Tag Archives: pain prevention

What I Learned About the Body…after I got hit by a car (Part 2)

If you’re joining the story now, please feel free to read the first part of it: http://bit.ly/1Leo8Fp

These are lessons that I have learned the hard way and that I’m here to share.  

 car accident 4

 

Lesson #5: Don’t give up on finding the right care from the right professional

It can be incredibly difficult to navigate the confusing network of health professionals. So many people get lost when they try to figure out if they should seek treatment options from general practitioners, massage therapists, physical therapists, acupuncture specialists, chiropractic doctors, nutritionists, personal trainers, psychologists, and more. One common question is: “Should I try one at a time or opt for multiple forms of treatment at once?” This is a tricky question to answer because it’s very different for each and every person, according to their condition and stage of healing.

For me, I’ve tried it all. Literally. I sought out acupuncture and cupping techniques with one specialist, cognitive therapy for post-traumatic stress with another, chiropractic adjustments with two doctors, physical therapy with five different professionals, and massage therapies from an uncountable number of nimble-fingered individuals. This is not even an exhaustive list of the professionals I worked with while trying to recover from my accident. The reason I kept trying different things is because every person gave me a different opinion. I would give heed to their opinion and try their approach for a while and if it wasn’t working out, then I moved on to the next.

Although I had moments when tears of frustration would roll down my face, feeling like I had set out on a fruitless treasure hunt, I just knew that I had to keep trying. What on earth would happen if I gave up?!  Thus, the years stretched on, but ironically, I started to learn so much more than I bargained for. I began to learn how to heal other people who were dealing with back pain. In the time that it took me to heal my own, I helped over a dozen people quickly dissolve their issues. Perhaps, I thought, those seemingly pointless efforts with other health professionals weren’t such a waste of time after all!

In the end, I’ve learned that different stages of healing may require different forms of assistance. For example, there was a time when the most important thing for me to do was heal emotionally. Once I was calmer, I began to believe in the physical healing process again. Once I rebooted that journey, I found that needling in physical therapy worked for a while, to bring flexibility back to stiff muscles that had been stuck in spasm. At another point, I found that my muscles were flexible enough to allow my back to get adjusted into alignment by a chiropractor. And finally, I found that my body was getting better and better at keeping me in alignment all on its own, thanks to being able to increase strength training again.

car accident 5

This long, drawn-out process is just my story. (Believe it or not, we barely scratched the surface.) It doesn’t have to be so convoluted for everyone. What’s important is that you keep looking for the right help. Once you’ve found a great professional, give them time to really impact your body with their treatment/approach. Full healing won’t happen overnight so try not to leave after your first session expecting the process to be done.

Lastly on this subject, although I’m preaching to give practitioners time and patience, it’s also important to recognize and get out of a bad situation. One chiropractor I used to work with actually had the audacity to tell me not to gain weight, citing that it wouldn’t be attractive to men. It was so out of the blue (not to mention UNCALLED FOR) that it completely took me aback. I told the chauvinist straight to his face that he was lucky he said that to me and not another woman because I wouldn’t sue the pants off of him for harassment. This was not the first comment of his that was inappropriate. I walked out of his clinic that day and never turned back. There is nothing more damaging than someone who is supposed to heal you trying to tear you down instead. I deserved better. You deserve better.

 

Lesson #6: Inflammation does weird things to the body

Yes, it’s true. When inflammation is high, your body reacts in strange and confusing ways. For example, I already mentioned to you that my body gained a lot of weight during this time. Part of this weight gain was my body hoarding fat because it was scared for its life (rightfully so). Another part of the weight gain was because of excessive water retention. My body couldn’t figure out how to flush anything through its system because it was so backed up and slowed down by all the stresses it was trying to combat.

I can remember one evening when I was with a group of friends, and the guy I liked at the time, at a bar. I drank a cocktail and it sent me over the edge. I felt sick and got an intense menopausal-like hot flash. I couldn’t understand what was going on with my body. All I knew was that I needed to cool down FAST. I was profusely sweating through my dress. I told my friends that I needed to go to the bathroom but instead, I snuck around the bar counter and flung open a beer fridge’s door. If I could have squeezed my whole body into that cool little space I would have. I was desperate.

I understand now that when the body is severely inflamed, even simple things like eating a food that you are sensitive to, or drinking an alcoholic beverage, can tip you into unpredictable states of discomfort. I wish I could say exactly what happens to each person in every scenario known to man, but I can’t. I can only say that keeping attuned to your healthy – or unhealthy – habits is more important than ever. Pay attention to how your body is reacting. It’s a powerful experience to realize just how prepared our bodies are to defend themselves. It physically feels like a bad thing, but it’s actually a good thing in the end.

