Human Performance and Rehabilitation Centers, Inc.

Preparing for Pregnancy

How can you prepare your body for the exciting nine month marathon of pregnancy?  Take stock in a healthy attitude and practice.  Your body will go through miraculous changes in a  short nine month period to bring your newborn to you. Learn how you can help. 

The most ideal situation is visiting your OB-GYN before you become pregnant.  Your MD  will perform blood work that reviews your current vaccination/ antibody status,and screen for viral infections, as well as advise about appropriate medications. He/she will review your/your family’s medical history, and make appropriate recommendations.

Nutrition

Eat a healthy diet. A balanced diet will assist in proper nutrients for your growing baby and your energy level.  Recommended weight gain through pregnancy depends on your pre pregnancy weight

 Pre pregnancy—-   normal weight—weight gain 25-35 pounds   

 Pre pregnancy—    underweight—   weight gain  28-40 pounds

 Pre Pregnancy—– overweight —  – weight  gain 15-25 pounds

 Keep in mind, the range of appropriate weight gain changes when you learn you are carrying multiple births. Your pregnancy weight includes your fetus, placenta,  amniotic and maternal fluids, breasts and maternal fat stores.

 This is a great time to learn to eat clean.Your diet should include whole grains, fruits, vegetables, lean protein and low fat dairy . 1,000 mg of calcium per day, which is about 3 8 ounces glasses of skim milk is recommended while trying to become pregnant, but you can substitute with low fat yogurt and pasteurized cheeses. Limit your sugars and high fat foods.  During your first trimester you do NOT need extra calories.  Take heart,  for those that want to eat for two, extra calorie consumption comes in the second and third trimester with the growing demands of the baby. A healthy weight gain limits the possibility of complications such as gestational diabetes, and or high blood pressure.  https://www.cdc.gov/reproductivehealth/pdfs/maternal-infant-health/pregnancy-weight-gain/tracker/single/Obese_Weight_Tracker_508Tagged.pdf  

Folic acid is most important in the earliest stage of your pregnancy.  It  is a B vitamin that supports the development of a healthy spine and brain, and is often prescribed by your MD before conception or at your first prenatal visit. It can be found in nuts, green leafy vegetables, fortified breakfast cereals, vitamin supplements beans and citrus fruits so if you’re eating a healthy diet prior to conception you are on the right track.

https://www.health.harvard.edu/blog/fertility-and-diet-is-there-a-connection-2018053113949

Exercise

If you are an avid exerciser stick with it, and monitor its effects on your body.  Staying active throughout your pregnancy is highly recommended. 30 minutes of moderate exercise per day, repeated 5 days per week, is the general recommendation of ACOG, The American College of Obstetricians and Gynecologists.  If you are not, the athletic runner or yoga  pilates guru, consider starting a gentle aerobic exercise routine…slowly…  that can be as simple as taking a 5-10 minute walk and building your exercise time over a matter of weeks.  Of course this all depends on your health status at the start.  If you have pre-existing conditions such as diabetes thyroid disease or heart lung issues you should rely more heavily  on your MD’s advice 

ACOG  recommends 150 minutes of “MODERATE” intensity exercise per week for generally healthy individuals…..

Moderate exercise activity can be assessed by utilizing the simple talk test, the exertion rating scale or target heart rate monitoring. 

 The talk test is a valid, reliable yet informal way to estimate the intensity of your exercise.  Generally if your ability to talk is a little challenged then you are in the right range.  In other words,  being able to talk with light effort but not sing are good indications you are in the right zone for moderate activity. Check out:  https://www.cardiosmart.org/~/media/Documents/Fact%20Sheets/en/abk5262.ashx                                                                                 

The Perceived Rate of Exertion Scale/       https://www.hsph.harvard.edu/nutritionsource/borg-scale/                                                                          Is another way to measure your exercise intensity.  Moderate exercise would indicate an 11-14 on the Borg scale of perceived exertion.

Monitoring your target heart rate is one more way to measure that moderate level of activity.

https://www.heart.org/en/healthy-living/fitness/fitness-basics/target-heart-rates

Include a warm up period with your exercise routine which can be as simple as the exercise  activity at a slower pace.  Warm ups are important in pregnancy due to the extra demand on your body with pregnancy.

