Week 3-4 Exercise Progression:

• Step Matrix
• Clamshell
• Bent knee fall out and March
• Quadruped – Rockback; Pelvic Tilts, Cat/Cow
• Resisted Row
• Shoulder matrix < 90 degrees

Management of thumb and wrist pain:

Mommy’s thumb and wrist is the inflammation of the tendons that lift the thumb up or out to the side and the nerves that run along the inside of your wrist. Managing this early is important for symptoms to not get worse. Symptoms you may experience with tendonitis are pain and burning along the top of your thumb and wrist, tightness in your forearm and hand. Symptoms you may experience with nerve tension along your arm are numbness and “falling asleep” feeling along the inside of your upper arm and forearm or hand. Nerve tension presents from muscle stiffness surrounding the nerve which can present after sustained postures, for example, slumped posture while breastfeeding or holding your newborn for an extended period.

Treatment Strategies:

• Self Massage
  • Forearm- tennis ball or Lacrosse ball 2 min
  • Thumb massage – golf ball, focus on web space between thumb and index finger
  • Upper Trap – tennis ball or Lacrosse ball
• Movement
  • Wrist and finger circles
• Stretching
  • Wrist
  • Pec
  • Cat cow
• Nerve glides
• Bracing and Ice
  • Wrist and thumb brace while holding your child or breastfeeding
  • Ice Wrist and Thumb for 5-10 minutes
  • I found that the Lanisoh Therapy Breast Packs also made perfect wrist and thumb ice packs that I could wrap around my wrist
• Ask your partner or friend for a massage
  • Pressure should be tolerable not painful, if you find a sharp point maintained sustained pressure for 30-60 seconds until it releases and then move to next point

I tried to spend 5-10 minutes during the day to perform these movements or when I was actively experiencing the pain. Pick 2-3 of the 5 things and it will help manage your pain. If your pain progressively worsens for greater than 2 weeks and you have tried these exercises, I recommend seeking out help through Physical Therapy. It is much easier to manage and resolve your pain early on.

I hope these tips were useful. If you are looking for more one on one guidance and support MOTI Physiotherapy has a Pelvic Floor team that has an expertise in pregnant and postpartum population. We offer in person and telehealth visits that are covered by insurance. Do not wait for your first postpartum checkup if you are starting to experience pain from the new demands of motherhood. Our Pelvic Floor Doctors of Physical Therapy can guide you through a personalized plan of care that will support you!

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Week 2-3 Exercise Progression:

1. Walking
   • I started with walking around my parents pool 3-5 laps and using a short stride because I was recovering from a cesarian delivery.
   • As I felt comfortable I continued with backwards walking and side walking for 5-10 minutes
   • At the end of week 2, I felt comfortable enough to walk to the end of the block and back with my abdominal binder
2. Weight shifting in a quarter squat position – the depth of each movement is unlocking the hips with a slight knee bend
   • Focused on maintaining my breath in the up and down phase of the position
     • See week one postpartum blog for breathing pattern
   • Quarter wall squat
   • Lateral squat
   • Quarter body weight squat
     • Focus is all on maintaining breath in the depth of the up and down phase
     • Spreading the floor with my feet
     • 5-10 reps max, 3-5 second pause at bottom
3. Pelvic Tilts
   • Lying in bed with my knees bent and feet on the bed
   • Small tilting of my pelvis
     • Anterior pelvic tilt: focus on moving your pubic bone towards your belly button
     • Posterior pelvic tilt: focus on moving your tailbone towards the bed
     • As you feel comfortable sink your inhale with the anterior pelvic tilt and posterior pelvic tilt with your exhale
4. Upper Body
   • Body weight wall angel
   • Body weight row
     • 5-10 reps, slow and controlled
     • Try to maintain length of your spine around the region of your bra strap

Cesarian Scar Desensitization

At week two postpartum I also began feeling comfortable with initiating scar tissue desensitization. It can be scary to look or have a material or physical touch to a healing incision. If you go too long avoiding movement or contact to the area muscle guarding and pain can occur in the long run. Desensitization is different than massage and stretching, avoid doing those things until after 8 weeks postpartum, scar tissue is not a bad thing and you want it to occur to have strong and healed incision. I highly recommend reviewing Dr. Lindsay Brunner’s post on Cesarian Scar Mobilization when it is appropriate in your recovery timeline.

Desensitization is using touch, after washing my hands I placed my hands over my scar and would breathe into the area, I would do this for only as long as I was comfortable and a few times a day. Ways to build on desensitization are with different textures, for example, your sheets or clothes. Finally, you can also have your partner gently place their hand on your incision. The goal is to introduce stimulation to the area that is non painful or threatening so that your brain does not create a pattern of needing to over protect the incision.

I hope these tips were useful. If you are looking for more one on one guidance and support MOTI Physiotherapy has a Pelvic Floor team that has an expertise in pregnant and postpartum population. We offer in person and telehealth visits that are covered by insurance. Do not wait for your first postpartum checkup if you are starting to experience pain from the new demands of motherhood. Our Pelvic Floor Doctor’s of Physical Therapy can guide you through a personalized plan of care that will support you!

The post Postpartum recovery weeks 2-3 appeared first on MOTI Physiotherapy.