There was another time that I experienced something really bizarre, that I think may have been related to inflammation too. It happened to me was about a year after the accident. I went for a jog on a treadmill one afternoon. It felt good. Later that day, I had red spots all over my legs. I couldn’t tell if they were burst blood capillaries, an allergic reaction, or what! Even doctors weren’t sure. It was terrifying.

I’m still not sure what the red spots were from but I have my suspicions. I was hyped up on Ambien every night, to help with my insomnia, and I took pain killers from time to time, when my pain got really bad. In other words, my body was dealing with a lot of foreign substances. It seemed that anything wacky was game to happen.

Since I noticed that my body was obviously NOT okay with me putting anything foreign or toxic into it, I started to strip down my diet and reduce medications. I was extra careful about everything I put into my body. Over time, eating clean and being cautious about medicines really helped me. I think the crazy bodily dysfunctions were its way of telling me to stop putting foreign substances into it, and to let it do what the human body is best at: take care of me.

car accident 1

 Pictures on top = post-exercise red spots.

Pictures below = marks from cupping treatments I did for a while…definitely not ideal during sundress season. 

 

Lesson #7: If your spirit is defeated, your body is defeated

A few months after my accident my cousin visited. She was excited to see Washington, DC and at the time, I lived smack dab in the center of “the action.” She was in my bathroom, showering and primping to get ready for a fun girls’ night out, while I was in my bed, head spinning and body screaming for more sleep. She came into the room and asked if I was feeling okay. The only thing I could say was “I feel like I want to go to sleep and never wake up again.”

She was in obvious shock at my statement and shared her concern. I had to explain to her that I wasn’t suicidal; I just didn’t want to keep fighting. I was spent! My comment just felt like the most natural statement I could make at the moment.

This feeling of burnout lasted for a while. I made many careless mistakes during that time in my life. I went out partying, initiated arguments with my family over nothing, and showed interest in “bad boys” when I had forever favored mamas’ boys. It wasn’t until I started to put more effort into finding peace within myself and with God that I got back on track.

I decided to initiate this process by taking a month off of work. I spent lots of time soul-searching in coffee shops and wrote a book that reconnected me to my faith. As I wrote, I started to realize that I wasn’t alone. I could stop feeling so afraid. I can still remember the day that I fell down to my knees in my shower – it hit me out of nowhere that God had been there for me the whole time, even when I had forgotten and lost my way. I began to understand how to replenish my spirit and thereby discovered energy to move forward and physically heal.

 

Lesson #8: The universe has a wonderful way of bringing the right people your way during times of need

I wonder if I would still be married to my husband if I hadn’t been hit by that car. I know it sounds crazy but it’s true! I met my husband during my “bad boy” streak and he was the farthest thing from dismissive, rude and reckless. He was compassionate and full of life. Although I tried to shrug him off, his persistence and light kept me tethered. Although I didn’t feel attractive or worthy at that time, he saw every good thing about me even though I was focused so exclusively on the bad.

I remember the night that we met. We ended up dancing for hours. Dancing became our favorite thing to do during the first few months of knowing one another. It felt great. We would find places to dance in the city and would continue dancing in our living rooms. Wherever we were, we found a way to celebrate and have fun. It was the most refreshing experience ever.

I really do believe that he was sent into my life at the exact right time. He helped show me that healing was possible and that there is much to be excited about, even when you’re not feeling physically great. I would briefly forget about my pain while I was having fun and laughing with him. Soon, the bouts of pain became less frequent and less severe. Eventually, I would go an entire 24 hours without severe pain. Even when pain did hit me with a vengeance, I found new ways to stay calm because I realized that someday I would get over it completely. Everything was going to be okay.

0376-Maggie_and_Casey

 

Lesson #9: Moments of weakness and frustration are not signs that you’re failing to heal

I wish I could say that healing is a linear process but alas, I can’t do that. I had many hang-ups and pitfalls along the way. Sometimes I would feel gently defeated and other times I would feel like an utter failure, but I learned to get over those negative mentalities. I learned to get stronger each and every time.

