Last week, I made a case for getting your postpartum body to a women’s health physical therapist.  

This week, I’m doubling down on that same subject to tell you about my own personal experience working with a women’s health PT.

While I was researching a good one in my area, I learned pretty quickly that these professionals aren’t just laying around for a quick visit.  They are pretty specialized, for a variety of reasons, and when you try to get into visit them, they seem to be generally booked out fairly far (considering they are pretty specialized, this makes sense).  So I booked my first appointment with my PT when I was two weeks postpartum, and had it set for when I was almost five weeks postpartum.  I visited the Institute for Athletic Medicine.

To be completely transparent, I knew I needed to make this appointment based on all the new writings and research in strength and conditioning world.  I knew I wanted to get back into strength training COMPLETELY ready to begin training smartly and progressing smartly.  I knew, after last time when I didn’t really know better, that I needed to take this seriously.

And to be completely honest, I booked my visit with the attitude that I was doing my due diligence in my postpartum health, but that I was only going to have to “clock it in” because I was probably one of those women who didn’t have any issues.

Did you know that women’s health PT’s want to know EVERYTHING about your core and pelvic floor health?  How many times a day do you go #1 and #2, can you hold it, for how long, do you ever leak, does it ever hurt, do you have back pain, how were your babies born, how many babies, how long were labors, any assistance during birth, EVERYTHING.

Upon talking about all these things with my PT, we began biofeedback testing.  Which basically means, I got undressed from the waist down, and got hooked up to little electrode thingies on my butt, on my thigh, and on my hip, and then she began coaching me on contracting my pelvic floor.  Then my core.  Then my core AND pelvic floor.  And we found out pretty quickly that my pelvic floor was hypertonic.  Meaning, it was ALWAYS working – contracted – and trying to do the job my transverse abdominis wasn’t.  A strong muscle is one that can contract AND relax.  My pelvic floor could not relax….thus, it was very weak.  Apparently this is very common, and especially common in those who lift.  Who knew?  Ha!

So, my first appointment was basically getting me to recognize coordinating JUST my pelvic floor and JUST my core, and then the two together via seeing a computer screen and the use of biofeedback to show me when I was contracting, relaxing, and the like.  And, my PT sent me home with some exercises to do daily to work on this.  We found that I could get my best contraction and coordination in a seated position versus a side lying position.  My PT also coached me on the importance of posture – sitting up straight, stacking ribs over hips, etc – in all of my daily life to support healthy core and pelvic floor function.  Feeding and nursing positions with baby especially, since that’s where a bulk of my time was spent.  She also gave me a hefty reminder to sit the hell down a TON during the day, because my pelvic floor needed rest and recovery, and getting up and doing a lot just made it work all that much harder.  She also recommended a follow up visit in two weeks to assess strength and coordination.

It was quite the coincidence that a few days after my first visit, I was at home, and began thinking I had symptoms of prolapse.  I felt weird.  I felt like I had something possibly lower than it should be.  I could feel something lower than it should be.  Cue all the freaking out on the planet.  I’m going to spare you about two weeks of drama until I saw my PT again, but the Cliff’s Notes are that I sat my ass off, I saw my midwife for my final PP check, and I also sought out an OB to double check, and to establish care since my care with the birth center was complete.  I also had emotional meltdown after emotional meltdown.  I knew that a prolapse would change a lot of things for me, strength training wise and work wise, and to be honest, it sorta felt like I was majorly getting betrayed by my body.  After visiting the OB, I had a sort of sigh of relief.  She was pretty confident after an exam that I didn’t have a prolapse of uterus or bladder, but since I had some symptoms (like I couldn’t go #1 all the way gone), that it could possibly be very mild prolapse, OR it could be par for the course of being only six weeks PP and still nursing, with very loose joints and connective tissue.  She advised continuing on with PT, and checking back in sooner (versus a year later for an annual visit) if I felt like things were getting worse instead of better.  I was happy to have this feedback, but to be honest, I trusted the expertise of my PT over the OB.  Not because the OB doesn’t know anything.  The OB knows women’s health, and specializes in the overall health of me and my female anatomy.  However, she doesn’t have the expertise of how specific muscles and systems work, and how those muscles and systems need to be treated, how they need to function, and how they respond to force during daily activities (I’m not saying any of this “right” but I hope you get my gist).  Her job ISN’T to know those things, and so the help of someone who’s job it IS (the PT) is vital.

