Thursday, 26 October 2017

Pelvic Health Series: Our journey to regaining strength, alignment and function Kellie - part 2

Hello! I am starting this post with a huge thank you!! Jamie and I are incredibly humbled by, and grateful for the beautiful messages we have received since opening up about our journeys through this pelvic health blog series. Amongst your notes, we have found joy in knowing that you are becoming more aware of the changes occurring within your body. Many of you have even sought assessment because of our journey and we could not be more proud of you for doing so. Truly!

If you have not read our previous posts in the series, please check out Jamie’s first and second installments as we as my first that precedes this post!

Also, I wanted to remind all of you that there are so many incredible women’s health physiotherapists in Edmonton and surrounding area. Jamie and I are both seeing Jillian Palmer, from Bounce Back Physical Therapy, because we had started to develop a professional relationship with her through referring clients. We appreciated her approach, and her proximity to our homes was perfect! We encourage you to find a Physical Therapist with whom you can connect and feel comfortable with. In order to help you find a physiotherapist that is right for you, we have compiled a list of many of the wonderful pelvic health specialists in Edmonton and surrounding area here. In addition, there are links to the Albertan and Canadian Physical Therapists Association pages where you can search for a Women’s Health physical Therapist in your area.

So, now let’s dig back into my journey. I was essentially symptom free, other than some nagging “tightness” with the excess scar tissue building around my cesarean incision. This tightness would bother me more on some days than others and most traditional abdominal (core) exercises were uncomfortable. The more I learn the more there is to learn. I knew by making an appointment with Jillian, that if nothing else, I would learn how to improve outcomes for my Fit Your Life clients, but would likely also learn many things about my own body.

I drove to my first appointment nervous and very unsure of what to expect. I made a point of arriving right on time so that I did not need to sit in the waiting room and allow the suspense to build even more. Thankfully, Jillian was also right on time and no waiting occurred! I really enjoyed the initial part of the appointment. We reviewed my pregnancy history, exercise background, and overall physical health. We discussed anything currently occurring in my body and focused in on habits relating to the core and pelvic areas. Through our conversation I realized over the last year, I was paying less attention to my body with two little bodies to look after. I could tell you how often they empty their bowels and bladders and how much water they take in, but I had to really think about the answers for myself.

After this portion, we moved into the external physical exam. This is where Jillian assessed my alignment and posture during static standing and while moving through a squat. Having a background in Kinesiology, I knew to some extent the things she was looking for, but I was still interested to learn her observations. She then had me climb up onto the table/bed to assess my linea alba (the connective tissue between the rectus abdominis) through single leg raises. Although I secretly hoped she wouldn’t feel the separation of my abdominal muscles when I crunched up through my upper body, I knew she would. I shyly admitted that I had felt the gap at my belly button and to my pleasant surprise, she was happy that it didn’t continue above or below. Whew! When she asked me to perform a single leg raise, I was able to complete this on both sides, without any doming (where your body tries to push through weakened areas in the linea alba), but my legs did feel quite heavy and I also felt the same tugging or tightness around my incision. THIS was my “magic moment”… Jillian then gently squeezed my rectus abdominis together with her hands and asked me to perform the single leg raises again. They practically floated into the air!!! Whoa. My face lit up. What did this mean? That although my core was strong and functioning even with a small separation, if we were able to close it, I could fire those muscles even more effectively!

Although I was on a high from this “magic moment”, I knew the internal exam was coming next.

With the Physical Therapist stepping out of the room and me physically and mentally preparing for the unknown, I took a deep breath. She could tell I was nervous and, like Jamie described in her story, I cannot begin to tell you how much I appreciated the knee analogy. She described this assessment just as any other body part. I relaxed a little. To my surprise, this exam was over really quickly. For that I was grateful mainly because that meant there were no startling diagnoses! Jillian left the room for me to dress so that we could discuss all of her observations and create our plan.