Simple moments challenged me, like when I slipped on ice during the winter and my back went into a brief spasm, and when friends would ask me to go to tough exercise classes with them and I would have to say no even though I had formerly always said yes. There were other more profound moments that set back my body and spirits too. For example, one mid-summer day I collapsed in my apartment building’s elevator. I had been carrying heavy groceries because I was planning to spend the whole day cooking for family. It was a quiet hour in the middle of the day so no one was around to help me. I crawled, dragging my groceries along the floor. I tried to stand up but keeled over again. I kept trying to get back on my feet but I collapsed another two times as I made my way down the hallway to my apartment. Once inside, I cried until I was too tired to cry more.

Although moments like this have the power to defeat you, they aren’t a sign that you haven’t made progress. Every time I would reignite the pain, I would get over it a little faster than before. Each time, I learned something valuable.

 

Lesson #10: Learning to let go is the final step

Has my body reached pre-trauma condition? Honestly…no. But, have I fully recovered? Yes. Let me explain…

Up until a few short years ago, I still had to put a heating pack on my back a few times every month. I would also occasionally have a sleepless night or two when my nerves would get set off and I’d fear falling back into insomnia. To this day, my back and hips have remained a little more sensitive and prone to instability. I keep it under control though.

My heart will always feel a little bit sad when I think of how dark some of those days of pain were but I also know that they taught me a lot. I decided years ago that I would be okay and my body has followed me in that decision. I’ve learned exactly what to do in 15-20 minutes to immediately correct a flare-up that would formerly last for months. I’ve also learned that I’m capable of surviving one of the worst kinds of pain in the world – the loss of self-identity. If I can rediscover myself and come out stronger, I know that you can too.

Recovery is possible when we decide to let go of hurt and move on. It’s a single, simple, profound decision [to let go] that one has to consistently choose, every day and during every moment of frustration. It’s a decision that is made in the midst of pain that can pull you through to the other side.

I believe that the power of letting go can have a meaningful impact in anyone’s life. I encourage you to give it a try.

 

I sincerely hope that sharing this authentic story will help someone else

find healing and joy soon too.

“Start believing you can.”

Maggie

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What I Learned About the Body…after I got hit by a car (Part 1)

Six years ago, from the day of this article’s publication (05/18/2015), my world literally turned upside down. While riding my bike to work, I was hit by a car at a busy intersection located in the heart of Washington, DC.

car accident 3

I immediately felt sharp pain in my back after plunging to the pavement in the middle of Florida Avenue. At that moment, a startling thought crossed through my mind, one that concerned me far more than the physical agony; Am I about to become roadkill?! I couldn’t move for a minute. My breath had been taken away. I couldn’t pick myself up to get out of the intersection. I couldn’t even wave my hands for help. All I could do was focus on trying to stay conscious in spite of bolts of pain through my hips and back. Thankfully, no other car ran an additional 4,500 lbs of steel and aluminum alloy into my 130 lb body.

The EMTs arrived quickly on the scene. They gave me a disapproving look when I waved them briefly away in order to call my work to say that I couldn’t teach my “Cycle and Core” class that morning. After placing the call, I let the EMTs strap me down to a spine board and make their assessments. I recall laughing with pride at how my blood pressure was still fairly stable, just minutes following a trauma. Only a crazy fitness professional would be proud of something like that. My amusement was quickly snuffed out though, thanks to escalating pain.

While on the way to the hospital, one husky, dark-and-dreamy man asked me several times to rank my pain on a scale of 1-10. I kept thinking, well, if you’d just let me off this stupid spine board then it would be a whole lot better. But, I couldn’t be let off that cursed board. It was protocol for the ambulance ride. So, my response was consistently and emphatically, “TEN!!!!!!”

…….

The pain didn’t stay at its initial 10 forever but it did continue. It troubled my health, threatened my career, and haunted my psyche for the next five years. It had such a palpable presence in my life that it felt like the pain was on the verge of scraping itself out of my body and becoming its own entity; an embodiment that could more properly pound the shell of my formerly strong self deeper into the unforgiving ground. It was the cruelest “thing” I’ve ever met – hell bent on squeezing every last ounce of hope and perseverance from my body.

But, I’m here today to tell you that the pain didn’t win. I did. I won thanks to the lessons I learned along the healing journey. The trying times taught me how to interpret the language of pain and how to affect physical well-being through a multi-pronged approach to healthy living.

It was a long process, let me tell you. But, the silver lining is that I get to share the things I’ve learned with others. I hope that lessons from my journey can help you with yours. I pray that they shed light on your pain or even personal challenges.

We all go through pain at some point in our life. The process of picking ourselves up again is not always pretty. But, it’s important that we try. And try again. And again. And again.

