Physical Therapy Where You Need It Most

When physical therapist, Evelyn Hecht, PT, ATC attended the Women’s Voices for Change luncheon that honored Every Mother Counts, she knew she wanted to add her voice to our message.

Evelyn wants to help women prevent post partum complications and bring awareness to one of our most intimate and most-ignored muscle groups — the pelvic floor.

Hecht is a licensed physical therapist who specializes in pelvic floor function and dysfunction. She’s treated patients for 20 years for pelvic, hip and low back pain that makes it difficult for them to sit, work, walk and have sex. Many of her female patients also suffer with pelvic pain, urine leakage and constipation caused by restricted or very weak pelvic floor and core muscles so Hecht developed a program that includes education, manual therapies and targeted exercises to help women heal and prevent issues from returning.

She shared with us more insight into how this type of program is especially important during pregnancy and postpartum when women’s core and pelvic floor muscles are put to the test.

There are two disorders that contribute to many pre/postpartum complications involving the low back, pelvis, hip, bowel, and bladder:

1. Diastasis Recti Abdominis (DRA) — 66% of women diagnosed with pelvic floor dysfunction have DRA, which occurs when abdominal muscles and connective tissue get stretched beyond the midline and lose their ability to support the back, hips, thighs and pelvis. That can lead to pain and pelvic instability but by practicing some safe, easy exercises, it can also be prevented:

• Avoid postures and exercises that further separate the muscles, like sit ups and crunches
• Avoid prolonged “all fours” positions such as Yoga’s “cow” or up-dog positions.” This puts too much pressure on the already stretched linea alba (midline of the abdomen).
• Tone muscles in the pelvic floor, lower abdominals and deep lower back with this exercise:

Sit or lie on your back, knees bent. Inhale. As you slowly exhale, tighten your rectal/vaginal muscles as if you are trying to pull them upwards. Now tighten the abdominal muscles towards your back. Keep breathing as you hold this tension for 5 seconds. Completely relax all muscles. Repeat 2 sets of 10 repetitions.

1. Pelvic floor dysfunction involves muscles located inside the pelvic ‘bowl.’ The pelvic floor muscles are shaped like a hammock. They attach to the front (pubis) and back, (coccyx) and to deep hip muscles on each side. Part of their job is to control the flow of urine from the urethra (the hose-like structure where urine leaves the body) by keeping the urethra closed when you’re not in the bathroom. If urine leaks when you’re walking, jogging or sneezing, that indicates the muscles aren’t strong enough to control leaks.

Pelvic floor muscles are also responsible for healthy bowel function. If muscles are too tight and contracted, women may be constipated or unable to fully empty their bowels. Pelvic floor muscles also play a large role in sexual function and pleasure. When women experience pain during sex it may be because the muscles that surround her vagina are too tight or may have scar tissue from an episiotomy /perineal tear.

Give this pelvic muscle exercise for preventing leakage a try:

Lie on your back, knees bent. Inhale. As you breathe out, tighten the muscles around the rectum/vagina for up to 10 seconds without squeezing your buttocks or inner thighs together. Then, fully relax the pelvic floor muscles for 20 seconds. Do 2 sets of 10 repetitions once a day.

Women in Europe receive this kind of therapy as a routine part of their post partum care. Women in the U.S. don’t even know it’s available and too many are told that pain and leaking is just a normal part of their childbearing life. That’s just not true.

Hecht offers programs at her clinic, EMH Physical Therapy in New York City, plus classes for pregnant women and new moms called, “Healthy Body After Baby,” that focus on exercises and posture techniques during and after pregnancy.