Upon visiting my PT for my third visit, she agreed with the OB.  Not a prolapse, but potentially a very mild one IF symptoms continued.  She also very optimistic that with additional exercises, we could take care of any issues. That visit was internal.  She checked the strength of my pelvic floor muscles, and rated them at a 2 out of 5 for strength.  We also checked coordination of them – could I contract them and not my TA, could I contract my TA and not my PF, and could I contract both together.  I was definitely getting way better at this.  Because I had good coordination, and because I was actually doing my exercises, she said I could begin strength training smartly, and without any additional load (aside from floor presses) than my bodyweight.  You KNOW I was jacked up to begin this!  I think that was somewhere around 7-8 weeks PP.  She also explained that while I thought I was feeling symptoms of prolapse, that it was likely my pelvic floor was just on overdrive, and that I needed to be diligent about relaxing it as much as I could.  I did that in various ways – laying on my back with my legs supported on a couch above me, and letting my legs have zero tension, doing some child’s pose stuff and breathing drills, and some other things I’m forgetting at this point.

Over the course of 14 weeks, I had five PT visits.  Each one, I could tell I was getting stronger and stronger.  I was also learning that those weird prolapse symptom feelings had way more to do with having an overactive PF, PLUS they were really present when I was overtired, and when my hormones were changing.  For instance, I work really long days on Mondays and Wednesdays, and could pretty much bank on prolapse symptoms those days, and then most of the rest of the week was fine.  And also, I quit nursing at 12 weeks, and not long after that I could tell that my body was trying to generate some sort of cycle, and that made me feel off again.  I guess this is all normal stuff with tiredness, stress, hormonal changes, and a host of other things.  I’ve also been very diligent about introducing “new” exercises into my strength training to test for a few times to see if any of THOSE generate weirdness.  So, basically, I’m just really freaking aware all the time about this stuff.

My last visit with the PT was learning how to make intense exercises – think jumping, running, and those type things….pelvic floor friendly.  How to add a PF contraction and when.  How to incorporate breathing.  My PT also said since I had good awareness and good PF and core coordination, that I was safe to begin pushing the envelope a bit and testing myself.  On a full bladder, try jumping.  Stand in weird positions and side lunges and try doing my contractions, etc.  It’s super interesting stuff.

I’m about four months PP at this point, and can tell you that each week is getting better and better.  My coordination is good with my core and PF.  My PF is beginning to do it’s job without me having to mentally think through it during every exercise, every sneeze, every lifting of the infant seat, etc.  I also still have those weird tired days sometimes where I can feel that it’s exhausted.  I’ve been working out with lighter weights for two weeks, and this week have begun increasing the load so long as that each exercise, each rep, feels good, feels coordinated with core and floor, and as long as I can pass the 3 P’s (no pain, pee, or pressure).

All in all, I would categorize working with a women’s health PT as self-care.  I had a reason to work with one for five visits.  I think every woman should visit at least once to get an assessment.  I wasn’t referred by an OB or midwife, so this was self-refer classification.  I think people should know the ins and outs of that too, financially.  Each visit was approximately $200-225, and everything except $32 each visit was covered by our insurance.  I know everyone and everyone’s insurance was different, but that’s the kind of info I wanted to know before visiting and couldn’t really find so I had no clue what to expect.  Here’s how I’m doing the math on this one – if I DID NOT go this route, I would likely be having the bladder/sling surgery (that has a 70% fail rate and/or has to be re-done every 10 years) down the road.  At who knows what cost, but also losing my ability to work for a minimum of six weeks in my profession.  So for roughly $150 out of pocket, I’m very confident in the workings of my body and managing this stuff on my own, and know what to do next if something pops up, and will likely avoid any type of surgery.  $150 feels like pocket change considering all that.

I also feel pretty strongly that even if prolapse is a diagnosis for someone, this can very much help the severity of it, or help things almost completely.  And if prolapse isn’t, but incontinence or other things are issues, this is what should be the first step – not “just accepting it as normal” or waiting until you are done having kids to have the surgery, or considering surgery as the only cure.

This is NOT a sexy topic, but it’s a necessary one.  Running a gym, I see about 60 faces a week.  During my post natal fitness certification, I learned that 50% of women deal with this stuff.  You know what?  That’s 30 of my weekly faces, and I’m one of them.  So….it’s pretty damn common, and there is a HUGELY helpful resource available that really isn’t talked about.

So I’m talking about it.  If you have questions, I’m an open book on this one…..I pretty passionate about it at this point.  So, feel free to PM me on Facebook for questions, or just to get pointed in the right direction of a PT, and I’ll do what I can to help you out!

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