 

Lesson #1: The first serious pain you experience is always the hardest…but it has the potential to be the one of the most meaningful experiences in your life

Before getting hit by a car, I had literally never broken, sprained or strained any part of my body. One time, when I was 5 years old, I was ambitiously trying to follow a friend across the monkey bars, swinging and stretching each arm to skip every other bar. It was the cool thing to do. I missed one bar mid-way across and landed in a precarious position on the ground, one arm twisted behind my back with my little body’s weight crushing it. Even then, I didn’t actually break anything; I bent my arm bone!

I assumed that injuring my arm would mean getting a cast with my kindergarten classmates’ sympathies strewn all over it, smiley faces, hearts and rainbows. I was miffed by the removable brace that I was given to wear. No cast tic-tac-toe? No purple marker heart encircled by stars?

Similarly, after getting hit by the car, I was certain that the pain I was experiencing would reveal itself on X-rays. It didn’t though. No fractures in my pelvis, no hairline fractures upon my follow-up appointment, nothing! Just one enormous, dark-as-night bruise taking up 75% of the real estate on the left cheek of my rear end. I will spare you those gruesome pictures…but below you can take a glimpse at some other ones. My face is the thing behind the purple wash cloth and ice…in case you were wondering.  

car accident 2

It was so frustrating for me to be told that nothing major was wrong because I could tell that something was actually very out-of-sorts in my body. It made it difficult to justify to my co-workers and friends that I was decidedly NOT okay. I was in pain for a long time. I just couldn’t pin a clinical name and prognosis to the discomfort. I didn’t have something like a cast as proof.

Unfortunately, because my pain lacked a “title,” I thought that all I needed to do was take the pain killers and muscle relaxants that I had been prescribed, and wait it out. The doctors at the hospital didn’t recommend physical therapy, so why would I need it? They didn’t say anything about psychological help, so why would I assume that counseling for post-traumatic stress should be considered? I could deal with it all on my own, right?! Wrong.

The first serious injury you experience is scary and overwhelming. You may even be in a situation like mine, with a lot of unanswered questions and mixed information coming at you. You may even have feelings that getting over the injury is your sole responsibility and burden to bear – but that is just false, false, false!

There is a reason that children color “get well” messages on a friend’s cast; it’s important not to feel alone as you undergo the process of healing. Finding the right support networks as you navigate the journey is essential because feeling confused and afraid is normal. Lean on everyone you can the first time around because how you respond to this injury will impact your mentality the next time you encounter pain or hurt. It can either cripple you or cause you to take a step back and calmly evaluate your plan to get over it.

It’s interesting…the first time that you’re injured, you’re in a position to learn and grow. For example, if a woman (let’s call her Angela) sprains her ankle and has to avoid her favorite sport, running, for 8 or more weeks, then she is likely going to feel frustrated and maybe even depressed. Instead of giving in to these defeated feelings, Angela can come out of her injury stronger than ever by remaining mentally patient, emotionally calm, and focused on things that she can control. She may decide to cook more healthy meals at home or spend time with friends whom she usually brushes off in order to exercise. If Angela does want to keep exercising rigorously then she can devote effort to building upper body strength so that she looks incredible come strapless dress season!

The options are endless, not ending, when you get injured and have to look at the world from a new perspective. It takes time to see things this way, but it can happen.

 

Lesson #2: It’s OK to take a little time to grieve

Okay, I know I just mentioned that learning from your injury helps you become stronger and move on. But, I know that it’s also important to grieve, to give yourself time to be frustrated and feel that the world crashing around you. If you don’t do it initially, you may have a surprise meltdown far later in life when buried emotions get unearthed. I wish I had listened to this advice. Instead, this is what I did…

car accident 6

Chick in picture looking lovely since this “accident” was merely staged for stock photography. Disclaimer: The real deal is NOT this tidy and attractive!

Once I was released from the hospital, I got a ride home from a cop. After she dropped me off, I took a nap on my couch and then hobbled down the block to the pharmacy for my pain killer and muscle relaxant prescriptions. Moving felt terrible but I took it as a positive sign that I was capable of putting one foot in front of the other. This meant that I could get back to my job, right?

The day of my accident I had 11 hours of work on my schedule. I was terrified of losing income and damaging accountability with my clients. Most of this fear stemmed from the fact that it was the spring of 2009, not long after the major U.S. economic crash. I was in a hustle mentality, happy to have a secure job and determined to pack my work days with exercise classes to teach and clients to train. I was exceptionally exhausted and simultaneously exhilarated from my one-woman daily mission to change the world in spite of the most obvious obstacle: people were tightening their purse strings because they were afraid they would lose money or already had lost money in the crash.

