Weakness and Imbalance: Pelvic Floor Physical Therapy Appointment Recap
As many of you know postpartum journey back to running has had a few hiccups( You can read about that HERE and HERE). I returned to running too soon (3 weeks postpartum) and at the end of October thought I might have a prolapsed bladder. I took the entire month of November off and at my last post-partum appointment my midwife informed me that I did not have a prolapsed bladder (thank goodness) but did have general weakness and a slight prolapse of the uterus. Giving birth does a number on your body, even when it is a completely natural delivery with a relatively short labor (You can read about Jack's birth story HERE.) Though my midwife gave me permission to run again, she cautioned me against hard-effort training, saying that I needed more time to recover. I spent most of December easing back into running and focusing on strengthening my pelvic floor. (You can read about that HERE.) Last month, I did a good job of staying in tune with what my body needed. When my pelvic floor felt tired or weak, I eased off the running and took a few days off to cross train or ride a stationary bike. Most of my runs in December were around 2-3 miles with the exception of a couple four milers, and I just did back to back runs for the first time last week.
I've been cautious and careful. Which is why I made an appointment with a physical therapist who specializes in pelvic floor rehabilitation, Cristin Zaimes, DPT of Oceanside Physical Therapy in Stratham, NH. I wasn't referred to physical therapy by my midwife or PCP, instead I elected to go because I want to make sure that I am able to run issue free in the future. I had my first appointment last Saturday and I learned so much, not only about pelvic floor health in general, but also about some imbalances and weaknesses in my own body.
I've been pretty open about my postpartum journey and pelvic floor issues, in some cases it boarders on TMI. But there are so many women out there (as I am finding out through being open and honest) that have some sort of pelvic floor weakness or disfunction after giving birth. Which is why I want to be as detailed as possible in the way I share my story.
The Appointment: My appointment started with a general medical history review: How many pregnancies? What were your labors/deliveries like? Do you pee when you run? That kind of thing. Then an internal exam to asses the strength of my pelvic floor muscles. No internal exam is ever "fun," but this was probably the most interesting. During the internal exam I performed a series of kegel contractions so that Cristin, the physical therapist, could determine the strength of my muscles of my pelvic floor. She concluded that I was a) activating the correct muscles (great! it can be tough to perform a kegel contraction correctly); b) performing them with moderate strength (better than expected, they are still weak and stretched from giving birth); and c) had a significant weakness on my right side (not so good). The first two facts confirmed that performing the exercises on the Hab-It DVD were paying off, although still weak I was in "better shape than most," according to Cristin.
She took another look at my hip and pelvis while standing, stepping forward and squatting. Which further showed a weakness on my right side and in my lower back causing rotation in the hips. What is significant is that I've had issues with plantar fasciitis in my right foot. Cristin, noted that imbalances and weaknesses in the hips can often affect things down the line: knees, feet. Whether or not one has caused the other is a mute point, what's important is correcting the imbalance. Which starts with strengthening the transverse abdominals, the multifidi muscles, deep rotators, hip abductors and adductors.
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All of these muscles are an integral part of the pelvic floor "basket" and without learning to activate them, it is impossible to strengthen the pelvic floor optimally. You can find a great description of all the muscles and how they should work together HERE.
What it Means for My Running: During my appointment we discussed at length my running. Cristin was understanding of my desire to run and train for a marathon, "We need to find a way to support your goals," she said. I love healthcare providers understand runners. Going forward I'll continue to run and even intensify my training, with the guideline that when my pelvic floor feels "weak" or "tired" that I will rest and take time off. Which means running around four times a week. The longer I run, obviously the more stress on the pelvic floor. While running I am trying to focus on pulling my pelvic floor "up" and engaging the transverse abdominus and the multifidi muscles of my lower back. This consciousness has resulted in a more upright posture while I run. Cristin commented that as I work to correct the left/right strength imbalance in my hips I will begin to notice improvement in my running. I believe it. I different already. I feel stronger, I am more aware. Needless to stay I am working on an new training plan that I'll share later this week.
The appointment was incredibly helpful and informative. I learned so much about my own body and the affect of child birth on not just my pelvic floor muscles, but my hips, back and thighs. Carrying and delivering a child is a significant "trauma" to the body: there is an incredible amount of stretching that takes place, leading to weakness and laxity in muscles and connective tissue. It can take a while to recover, which is why it is so important to return to intense activity slowly. If you have recently had a baby or are expecting one in the near future I would highly recommend you speak with a physical therapist and discuss activities you can do to strengthen your pelvic floor.
Have you recently had a baby? What has your experience been returning to running postpartum? How aware are you of the strength of your pelvic floor?
--Sarah
I am not a licensed health care provider. The information in this post should not be taken as medical advice. If you have pelvic floor issues please consult your doctor.