What filled me with so much excitement and anticipation for the months to come was when she sat down and told me, “You are strong. You would have been completely fine if you never booked an appointment with me, but you are here and now we are going to make you so much stronger!” Sold!!

So, what were her findings?
  • Holding excess tone through my core and pelvic floor
  • Two finger separation at umbilicus (belly button)
  • Rib flaring
  • Alignment – standing and squatting with a “tucked bum” and not allowing the natural curve of the thoracic (mid) spine
  • Pushing down through my pelvic floor, rather than containing while coughing and sneezing

What were her recommendations after our initial visit?
  • Oblique (side abdominals) and quadratus lumborum (side low back) stretches and pelvic floor relaxation techniques. These will help my rectus abdominis close by creating space within those muscle groups, as opposed to holding. 
  • Actively practice relaxing through my core and pelvic floor during the day. This will help those muscles know how to relax and therefore be able to fire maximally when needed!
  • During walking and exercise, keep my weight overtop of my heels and keep my bum untucked. This will help me also to find neutral posture when carrying the girls and assist my ribs to unflare and come back to neutral.
  • Actively contain (or squeeze up) through my pelvic floor when coughing or sneezing to re-train my body, as that is what those muscles are meant to do (i.e. keep everything contained!).
  • Continue with self-scar massage to break down the scar tissue and which we will address more at the next appointment.

I really appreciate that Jillian doesn’t attempt to fix all things at once. I will expand in my next post, as I felt this was a manageable amount of tasks to work on and things to consider as I move through my day. She addresses the most important aspects of re-aligning and strengthening my body and gives new homework at each visit to build upon the last.

Driving home, I felt so inspired!! Yes, I had a list of things to work on and by no means was my body perfect, but I felt I had been given tools to effectively and efficiently re-train my body while it was still adjusting postpartum. Back to that “magic moment”! I wish I could re-create that sensation in all of you – to be bluntly shown how strong your body can be! The best part was to achieve a closer connection of my rectus abdominis and to begin to close my belly button separation, all I needed to do was relax! Jillian straight up told me that likely by doing “nothing” it would begin to close on it’s own over time.

I truly believe that we can all benefit from a posture and alignment assessment. In our busy days – sitting, standing, carrying, holding, laying, breastfeeding in all positions – our spines take a toll. Even small shifts can make a huge difference in the way you carry your body and finding its optimal alignment.

“You don’t need to have perfect alignment 100% of the time. Our goal is to have optimal alignment available to you.”
When Jillian said this to me, I felt like I finally had permission to “let go” and relax throughout the day. This has been a game changer for me.

Thank you again for following along this journey with me as I share my discoveries and inspirations! In my next installment, I will take you through my daily routine to incorporate my homework as well as my high five moments and accomplishments!

Stay tuned for Jamie’s next post where she shares her successes and challenges as she and Jillian Palmer continue to work together to tackle her list of diagnoses.  

Thursday, 19 October 2017

Pelvic Health Series: Our journey to regaining strength, alignment and function Jamie - part 2

If you haven’t checked out the first 2 articles in our Pelvic Health series, go do it now.  Click here and here, then come back and check out post 3.  Or, since you’re here, read this one and then go back and read the other ones.  

My heart was beating a mile a minute as I nervously waited for my appointment.  I thought the hardest part about this whole process was going to be making the initial appointment.  Turns out, it was even harder to get my butt to the there and through the door of the clinic.  But, here I was, sitting in the waiting room of Bounce Back Physical Therapy, mindlessly scrolling through Instagram, looking for any kind of distraction to keep my mind off the looming exam.  

After what felt like forever, but in reality was a few minutes, Jillian Palmer, the physiotherapist, walked into the waiting room and I felt so much better to put a face to her name.  She sounded nice on the phone and via email but upon meeting her, her smile and calm demeanor put me at ease.  I walked into her private office in the clinic, sat down and the appointment began.  The initial portion of the exam was filled with questions.  Jillian wanted to know in depth about my prenatal, birth, and postnatal history, my daily water intake, voiding, and sleep habits, a thorough medical history, and if I had any concerns or questions for her.  After the history portion of the exam she checked the alignment of my body while standing and squatting.  From there Jillian had me lay down on the exam table to check my core.  

