes and wine help reduce risk of several types of cancer, including prostate cancer. 

Orange. Colored by carotenoids, foods like mangos, persimmons, apricots, yellow apples and sweet corn are vital to healthy eye sight and may reduce the risk of heart related diseases.

Green foods are colored by chlorophyll and lutein. Honeydew melon, onions, limes, kiwi and avocado can all help protect against cancer, fight cataracts and reduce the risk of birth defects due to the high amounts of folate often found in green veggies.

Blue foods like plums, eggplant, juneberries and raisins are colored by the pigment anthocyanin which is a powerful antioxidant helping to protect cells against damage and improve memory all while fighting against strokes and many forms of cancer.

So, now that you know the benefits – why not show us your plate? We want to see pictures of your favorite, colorful meals. Post pictures and recipes on Facebook and Twitter, join the conversation by liking us and participate to win prizes. What foods help you get through your workout?

The winners are in for the About.com Reader’s Choice Awards 2011! Thanks to thousands of votes, we know the best of the best according to the members of the Pilates community.

Best Pilates DVD

Kick Abs Pilates Workout by Virginia Nicholas

From what I hear, this is a great DVD. It is always nice to try something new. I can’t wait to get my copy.

Click here to purchase yours!

https://clients.mindbodyonline.com/ASP/home.asp?studioid=6377

Best Workout Clothes

Lululemon

No surprise here! Lululemon has quality clothing that lasts even through the washing machine. I am a big fan of the Groove Pant. They are so comfortable and have colors that pop! You will love showing them off when you are doing Spine Stretch Forward and Saw!

http://www.lululemon.com/

Best Pilates Reformer

The Studio Reformer from Balanced Body

I have worked out on this Balance Body Reformer before and it has never let me down. The carriage is lightweight but stable. I always feel safe even when I am struggling to reach the end of my work out!

http://www.pilates.com/BBAPP/V/store/reformers/pilates-studio-reformer.html

Pilates-Pro encourages everyone to try new products and let us know what you think. Do you have the next best thing for Pilates?

March is Nutrition Month. That means Pilates-Pro will be highlighting several super-foods throughout the coming weeks – foods that truly need to be a part of any healthy diet. Along the way, we’ll be offering some helpful tips and recipes making it easy to add a nutrition spike to any one of your daily dishes.

Pilates-Pro is back with another super-food, and it’s a sweet one. Now, before you get excited that we’re going to reveal the health benefits of cupcakes, we want to make it clear that this one is tasty in a different way – were talking sweet potatoes.

Although many of us picture sweet potatoes as a Thanksgiving Day food, they can actually be found year-round and are best during the spring and summer months. Aside from being easy to find and cheap, Sweet potatoes (or yams) are literally a powerhouse of nutrients and a great way to enhance any meal with few added calories.

A medium-sized sweet potato often contains more than your daily required intake of vitamin A, nearly a third the Vitamin C we all need every day and almost 15 percent of your daily dietary fiber intake.  All this from just a simple side dish low on the glycemic index!

So – we all know you can just pop a potato in the oven or microwave for a simple and fast baked side, but we’re talking about super-foods here. We want to mix things up and really explore great ways to add health to our diets without being boring. Here are some great places to start:

How about Sweet Potatoes with Warm Black Bean Salad to start? Microwave your yams covered in plastic wrap for 10-15 minutes until tender (or bake in a 425 degree oven for about an hour). Then, mix black beans with some fresh diced tomato, olive oil, cumin and cilantro in a bowl. Microwave or simmer this mixture until warm and spoon on top of your halved potato with some low-fat sour cream. The cumin adds tons of flavor while helping aid in digestion. You can find a more detailed recipe here.

Or, if you’re looking to have some more fun, try Spicy Baked Sweet Potato Fries. Slice your potatoes into fries. Then, place them in a zip-top bag with some canola oil, cayenne pepper and pre-packaged taco seasoning. Shake the mixture and spread it onto a baking sheet. Bake for 30 minutes in a 425 degree oven and done! It’s a perfect side for those spring-time and summer barbeques. Find the full recipe here.

There are so many ways to add this super-food to any meal – why not take some time and discover some recipes of your own? If you’ve got any you’d like to share, we want to hear them! Join the conversation by leaving a comment or by adding your thoughts on Facebook and Twitter.

This is the first year that Pilates at About.com has participated in the About.com Readers’ Choice Awards and Pilates-Pro couldn’t be happier. The Readers’ Choice Awards program encompasses categories from technology and sports to health and hobbies. In Pilates, there were three types of products that could be nominated for awards: Best Pilates DVD, Best Pilates Reformer, and Best Brand of Workout Clothes. We know how important it is for the people actually using Pilates tools to review and recommend what think are the best right now.

Voting end tomorrow March 8, so make your voice heard. The winners will be announced on March 15. Here are the categories and nominees.

Best Pilates DVD

Kick Abs Pilates Workout-Virginia Nicholas

Pilates Playground DVD-Nico Gonzales

Pilates Power Ball Sculpt-Bernadette Giorgi

Rael Pilates System 17-Rael Isacowitz

Winsor Pilates Slimming Pilates-Mari Winsor

Vote for Best Pilates DVD

Best Pilates Reformer

The Allegro Reformer by Balanced Body

The Classical Reformer by Gratz Pilates

The Studio Reformer by Balanced Body

Vote for Best Pilates Reformer

Best Brand of Workout Clothes

Lucy

Lululemon

Gaiam

Vote for Best Brand of Workout Clothes

What are your picks? Was something left out? Pilates-Pro wants to know what you think.