So, ignoring my exhausted body’s protests, I went in to train the last few hours of clients I had on schedule for that evening. I was delirious and in denial. I laughed off others’ concerns about the “crazy accident” that happened earlier that day. Needless to say, nothing about it was funny.   

I wonder, if I hadn’t been so naïve and if proper discharge procedures had been in place, would I have stayed home and gotten the appropriate rest and recovery that I needed? If I had gotten that rest, would I have continued to deal with severe pain, bulging discs, spinal disc fissures, hip instability, and dysfunctional scar tissue on my piriformis for years to come? Would I have still slipped into insomnia, chronic pain, anxiety, weight gain, and borderline depression? It’s hard to say…

All I do know is that I refused to think of myself as “injured” for too long. One of the most critical things to do when injured, is to accept it. Also important is learning (over time) that acceptance doesn’t mean your life is over. Acceptance is simply the first step towards truly healing.

 

Lesson #3: The mind-body connection is REAL; sleep-deprivation & somatization

As mentioned in lesson #2, I dealt with some major challenges after getting injured, one of which was sleep deprivation. At first I couldn’t sleep because of the severe inflammation in my hips and back. Any direct pressure on that area was excruciating. Sleeping directly on my back or stomach was simply out of the question due to the discomfort, so I slept on my side. Even that posed challenges. I could be sound asleep in the middle of the night and wake up to pain while attempting to roll from one side of my body to the other. Over time, I couldn’t even fall sleep because I was afraid of the pain and restlessness that lay ahead of me throughout the night.

This fear caused me to stay in a fight-or-flight mode throughout the night, my heart racing. The harder I tried to fall asleep, the more sleep evaded me. My efforts regularly turned into frustrated tears and fits of fatigued hysteria. For almost a year, I barely got 6 hours of sleep each night. The majority of this timeframe, I was working 10-12 hour work days on a broken 4-5 hours of rest. Obviously, my mind and body began to break down even more. The more I mentally and emotionally caved under the pain, the worse it became. It was a vicious cycle that I didn’t know how to break. I can remember days when I wondered if my life was over. I thought I would never see the day that the pain ended. It was stifling and slowly suffocated my ability to stay positive.

As I became more physically inflamed and emotionally overrun, my stress translated into many new physical issues. This is sometimes considered to be somatization; mental and emotional stress resulting in physical problems. I suffered a few panic attacks that seemingly struck me out of nowhere, I had a moment or two of binge eating in my distress, and I began moving in pain-avoidance patterns that exacerbated my issues. My stomach would hurt. My head would hurt. Everything hurt. I could no longer tell which pains and challenges were the cause of my physical stress versus my emotional stress…there were no hard lines separating the two because they were inherently connected.

car accident 7

 

Lesson #4: Pain pathways are tricky to navigate – understanding the “language” they speak is essential

For the longest time, I felt like I could control the pain if I just tried hard enough. Eventually though, after many months and years of playing ring-around-the-rosy with this nemesis, I discovered that the world could stop spinning…if I learned my pain’s language. I realized that the pain wasn’t actually trying to hurt me, it was trying to help me! My body was sending me signals that something was wrong and if I learned what my body wanted most, then it would reduce the pain, sending me the message that we were finally on the same team with the same mission: to get better!

Although I already mentally knew that the body acts like one integrated machine, with all its complex parts influencing one another with every step and every breath, I didn’t really understand this firsthand. I hadn’t felt this truth before. But suddenly, I started to realize that a brand new pain in my knee, and a strange crackling in my ankle, were both related to my initial injury. They weren’t brand new injuries out of the blue, they were responses that my kinetic chain (i.e. musculo-skeletal system and neuromuscular system) was having to the primary issue: back and hip misalignment and instability resulting from damaged soft tissue (i.e. muscle).

The more I remained out of alignment and unstable, the more the different parts of my body started talking in foreign languages and losing touch with one another. It was up to me, and me alone, to figure out how to treat the initial issue in order for my body to send out a message to all its parts, commanding that they get back to their primary language. They needed to speak the same language to work properly together.

When I started to realize that my body wasn’t breaking down in a million places haphazardly, I began to look at exercise and recovery solutions that would benefit my whole body rather than its isolated parts. If I continued to ignore the relationships between my various body parts then each would continue to grow stronger in its new language (which subsequently would make the whole body weaker).