Next came the dreaded internal exam. Jillian left the room so I could change.  I got my bottom half undressed, climbed onto the table and waited patiently, totally exposed except for the sheet she gave me to cover up.  Thankfully this time it was an actual sheet and not those extremely uncomfortable and awkward paper ones you get at the doctor.  At this point my heart rate was through the roof.  I hate internal exams.  I mean, sitting there in an uncomfortable position, with your nether regions exposed, waiting for a stranger to come in and thoroughly examine your vagina, isn’t something I look forward to, especially this time, knowing I was experiencing symptoms that likely meant she was going to find something not quite right with me.  

Once again, as soon as Jillian entered I felt calmer and I could tell this exam was going to be different than the ones I had experienced in the past.  She assured me that I had nothing to worry about and even used the analogy that the exam of my vagina was just like her examining my knee.  Don’t get me wrong, I was still nervous but it was a little bit easier to calm down without my feet in metal stirrups and a paper sheet crunching with every shift of my body.  Jillian offered me a mirror to view the exam, and I’m not going to lie, I was not on board at first.  I didn’t want an already awkward situation to be worse.  I just wanted her to examine me and get this part over with.  That being said, as the exam went on and I started to relax, as much as one can in that type of situation, I became more and more intrigued.  I found the use of the mirror very helpful, educational and interesting.  She showed me what was happening as I engaged and relaxed my pelvic floor and what it looked like internally when I coughed and barred down.  I was able to see exactly what was going on with my body and seeing and learning first hand made me feel so empowered.  It was a whole new experience for me and it wasn’t nearly as awkward as I made it out in my head to be.  

Throughout the appointment Jillian was very honest with me about what she was finding, in terms of what I needed to work on to improve my body’s strength and function.  We discussed what she found and the strategies we were going to use to tackle each of the following areas.  
  • Diastasis Recti or abdominal separation
  • Grade 2 posterior vaginal wall prolapse
  • Excess tone (holding muscle contraction when at rest) throughout my body including in my pelvic floor and abdominal wall
  • Cesarean section scar tissue resulting in adhesion of abdominal layer

There it is, the list of the areas in my body that needed some love and attention ASAP. On the drive home after the appointment, I had a chance to think.  My brain was going a mile a minute.  I was feeling defeated and embarrassed.  How was I ever going to fix all of this?  How did I let my body get to this point?  Why didn’t I address these issues when I first felt them, instead of pushing them aside?  
Our bodies don’t lie and mine had been telling me that it wasn’t happy or functioning at its best and I just ignored it, until now.   Even that small discomfort and pressure I was feeling while doing jacks and my new outie belly button was my body’s way of saying that something was out of place.  
It’s remarkable really.  When you think about all the changes a woman’s body goes through to grow a human being.  The shifting of all of the organs and stretching of tissues to make room for a growing baby and expanding uterus is truly amazing.  But it’s also amazing to think that after all of that, your organs and tissues can go back to exactly where they started before pregnancy.  It shouldn’t be surprising to me then that things weren’t back in place 100% and my body was trying to tell me this.  
I got home and read through my list of homework, which mainly included stretches and mindfully relaxing, and after some reflection I was ready to tackle my new mission.  Operation stretch and relax was underway and I was excited to see the changes I could make.

It’s been a few months since my initial appointment and I’m excited to share with you the progress and setbacks I’ve experienced throughout this journey. Stay tuned to our next instalments to see how Kellie’s first appointment went, read about her magic moment, and learn how we are discovering our true strength through this humbling journey.

