Exercise and Pregnancy

Kate Schwartzkopf-Phifer, doctor of physical therapy, discusses the benefits of exercising while pregnant. Kate works at the ProRehab on Indiana Street and is an avid runner and triathlete. As with any pregnancy, it is important to discuss exercising with your physician and obtain approval first. Kate provides some general guidelines regarding exercise and the benefits both during and after pregnancy.

Enjoy! 

Now that you’re pregnant, you’re probably feeling like it’s a good time to kick your feet up and relax. After all, you’re more tired than you’ve ever been, and your “morning sickness” has turned into “all day sickness”. You deserve a break, right? Well, yes and no.

While getting adequate rest is definitely recommended, if you have an uncomplicated pregnancy, a respite from exercise is not. The American College of Sports Medicine and the Centers for Disease Control and Prevention currently recommend 30 minutes of moderate intensity exercise on most, if not all, days of the week. Recreational activities are deemed appropriate based on the physical movements required for the sport. Those activities that put the individual at high risk of falling or high risk of abdominal contact should be avoided. Such activities include skiing, horseback riding, hockey, soccer and basketball. Scuba diving should also be avoided due to the risk for decompression sickness and exercising at high altitudes should be cautioned due the risk of altitude sickness. Exercises that require you to be in a supine (lying on your back) position are considered unsafe after the first trimester, as this position tends to decrease venous return. Safe, moderate intensity activities include brisk walking, aquatic aerobics or swimming, stationary biking and even push-mowing your lawn. Women who participated in more vigorous intensity exercise pre-pregnancy, such as running, can likely continue these activities. However, these high intensity exercises should be monitored closely by a physician.

Aside from helping to prevent excess weight gain, there are plenty of benefits to maintaining a safe fitness routine while pregnant. Regular exercise can actually give you more energy, even though that sounds contradictory. Shouldn’t exercise make you tired? If you exercise at the recommended intensity for 30 minutes daily, it actually gives your system a boost of energy, while also helping you to sleep more soundly at night. Many women also report difficulty with constipation while pregnant; yet another ailment exercise can improve. Active bodies promote active bowels, so even a short walk can help alleviate the discomfort of bloating and constipation. Active, fit mommy’s-to-be also tend to tolerate labor better, and recover faster. Lastly, staying in shape during your pregnancy also helps to return you to your previous shape sooner, and say good-bye to those fashionable stretchy waistbands.

The benefits of a regular exercise routine are not just limited to the mom-to-be. Babies of mom’s who exercised during pregnancy tend to be of healthier weight, and maintain a healthy weight throughout their lifetime. There is also some evidence that suggests babies of exercising mom’s slept through the night sooner than those born to non-exercisers. That alone can be reason enough to put on your walking shoes.

Not a regular exerciser before you were pregnant? No problem. As long as you have the OK from your physician, you can start with just a 5 minute walk every day. Gradually work your way up to 30 minutes over a period of several weeks, listening to your body along the way. Don’t ignore any aches or pains, whether in your mid-section or otherwise. Make sure to stay hydrated, and maintain healthy nutritional intake (which increases after the first trimester).

Of course there are going to be days where you are too tired to even put on your tennis shoes, let alone walk around the block. That’s okay! Take the day off, and get back at it tomorrow. Remember, it’s not too early to introduce your little one to the benefits of a healthy lifestyle!

Toe Touch Progression

Can you touch your toes? Most people would say no, even seasoned athletes. Tight hamstrings? Probably not the sole culprit. Muscle tone and your body's misuse of stability? Sounds more likely. Give your body credit though, it's pretty good at taking the easy way out and choosing the simpler option. If your core lacks the ability to stabilize your pelvis, the hamstrings take over and create it. This might make your hamstrings feel "tight" but in actuality, they are working non-stop and always "on" so to speak. Try this exercise demonstrated by Paul Gorman from The Tank Gym. If you are able to do the toe touch progression and see a noticeable difference in your ability to reach your toes, you are NOT dealing with a muscle tightness issue; it's muscle tone. Perform this exercise daily to "turn off" your hamstrings and allow your core to be more efficient while stabilizing your pelvis.

The Truth About Barefoot Running: It's not for everyone!

Barefoot running is on an upward trend across the country, however those new to it should beware because it is not for everyone! Before making the transition, an athlete should make an informed decision by understanding the pros and cons of unshod running/walking.

Bob Tank, Doctor of Physical Therapy and orthotic specialist at ProRehab, PC discusses both the facts and his opinions of barefoot running.


The arguments for barefoot running are that it is more efficient energy wise and that it leads to fewer injuries.