Thank you for reading Part 1 of this story. As you can tell, it’s very personal to me. Part 2 is coming up soon! Stay tuned.

 

Yours in health and wellness,

Maggie

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Two Sources of Pain for Women

At some point in life, lots of women experience pain in their stomach, back, hips and/or knees. The sources of these pain points may feel elusive, but in many scenarios, there are two culprits to blame. I’m here today to help you identify whether you, or a woman you care about, has one of these conditions.

Q Angle

 PAIN SOURCE #1: LARGER Q-ANGLE

Women have wider hips than men. This is not surprising information. In some women, a wider pelvis results in a steeper angle between two landmarks: the ASIS and the patella.

The ASIS stands for Anterior Superior Iliac Spine. Don’t be intimidated – this is easier to identify on your body than it is to pronounce. Place your hands on your hips, like you’re standing with a little sass (thumbs pointing back and fingers forward). Feel where your middle and ring finger fall on the front of your hips. Slide your fingers slightly inwards and you will feel a bony part of your pelvis if you push into your flesh. You found it!

Next, place two fingers on your kneecap. You found the patella! So much easier. 

The Q-Angle is an angle measured between these two landmarks. It’s best done by a physical therapist or qualified fitness professional using a goniometer. Yuck, so many dull scientific words.

For a great visual, check out the illustration on this website: http://bit.ly/1CWkk4X (scroll down just a little on the page)

Why is this relevant to you? 

If you’ve experienced knee pain or instability, ACL issues, pain with running or jumping, and/or hip pain, then you may have a “large” Q-Angle. This doesn’t mean there is anything wrong with you, so don’t panic! It simply means that your kneecap tends to be pulled at a harsh angle, causing stress on the surrounding soft-tissue structures.

Although it’s super unfair that nature has made women more prone to knee pain than men, there are simple ways to ensure knee health. Here are a few:

1) Strengthen your quadriceps. Your quads are the large muscles on the front side of your thighs. These muscles are above the knee and help stabilize your kneecap’s movement. You can strengthen these muscles through controlled leg extensions, leg presses, and squats.

Leg Extension

2) Foam roll your IT bands. Your IT-bands are dense, connective tissue on the outside/lateral aspect of your thigh. Tight IT-bands can add tension and stress to the knee.  Since there is already a strong pull on your kneecap based on a large Q-Angle, it’s important not to add any unnecessary tension to the knee.

A foam roller is a cylinder made of densely packed foam. You can roll your body back and forth on the roam roller to relieve tension in any area. It’s like you’re a big ball of dough on a rolling pin! Not what a woman wants to imagine herself as, I know, but the analogy works!

If foam rolling hurts a lot, it’s a sign your connective tissue is really tense and needs this release. You can reduce discomfort by placing one leg in front of the other, distributing your body weight into the assisting leg.

Note: It’s really important that you don’t roll directly over joints. Ouch. 

3) Control knee stability during lower body exercises. If you watch yourself in a mirror, or even look down at your knees, while performing a lower body exercise, you may notice that your knees drift slightly inwards. When your knees drift towards one another, it creates stress on the joint capsule. Although this may improve with leg strengthening exercises, it may also be a factor of form.

You can increase your awareness by simply being mindful of your form. If you notice that your knees are drifting inwards, simply exert a little effort and move them wider. It doesn’t have to be excessive. It should feel more comfortable and will help you feel better balanced.

4) Strengthen your “outer thighs.” This may surprise you, but there aren’t any “outer thigh” muscles per say. When you perform exercises to target this area, you’re actually working muscles in the outer region of your hips/gluts. More specifically, muscles called your gluteus medius and gluteus minimus. 

A wider Q-Angle means that these muscles are pulled and elongated a bit more than usual, resulting in them being less stable and strong. Since knee health depends a lot on ankle and hip stability, it’s a good idea to strengthen these oft-forgotten muscles. You can do this through side lunges, lateral movements, lying side leg lifts, clams, and more.

 

PAIN SOURCE #2: DIASTASIS RECTI

Even if your baby-making years are far ahead or behind you, this is relevant information because it may impact you some day, or it may have taken place during pregnancy without your awareness. For women who plan to have children soon, or who are currently pregnant, listen even closer.

Diastasis Recti

We’ve all admired another person’s six-pack at some time or another, right? Well, imagine that the rippled six pack has an enormous split down the middle, separating and pulling the two halves away from one another so that the abdomen looks a little more like two three packs. This is what Diastasis Recti looks like. For a great visual, click here: http://bit.ly/1JQoYaS

Why does this happen?