  • Safe Aerobic exercise in pregnancy
  • Walking at a brisk pace
  • Stationary bicycle riding
  • Swimming and water exercise
  • Modified Yoga
  • Modified Pilates
  • Running/ if you were running before pregnancy/ consider modifying intensity and frequency/ clear with MD
  • Weight training 
  • Generally avoid contact sports,hot yoga, hot pilates, scuba diving and of course skydiving and surfing.  We want to keep your fall risk at a minimum.  

Abdominals

If you are a big abdominal class proponent, you should know that crunches and exercises that shorten the abdominal muscles and increase intra abdominal pressure are not advocated during your prenatal period. Your abdominal muscles need to stretch to accomodate your baby’s growth.  There are acceptable ways to exercise the abdominals during this time and a physical therapist can help you coordinate your inner core, abdominals, breath, and pelvic floor, so you feel supported  as your abdominal muscles stretch.

Exercise with awareness  and mindfulness of your body. Exercise will give you more energy, support healthy joints and spine, reduce your chances of constipation, may decrease your risk of gestational diabetes, preeclampsia and C- section delivery.  It can improve your mood, enhance your sleep, and make it easier to lose pregnancy weight.  

Please, don’t forget to include a cool down period in your exercise routine, that should consist of gentle stretches of the hips spine and chest musculature, and general relaxation exercise for the pelvic floor in the later stages of pregnancy.  Make sure your water intake  keeps you hydrated through your exercise.  Be aware of the signs of over exerting yourself. Learn to listen to your body.  Consult here for more info on precautions  and warning signs to stop exercise .https://www.acog.org/patient-resources/faqs/pregnancy/exercise-during-pregnancy

Kegel or not

“Kegels” are strengthening exercises for the muscles that sit at the base of the pelvis.  These exercises are generally considered an important aspect of pregnancy.  They are a group of muscles that never stop working, they keep us dry/continent, and  lengthen and relax to allow the bladder and bowel to empty and to deliver your baby. Their ability to support the organs within the pelvis are taxed with the weight of the growing baby which makes them more vulnerable to weakness in some but not all women.  Some women exhibit tightness of the pelvic floor muscle and do not need to perform Kegel exercises. It may be best to consult with a pelvic physical therapist to help you decide if Kegels are needed during your pregnancy. Every woman should know how to coordinate her pelvic floor muscles with a regular exercise regime and be able to demonstrate lengthening and relaxation of these same muscles .  It is the reverse Kegel taught towards the end of your 9 months that will assist with your  vaginal delivery.  

 Follow these recommendations and treat yourself to your best possible pregnancy.  Happy Baby!

 

Joanne O’Connor, PT, PRPC

 

Joint Pain? Physical Therapy Can Help Osteoarthritis

Osteoarthritis is a common condition that impacts about 27 million Americans a year, and is experienced among many men and women as they age. Targeted physical therapy, along with appropriate physical activity and a healthy lifestyle can help slow the onset of osteoarthritis and reduce the pain and stiffness associated with this condition.

What is osteoarthritis?

Osteoarthritis is what we think of when we say “arthritis.” It’s the inflammation of the joint caused by deterioration of cartilage and protective tissue. Osteoarthritis is common in weight bearing joints, such as hips and knees. The pain stems from bone-on-bone friction during movement, caused by cartilage and tissue wearing away. Osteoarthritis is different from rheumatoid arthritis, which is a chronic condition in which the immune system attacks the joints.

What causes osteoarthritis?

A number of factors can contribute to osteoarthritis, including age, past injuries, overuse injuries from athletics, occupations that require repetitive weight-bearing activities, genetics and obesity.

How can physical therapy help?

Physical therapy is a noninvasive way to minimize the progression of osteoarthritis, lessen the pain caused by it and improve strength and flexibility. PT for osteoarthritis is widely seen as an alternative to surgery and prescription pain killers. A physical therapist will begin by assessing the extent of the joint inflammation, how it impacts your body mechanics and how to strengthen and or stretch the muscles surrounding and supporting the joint. This assessment will be used to create an individualized treatment plan aimed at reducing pain and inflammation and maximizing pain free movement.