I do not believe either of these statements have been scientifically proven and in fact, it can be argued that it may be less efficient since the energy absorbed in barefoot running is an additional load to the calf muscles. In regards to less injury risk, the premise is that barefoot running results in landing more on the forefoot or midfoot as opposed to having the impact at the rearfoot or heel. Heel striking generally results from a longer stride (step length) and results in the foot landing more out in front of the body. This is thought to then result in the body having to exert a “braking” force to maintain our balance and this force is then transferred and ultimately absorbed up to the knees and hips. If in barefoot running the foot lands more on the front part of the foot, it is argued that the foot placement will be more directly under the body (knees) and therefore the impact will be decreased and absorbed by the muscles more than the bones and joints. None of this has been conclusively proven. One of the drawbacks to barefoot running is this can shift the impact stresses to areas that are not accustomed to those types of loads and therefore may result in increased injuries to the Achilles Tendons, Plantar fascia (arch strut) and metatarsals. Because of this, if a runner chooses to change their running style to involve barefoot running, they need slowly transition to this over an extended period of time (months). Greater tension is placed upon the Achilles tendon and arch structures in unshod running simply due to the fact that running shoes keep the heels from dropping down to the normal 12mm heel lift built into the midsole of a running shoe. Minimalist shoes are somewhat of a compromise as they have 0-5mm heel lifts built in (depending on the model) and allow the runner to more comfortably land on their forefoot. They are also more flexible, lighter weight, and have more cushioning that the standard running shoe but, this results in less control over excessive movement or rolling of the foot. They also wear out quicker due to the less durable materials used in manufacturing them.

My opinion is that if a runner is considering transitioning to barefoot running, that they first try to shorten their stride in their regular shoes, which should alter the landing point to more toward the forefoot (away from the heel). They can practice this on a treadmill first with emphasis on quicker turnover, at a set speed, and they should focus on running tall, landing soft and with less noise at impact.

It should be mentioned that foot strike position at initial impact is not solely related to type or absence of shoes but is also related to fatigue, speed, joint flexibility, previous injuries and body structure. Those runners with a foot type that is either extremely flat (pronated) or extremely high arched (supinated) should be especially cautious about trying to run barefoot. In my experience, these runners would decrease their chance of injuries by wearing a shoe designed for their excessive pronation movement (more stability built into the shoe) or one designed for additional cushioning in the case of the high arched foot type. Further protection can be provided through the appropriate use of custom molded foot orthotics which are designed for total contact with the sole of the foot and built with a deep heel cup to not only help absorb impact forces but also to control excessive side to side rolling of the foot (side note, not all custom orthotics are built with these features included). This type of running orthotic is designed to accommodate for faulty foot or leg structure and cannot be used during barefoot running and is less effective in minimalist shoes. 

For clarification, in my mind I would classify minimalist shoes as Nike Frees, other light weight shoes with minimal structure but nonetheless they have a full outersole, just minimal heel lift built into the sole. The Vibram 5 toed shoes I would classify as more of a barefoot shoe. 

Part 3: Urinary Incontinence

To conclude Lisa's 3 part series on urinary incontinence, we have put together a video! She discusses what conditions we treat and the methods of treatment.

Pelvic Floor Video

Enjoy!

Part 2: America's Best Kept Secret...Urinary Incontinence

Last week Lisa Kiesel, physical therapist at ProRehab, wrote a great article on Urinary Incontinence. You can reference her first article below. Today, she is talking about what foods are good and what foods you should avoid for optimal bladder health. Enjoy!



Bladder habits are also very important to consider. Certain foods and drinks can be irritating to the bladder and cause you to urinate more often. Some examples of these are spicy and citrus foods, tea, coffee and soda (caffeinated and decaffeinated), foods and drinks with artificial flavoring, coloring and sweeteners, alcoholic beverages, milk products and chocolate. You may say “What CAN I eat?” The key is a balance between these irritating foods and drinks and plenty of water. One common mistake people make with bladder control issues is to limit their fluids. This causes the urine to be more concentrated and irritates the bladder which causes an increase in frequency. If you wake up a lot at night to urinate, drink most of your fluids during the day and limit what you drink after dinner, making sure most of it is water.

Some foods that promote bladder health include fresh fruits and vegetables, whole grains, foods high in Omega-3 fatty acids and water. Fruits and vegetables high in vitamin C, E, magnesium, potassium and fiber include carrots, sweet potatoes, strawberries, blackberries, cranberries, blueberries, mustard greens, turnips and cabbage. Whole grains such as rye, wild and brown rice, barley, brown pasta, oatmeal and whole grain breads promote liquid and solid waste removal from your body and promote a healthy bladder and colon. Foods high in Omega-3 fatty acids such as nuts (Brazil nuts, almonds, peanuts, macadamia nuts) and fish (trout, salmon, mackerel, tuna, herring, halibut, sardines) are helpful to reduce inflammation to enhance bladder health. Water is also very important because it flushes harmful toxins and bacteria out of the bladder and urethra.

You don’t have to live with it…remember that 80% of incontinence cases can be improved by a combination of behavioral changes and pelvic floor exercises when done correctly. Talk to your health care provider today and see if you can improve your symptoms.


Lisa Kiesel, PT, DPT, BCB-PMD

ProRehab, PC

812-476-0409

lisa@prorehab-pc.com

www.prorehab-pc.com




National Kidney and Urologic Diseases Information Clearinghouse

1-800-891-5390

www.kidney.niddk.nih.gov




National Association for Continence (NAFC)

1-800-BLADDER (252-3337)

www.nafc.org

Quick Bites: Homemade Energy Bars | Runner's World

Quick Bites: Homemade Energy Bars | Runner's World


I saw this on Runner's World's webpage and thought it would be good to share. Have I made them? No. I have a newborn at home! I might get around to it in a few months...