When a woman gains weight with pregnancy and extra pressure is placed on the abdomen as it stretches, the core muscles are under great strain. The six-pack muscle naturally stretches with a growing uterus, but in the case of Diastasis Recti, the connective tissue that coats your core (the linea alba) gets stretched to a greater degree. The split can sometimes appear as a ridge in the abdomen and can be felt by placing fingers into the crevice. Diastasis Recti is usually diagnosed when the space is two finger widths.

What are the consequences?

Diastasis Recti can compromise a woman’s overall core strength, leading to secondary conditions that challenge overall health and wellbeing. Some women also experience a post-pregnancy “pooch” that they just can’t seem to get rid of because it isn’t a factor of weight loss. Diastasis Recti may present with multiple other conditions such as:

  • Back pain and instability
  • Compromising posture
  • Pelvic floor dysfunctions Hernia
  • Pelvic pain and instability
  • Gas and Digestive problems
  • Fecal incontinence (Constipation)
  • Pelvic floor dysfunction (SPFD)
  • Urinary incontinence
  • Pelvic organ prolapsed

One of our readers shares her personal experience…

When Jenna knew something was wrong:

“Sometime in the middle of my third trimester (while pregnant with my first child), I realized that I had Diastasis Recti. I was only aware of the condition because of my background in nursing school. The particular activity that made me aware of my abdominal separation was trying to sit up in bed (the wrong way). As my stretched-out abs attempted to engage, I saw what looked like a mountain ridge down the middle of my abdomen. This was a little frightening to see and though I was not experiencing pain, I could tell something was not right. When I mentioned this event to my caregiver, I received no concern and no education was given regarding how to protect myself when bearing weight or how to properly exercise my core post pregnancy.

Roughly two years later, I gave birth to my second child and suffered three tears. Even after my injuries healed, my pelvic pain lingered. It was noticeable with long periods of standing at my kitchen counter or when taking long walks outside. The pain was especially acute when I would sit up from a reclined position in bed after nursing my newborn for night-time feedings. I made an appointment to discuss the pain with my provider. She recommended pelvic physical therapy for my ‘pubic symphysis dysfunction.'”

How Jenna got better:

“I am so thankful that I took this recommendation! My pelvic PT taught me about the anatomy of the female pelvis and how childbirth impacts and often compromises core strength. I learned how to measure my diastasis recti and what exercises I could practice to help approximate the abdominal muscles. I learned how to protect my core by creating a “pelvic brace” for exercising and weight lifting. I also learned the proper posture for carrying my baby, how to get in and out of bed, and safe body mechanics for lifting my car seat.

Over a five week period, my pain significantly improved and was rarely noticeable! Only after a two week period of not exercising did my pain return (minimally). I discovered the reason for this is because I’m still breastfeeding my baby and this allows the relaxin hormone to linger, thereby creating instability at the pubic symphysis and also making it difficult to build muscle. While breastfeeding, maintaining my core stability means that I have to exercise regularly (4-5 times a week) and practice Kegel exercises daily. If I can commit to these practices, I remain pain free!”

Thank you, Jenna, a million times over for sharing this personal journey!!! It takes a lot of courage to share it and no doubt other women will benefit from hearing it. 

How do I exercise to prevent or correct Diastasis Recti?

If you believe that you have diastasis recti, then I suggest you work with a reputable physical therapist for at least a few sessions, to get on the right track. As mentioned in the former testimonial, it’s important to learn proper biomechanics for sitting up in bed, lifting heavy objects, and bracing your core during exercises. A great place to start is by checking these exercises, performed by my lovely former colleague, Alison, and presented by my wonderful friend and former PT Cari: http://www.releasept.com/videos/low-back-core/ (The first nine videos work on core bracing in a gentle, but effective, way.)

Jenna’s PT, Stephanie Fournier, has also been extremely generous with her time, and has offered us some answers to important questions about this condition. See her interview below.

 

INTERVIEW WITH WOMEN’S HEALTH CLINICAL SPECIALIST

Maternal Health

1) How many women do you encounter postpartum who have severe pelvic and core instability, and/or a diagnosable condition?