What kind of treatment can I expect?

A physical therapist will perform a number of different modalities, including ice and manual therapy with soft tissue work to help reduce pain. He or she will prescribe exercises that improve range of motion, muscle strength and balance. The therapist will also have the patient perform low impact stretches and exercises that help build strength in the muscles surrounding joints. For example, patients with osteoarthritis of the knee will perform exercises that help strengthen the quadriceps, helping to relieve pressure on the joint. Finally, the physical therapist will help the patient establish a lifelong maintenance plan for joint health.

Is physical activity important?

Light to moderate physical activity can make a big difference in the quality of life of osteoarthritis patients. Swimming, walking and bike riding are all activities that can help build strength without introducing unnecessary load on the joints. These exercises, along with a healthy diet and plenty of water, can help overweight patients lose weight, an important step in reducing extra joint pain and pressure.

It’s important to remember that your therapist will also advise an at home plan to complement the work accomplished in the clinic for lifelong self-management of osteoarthritis symptoms.

Sachiko Garner, PT, is a licensed Physical Therapist. Employed with HPRC since 2005, she received her MSPT degree in 2004 at The University of Alabama at Birmingham and her BS degree in Exercise Science/Athletic Training at Columbus State University in 2001. She is credentialed as a Clinical Instructor and certified in the treatment of myofascial pain and dysfunction with dry needling and ASTYM. Her specialties and interests include shoulder rehabilitation, post-breast cancer rehabilitation including lymphedema and running biomechanics. She is a member of the American Physical Therapy Association (APTA) and Orthopedic Section of the APTA.

 

hip scope

Physical Therapy after a Hip Labral Repair by Scope

Hip arthroscopy, otherwise known as a “hip scope,” is a common, minimally invasive procedure used to address common conditions in the hip, such as a labral repair (a repair of the cartilage that lines the hip socket), to help reduce hip pain, improve stability and restore movement. This type of procedure is used to treat younger athletes who have suffered hip injuries as well as older patients who are experiencing normal degeneration.

Protocols may vary by physician, but usually a patient should avoid bearing weight on the hip scoped immediately after surgery. The patient can also expect to use crutches for the first week or two. Physical therapy generally starts within a few days after surgery. Depending on the patient and protocol, it takes about six weeks of physical therapy, once or twice a week, before the initial range of motion is restored and a patient can safely embark on more rigorous therapy. It may take another six weeks of targeted exercises to restore full range of motion and athletic function.

What to expect from physical therapy

The goal of physical therapy is to restore the patient’s functionality, whether they’re a younger athlete or an older adult. A physical therapist will start with isometric therapy, in which the patient squeezes and holds the quads and glutes to encourage these muscles to “fire” and regain strength. Manual therapy is also an important part of this first phase. The therapist will carefully move the hip joint to encourage soft tissue and joint mobilization.

Restoring hip mobility

As the patient is able to bear more weight, the therapist guides them through exercises in both standing and sitting positions. The therapist will use a variety of exercises to help rotate and stretch the hip to restore hip flexion.

Regaining stability and strength

After about four weeks, the therapist helps the patient regain function hip strength and stability. Exercises are usually focused on specific hip muscles such as glutes and hip rotators to improve stability of the hip during functional activities. Exercises tend to start with standing on both legs and will progress to single leg activities. Progressive activities tend to challenge the stability of the leg as a whole, including both hip and ankle stability. Depending on the patient’s goals, exercises are tailored to aim for a full return to specific activities.

In addition to regular therapy with a clinician, patients should follow an at-home therapy plan. At home exercises extend the work accomplished in the clinic and a good way to speed along positive results.

 

Brittany West, DPT is a licensed physical therapist with HPRC’s St. Francis Rehab River Road location. Brittany earned her DPT degree from the Medical College of Georgia and is a member of the American Physical Therapy Association. Her practice areas include orthopedics and sports injuries.