Thursday, 5 October 2017

Pelvic Health Series: Our journey to regaining strength, alignment, and function Kellie - part 1

photo by Roughley Originals

Every single one of us is different. One of the most amazing aspects of my job is to witness the vast differences between each pregnant body as they exercise and how their body transforms postpartum. Most women will have similarities between their own pregnancies and births. Many women can even find a few similarities with other women as they discuss their stories. I think you would be hard pressed to find two stories more similar than mine and Jamie’s are, which is truly incredible, as we have only known each other for 18 months. That being said, they are not identical stories and for that reason I will also be sharing my story of regaining strength, alignment, and function through the help, expertise, and guidance of a pelvic health physical therapist.

photo by Roughley Originals
After one miscarriage, my husband and I went on to have two healthy pregnancies. Our oldest daughter Brooke was born by urgent cesarean section in April 2014. Our youngest daughter Mikah was born by elective repeat cesarean section in October 2016. You can read her birth story here. I stayed active through both pregnancies, which included running (stopped at 25 and 32 weeks, respectively), strength training, and yoga amongst other leisure activities and hobbies (biking, hiking, etc.). I officially started Fit Your Life by offering prenatal and postpartum fitness seminars in February 2015. Since that time, I have continued to learn, through various means, about pregnancy health and postpartum fitness. I absolutely fell in love with putting this newly discovered knowledge into practice within my own body during Mikah’s pregnancy. After her birth and through my healing, I began finding my new daily routine. Even before I was cleared for exercise postpartum, as a new family of four, we would go downstairs first thing in the morning and pull out our mats. This was an awesome ritual Brooke, Keith, and I had developed and wanted to continue. While Keith and Brooke worked out, Mikah would lie on my exercise mat and I would stretch, move gently, and connect with my changing body through breath. As I was able, I slowly re-introduced more movement in these morning sessions and loved the way I was feeling! I felt strong and connected! I thanked my prenatal exercise routine, my balanced nutrition intake, and my supportive family for this.

Although feeling great and sinking into the new routine, there was one nagging thing that continued to bother me even months after Mikah’s birth. My incision scar tissue did not seem to be going away. The slimmer I became, the more noticeable I thought the “bump” above my external scar was. Through self-massage, chiropractic, and deep massage, I noticed some change, but I started to wonder if this was part of my new normal.

What does this have to do with making an appointment with Jillian Palmer (MScPT) at Bounce Back PhysicalTherapy? Well… this scar tissue was the only postpartum “issue” that I would fully admit existed. I was actually in complete denial that I had a 2+ finger abdominal separation (diastasis recti or DR) at my belly button. Yes, I am trained in assessing this and did feel it within my own body. Since I was virtually symptom free and am very well trained in what not to do with DR, I was cautious, but did not even think about having it assessed. I worked on this in my own way through core connection, mindful core movements, and pelvic floor engagement and relaxation. [It is perfectly normal if you are having flashbacks to Jamie’s blog post. Haven’t read it yet? Find it here! I told you we are similar!] Over the summer, Erin, Jamie, and I wanted to open up the conversation about pelvic floor and core symptoms postpartum. Through this process, more women were asking us to assess them for DR and were discussing what was going on in their body before, during, and after our classes. We loved that women were realizing that Fit Your Life is a safe space for them to talk about their discomforts, pain, leaking, and to ask what is “normal recovery” and what might need require further investigation by a pelvic health specialist.

As the number of these conversations grew, I started thinking about my own body and how I really should make an assessment appointment to see what it is really like. What held me back? To be frank, I was most nervous about the internal exam. Why? I was scared she would find something “wrong”. BUT I was finally able to take a deep breath and book an appointment. I was recommending so many clients to go and knew I could probably learn a thing or two. Well, that is an understatement!

Am I happy I booked? HECK YES!
Did Jill find something “wrong” with my body? NO! But we did discover areas in which I can “let go” in order to be my most functional!

Excited to hear more? In my next post, I will take you through my first assessment and my “magic moment” as I have been calling it ever since!