First, I would define severe pelvic and core instability as any pain or dysfunction in the postpartum period that is affecting activities of daily living. This could include severe pain, restriction in activities, avoidance of activities, or slowing a woman down in her normal activities. That being said, the exact number is hard to quantify since I treat in an outpatient clinic where I am only going to encounter those women who do have problems (core instability and/or pain) and who are coming to me via doctor or self-referral. However, I do believe that pain and dysfunction in the postpartum period go largely under diagnosed. What I hear most often from patients is that they tried to talk to a friend, family member, or healthcare provider about their pain/instability/limitation and they are told things such as, “That is normal, you just had a baby,”… “It will get better after the pregnancy,”… “You just have to live with it.”

Some research numbers to reflect on:

  • Incidence of lower back pain and pelvic girdle pain (PGP) in pregnancy range from 68.5% to 76% in prospective studies (Wang, 2004; Kristiansson, 1996; Ostgaard, 1991). And the incidence of PGP alone in pregnancy was 20%, in one prospective ,study (Vleeming, 2008). Why the discrepancy? Most likely pain is under reported.
  • 70% of women experience some sort of lower back or pelvic pain during pregnancy.
  • 1/3 of women report severe limitations in activities of daily living as a result of back and pelvic pain (Ostgaard, 1991). The risk for back pain increases postpartum (Ostgaard, 1997).
  • Most importantly, women having back and pelvic pain are 3x as likely to have postpartum depressive symptoms than those without pain (Gutke, 2007).

2) How do most women identify that they have Diastasis Recti? What tips do you have for identifying it as early as possible?

Most women that I see in the clinic do not realize that they have a diastasis recti (DrA). Often, they are coming to me for pelvic pain (posterior pelvic girdle pain, pubic symphysis dysfunction, lateral hip pain, or abdominal pain) and it is something that we find during our evaluation. They might have noticed a tent or pooch in their abdominal area with sits ups, supine to sit (getting in and out of bed) but didn’t exactly know what it meant. For identifying early on, women can measure themselves with their fingers or a tape measure or just look at their tummy when they are rolling in bed or sitting up in bed.

To measure; the patient starts in supine with their knees flexed. They can place their fingers horizontally in the umbilicus and raise their head up. They are measuring how many fingers they can place inside the gap in the rectus abdominis. [It should be noted that this finger method is highly unreliable and it is better to use a tape measure, however the tape measure is hard to do on yourself]

Some more research numbers to be aware of:

  • 66% of women develop a DrA by their 3rd trimester.
  • 39% of women have a significant DrA several years after delivery. Significant is defined as separation of 2.5cm or more (Ranney, 1990).
  • More than 50% of women presenting for urogynecological examination presented with a DrA. These are postmenopausal women. Likely, the DrA developed during the child bearing years and never fully resolved postpartum, leading to poor core stability and pelvic organ prolapse (Spitznagle, 2007) .
  • DrA is associated with varying degrees of stress urinary incontinence, fecal incontinence, and pelvic organ prolapse (Spitznagle, 2007). This is why treating DrA early on in the postpartum period is so important to me. We could potentially be helping women to avoid major symptoms and even surgery.

Also, Parker (2008) found that women with DrA tend to have higher degrees of pelvic or abdominal pain.

3) How soon after pregnancy can women start working their core muscles again? How do you suggest they start?

I recommend that women return to activity postpartum as they feel comfortable. However, I do have a few recommendations for those women who do have a DrA [separation of 2.5cm or more at the umbilicus, 4.5cm superior to the umbilicus, and 4.5cm inferior to the umbilicus].

  • Avoid obliques, regular crunches/situps, and planks until the DrA is reduced to 2.5cm or less OR the woman can affectively activate a co contraction (transverse abdominis + pelvic floor muscle contraction)
  • When treating a DrA, I start with initiation of TrA (transverse abdominis) which they can start day one postpartum with or without a c-section
  • Progress to DrA curlup (Neville, 2008)
  • Various TrA stabilization activities or progressions, depending on the individual
  • Consider corset or elastic binder per the individual
  • Avoid bearing down (valsalva) and sitting straight up (in bed/jack-knife)
  • As always, ensure proper pelvic floor muscle activation (including power, endurance, and coordination)

Thank you, Stephanie, for sharing your wisdom and expertise! You went above and beyond!

If you have any questions about this content and/or exercises to improve your health, then please don’t hesitate to reach out! Upon request, I’m happy to share the medical studies that Stephanie referenced too.

Being a woman can be tough stuff, but there’s no reason why we can’t feel amazing and pain free!

Yours in health and wellness,

Maggie

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References:

https://www.abdominalconnections.com/diastasis-recti/

http://gregnuckols.com/2013/07/17/do-women-need-to-train-any-differently/

http://www.webmd.com/baby/guide/abdominal-separation-diastasis-recti