March is Nutrition Month and Pilates-Pro wants you to be the know about more than just Pilates. We’ll be highlighting several super-foods throughout the coming weeks – foods that truly need to be a part of any healthy diet. Along the way, we’ll be offering some helpful tips and recipes making it easy to add a nutrition spike to any one of your daily dishes. Next time your clients ask you about nutritional advice, tell them about super-foods!

 Today’s super-food is an old – but underappreciated – standby: Yogurt.

Yogurt is loaded with vitamins like potassium, phosphorous, riboflavin, iodine, zinc and vitamin B5 just to name a few.  And, aside from being a virtual powerhouse of vitamins, yogurt also contains healthy fats, protein and probiotics – an organism that serves as support to the groups of constructive bacteria in your body – helping boost your immune system and even providing protection against cancer.

The good news is yogurt doesn’t have to be reserved as a breakfast or snack food anymore. Here are two ways you can incorporate yogurt into any meal. Hey, one is even kid friendly and guaranteed to have them asking for more.

Tzatziki Sauce. Although hard to read, Tzatziki is a delicious cucumber and yogurt sauce commonly found in Greek dishes. It goes perfectly with chicken or vegetables and can easily be used as a dip or sandwich spread in place of mayo.

Just mix drained Greek yogurt with pureed cucumber, garlic, lemon juice and dill and you’re done! You can find a more detailed recipe with step-by-step directions here. 

Yogurt Popsicles. This fun dessert is a great way to get kids to enjoy the all benefits of yogurt or just quell that sweet-tooth craving after a healthy meal. 

Start off by taking your favorite yogurt (flavored or plain) and mixing in some honey or Agave nectar as a natural sweetener. Then, mix in some fresh or frozen berries of your choice. Place the mix into a popsicle mold with a tongue depressor for a handle. If you don’t have a mold, try using an ice cube tray or plastic cup with tooth picks for the handle.

Then, just pop it in the freezer and a few hours later you have a healthy, vitamin packed dessert.

Yogurt truly is a super-food and one we hope you can make a little more room for in your daily diet. If you have any tips or recipes for yogurt-based foods, be sure to share them. We want to hear from you!

Pilates Day is only two months away (May 7th) and we all need to get into tabletop and start pumping! Pilates Day serves as an opportunity to bring the benefits of Pilates to the masses. It is only a matter of time before everyone is practicing Pilates. Wouldn’t you like to say you played a role in bringing Pilates to your community? Now is your chance.

What is Pilates Day?

Pilates Day is an annual community event celebrated on the first Saturday of May throughout the world. The focus of Pilates Day is to cultivate awareness about the Pilates Method. This is achieved through Pilates events that are made accessible and affordable to local communities. These events most often include free Pilates Mat classes.  Pilates Day is a program of the Pilates Method Alliance (PMA) and events are produced and hosted by PMA members.

Free Pilates?! Is This Good for Business? Yes!

A free day of Pilates may seem like a strange idea but the benefits are many.

By hosting a Pilates Day event, you will build goodwill within your community, create networking opportunities, be part of a formally organized, international celebration and as a result gain new clients. What’s better than that?

Offering free classes is a great way to introduce your community to Pilates and gain publicity through your event. Once people are in the door, you can demonstrate the benefits of Pilates and the other offerings at your studio.  This is a great time to up sell new and current clients.

The PMA makes hosting a Pilates Day event easy. As a PMA member you will have access to their electronic Pilates Day Kit™. The kit includes artwork for marketing collateral, the PMA Pilates Day logo, sample advertisements, press releases, production time lines and the resources for production. The kit allows you to participate whole heartily without the worry of “Am I doing it right?”

What Will You Offer on Pilates Day?

The possibilities are endless when it comes to hosting your Pilates Day event. This is your time to show why your studio is the best place to practice Pilates. Here are just a few ideas:

• Partner with your local community center and invite the different groups there to take a break from their regular activities and try a Pilates class.
• Reach out to special interest groups such a Senior Citizens, Teens, Surfers, Musicians, you name it! Whoever makes up your community! Everyone can benefit from the core building and mental focus that Pilates provides.
• Do you have access to a local park? Host a Paw-lates class! Encourage dog lovers to try a Pilates class with their pet. And of course, invite attendees to check out your studio when Fido is at home.
• Generate sales on Pilates Day by offering special discounts that day only. It worked for APOGEE Pilates & Wellness Centers in Westchester, NY! Attractive offers are hard to pass up. By showing the value of Pilates with a free class, the discounted offer is sure to bring in sales.
• Provide attendees with a small gift bag including a free pass to come back to your studio.
• Hold a raffle for attendees to enter for a special prize featuring private Pilates training or other studio offerings. If you offer massage, a Workout and Relax prize would be a great option.

What will your event look like? Here are pictures from last year’s Pilates Day. http://www.pilatesmethodalliance.org/mc/page.do?sitePageId=115966

Here at Pilates-Pro, we are committed to provide the tools for success in the Pilates Industry. We hope to inspire you to bring Pilates to your part of the world.  

To join the PMA, click here: http://www.pilatesmethodalliance.org/mc/page.do?sitePageId=112962

Already a PMA member? Sign up to host a Pilates Day event by clicking here: https://web.memberclicks.com/mc/quickForm/viewForm.do?orgId=pima&formId=76327

As the winter chill eases, there is a sense of renewal that sets in with spring. A time for new beginnings is upon us and Pilates-Pro is your partner. This month we will be posting articles about ways to wake up your business. Look for ideas on hosting Pilates Day, partnering with local businesses, and insight from a master trainer and industry leaders.  

May these articles serve as seeds to help “sprout” new clients for you.

Happy Spring!

Register for the APOGEE 360 Fitness Conference in the next 24 hours for a chance to win a free APOGEE 360° Conference Registration. The promotion is open to the first 50 registrations.

Visit https://www.apogeewellness360.com/ for more information.