If someone makes these, I'd love to hear from you! Post to 'Comments' below.

America's Best Kept Secret...Urinary Incontinence!

This is the first article in our series of pelvic health. Although it is sometimes embarrassing to talk about, incontinence is a problem that both men and women face and can be a common topic around runners. Seasoned runners or athletes may even jokingly say that it's an initiation of sorts to pee while you're racing or training.

This article is courtesy of Lisa Kiesel, PT, DPT, BCB-PMD; ProRehab's pelvic health specialist. Her contact information is listed at the bottom of this article.

Would you wait an average of 3-6 years to talk to your doctor about your knee or back pain? Most would say no! Then why would you wait that long to talk to your doctor or health care provider about urinary leakage. Many men and women have one thing in common…they would rather not talk about their urinary leakage with their health care provider. Incontinence can be an uncomfortable topic for many people but it does not have to be because it is a common, treatable occurrence. Some people remain quiet about their bladder control because they believe it cannot be improved or that it is a “normal part of aging”. Men and women of all ages have trouble with urinary incontinence but it is more common in women. THE GOOD NEWS IS THAT 80% OF ALL INCONTINENCE CASES CAN BE SIGNIFICANTLY IMPROVED!

The Agency for Health Care Policy and Research (AHCPR) reports that one in four women age 30-59 have experienced urinary incontinence. A March 2011 report provided by the United States Food and Drug Administration (FDA) states that up to 50% of the female adult US population experience some form of urinary incontinence. The annual cost for caring for people with urinary incontinence in the community is $11.2 billion (an additional $5.2 billion spent on those in nursing homes). The majority of this money is spent on management measures such as pads for protection vs. treatment.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has developed an organization (The Women’s Urologic Health Program) with two goals in mind:

Increase the number of people reporting and seeking treatment for urinary incontinence.

Raise health professional’s awareness and knowledge about urinary incontinence.

There are many systems that must work together to provide control of the bladder. The pelvic floor muscles hold the bladder in place. The sphincter muscles keep the urethra (tube that carries the urine out of the bladder) closed. The bladder muscles relax as the bladder fills with urine and these same muscles contract when it’s time to empty the bladder. Nerves carry signals from the brain to tell the bladder when it’s time to empty. Hormones help to keep the lining of the bladder and urethra healthy. Bladder control problems occur when any one or combination of these systems are not working correctly.

There are six types of urinary incontinence. The three main types of urinary incontinence are stress, urge and mixed incontinence. Stress incontinence occurs during physical activities that cause an increase in intra-abdominal pressure such as coughing, sneezing, exercise, lifting or laughing. Normally the pelvic floor and sphincter muscles are strong enough and can handle the extra pressure (or “stress) from a cough, sneeze, or laugh but when these muscles are weak, that sudden pressure can push urine out of the bladder.

Urge incontinence is leakage caused by a sudden, strong desire to urinate. This type of incontinence is generally caused by either an involuntary bladder contraction or neurological impairment common with diabetes, a stroke, an infection or another medical condition.

Mixed incontinence is a combination of stress and urge incontinence. You may leak urine with a laugh or sneeze one time and at another time you may have a sudden uncontrollable urge to urinate just before you leak.

There are many ways to treat urinary incontinence including changing daily habits, exercises, medications, using a device such as a pessary or surgery as a last resort. As reported above, 80% OF ALL INCONTINENCE CASES CAN BE SIGNIFICANTLY IMPROVED through a combination of behavioral changes and pelvic floor exercises.

Exercises that strengthen the pelvic floor muscles are called “Kegel” exercises. They don’t require any equipment and can be done in any position at any time and if done correctly. The key is finding the correct way to contract these muscles. Without proper education or instruction 50-70% of women do Kegel exercises incorrectly and 25% of those do them in a manner that makes their leakage worse. There are several ways to find your pelvic floor muscles. Women will feel a slight pulling in the rectum or vagina. Men will feel a pulling in the rectum or a movement in the penis. One of the most common mistakes people make when trying to do a pelvic floor contraction is using the wrong muscles. Many people use their upper abdominal muscles, buttock muscles or hold their breath. If you are using the correct muscles, no one should be able to tell that you are squeezing your pelvic floor muscles – except you! The nice thing about doing these exercises is that you can do them in any position at any time. Make these exercises part of your daily routine so that exercising your pelvic floor muscles becomes a habit. Some good times to do them are standing at the sink when doing dishes or washing your hands, sitting on the couch during a commercial, sitting in your car at a red light, sitting at your desk when checking your email or while standing in the grocery line.

Lisa Kiesel, PT, DPT, BCB-PMD

Doctor of Physical Therapy, Board Certified in Biofeedback for Pelvic Muscle Dysfunction

ProRehab, PC. 

Indiana St Clinic 476-0409

If this is something that speaks to you, it is time to get help. Talk to your physician about a referral to see Lisa!!