I was grateful for an amazing nursing staff at the hospital we delivered at and my knowledge as a physical therapist for how to move without straining my incision. I realized that there was no discussion on expectations pre cesarian on pain management and recovery, all our focus was on the birth plan but not what to expect afterwards. I felt so disconnected from my body with not being able to exercise during the last part of my pregnancy and especially after receiving an Epidural.  I would like to share some bed mobility tips and gentle exercises I started in my first 72 hours after my cesarian birth. 

BED TRANSFERS

Log Roll: Going from your back to side to prepare for sitting

• Utilize your hospital bed to your advantage and adjust the head and leg rest to help assist yourself to a semi reclined position
• Exhale and roll to your side
• Once in this position exhale again and use your bottom forearm and top arm hand to push yourself upright. *Exhaling with movement reduces abdominal pressure and puts less stress on your incision
• Once in sitting scoot towards the edge of the bed, raise your bed height as high as you can go without feet coming off the floor
• Lean forward and exhale as you focus on pushing the ground away through your feet to stand

Shifting upward in your bed:

• Adjust the bed to be semi flat
• Hold the hand rails or push through forearms/hands and pull or push your self upwards without holding your breath or pushing through your legs

HOSPITAL EXERCISES

• Diaphragmatic breathing – sitting, sidelying, lying on my back 5 minutes. Focus on nasal inhale/exhale guiding my breath below my belly button, to the side of my rib cage and back of my rib cage
• Glute squeeze – Lying on my back, squeezing my butt cheeks for a 3 second hold
• Quad squeeze – Lying on my back, squeezing my quads to make my legs straight and rigid, for a 3 second hold
• Shoulder blade squeeze – Sitting upright or standing, squeezing my shoulder blades together and pulling my elbows behind me, for a 3 second hold
• Weight shift – standing weight shifts in place working on loading evenly into each foot going side to side and forward/backwards

HOME EXERCISES

*wearing my belly support wrap, here is a link to the one I used https://itsbodily.com/products/belly-band

• Walking 5 minutes – forward, backward, side step…small steps to not pull on incision. Standing weight shifts in place working on loading evenly into each foot going side to side and forward/backwards
• Diaphragmatic breathing – sitting, sidelying, lying on my back 5 minutes. Focus on nasal inhale/exhale guiding my breath below my belly button, to the side of my rib cage and back of my rib cage
• Toe Yoga – Seated – focus on grounding through my feet with even weight bearing through my big toe, fifth toe and heels. Then lift only the big toe off the ground without losing contact on the rest of the foot after about a minute switch to lifting the other four toes without lifting the big toe

Continuation of Hospital Exercises *can be performed during naps or breastfeeding

Breastfeeding:

I felt like Goldielocks trying to find the right spot that felt the most comfortable for breastfeeding. I moved from the bed to the couch, sitting on the toilet or kitchen chair. I was happy I did not purchase a rocking chair or glider because I have moved around so much and found the most comfortable spot has been my home office chair and using my nursing pillow. My friend gifted me the My Breast Friend Nursing Pillow which has been great and when I attempt to nurse in bed I also use a Foam Bed Wedge Pillow.

Breastfeeding has definitely been challenging and anxiety driven, and I learn something new each day. I highly recommend a lactation consultation in the hospital, when you get home and even before you deliver to help with expectations. When my milk first came in it was painful and overwhelming. I found my neck, wrist and thumb starting to hurt, making sure he was maintaining a good latch.

Movements I started to incorporate early on to help ease this pain were:

1. Massage to my forearm and hand

2. Wrist circles

3. Double hand cradle to support my sons head so that the arm supporting his body wasn’t overstressed by taking on the full weight of his head as well

4. Thumb and wrist position – Supporting his head with both my hands allowed me to not wrap my thumb around his head

   • Try to make sure the tip of your thumb is relaxed and not pointing backwards towards your wrist, this will alleviate the stress placed on your thumb extensor tendons

5. Mom’s head and neck position while feeding – Pause every minute or to look forward, roll your shoulders back and sit upward. Gaze along the horizon and gently draw your chin in towards your neck making a double chin and hold for 5 seconds, release and repeat 5 times with a shoulder blade squeeze

6. Diaphragmatic breathing

   • This is a great time to practice your diaphragmatic breathing utilizing your breastfeeding pillow for feedback and focus your inhale going into all aspects of your pillow that is wrapped around you

Changing table and Bassinet lifting mechanics:

• Just like your bed transfer mechanics exhale with lowering and lifting
• Wearing your belly band can help support your back
• Unlock your knees with bending and lifting and don’t round through your mid back
• If you are not ready to lift ask for help from your partner

I hope these tips were useful. If you are looking for more one on one guidance and support, MOTI Physiotherapy has a Pelvic Floor Specialilst team that has expertise in pregnant and postpartum population. We offer in person and telehealth visits that are covered by insurance. Do not wait for your first postpartum checkup if you are starting to experience pain from the new demands of motherhood. Our Pelvic Floor Doctors of Physical Therapy can guide you through a personalized plan of care that will support you!

The post My first week Postpartum: Cesarian birth recovery and body mechanics appeared first on MOTI Physiotherapy.

After you complete your physical therapy evaluation your Doctor of Physical Therapy will provide you with your home exercise program that will compliment your plan of care. Your home exercise program is a combination of exercises skillfully organized by your doctor to help you achieve your goals established at your evaluation. 

At MOTI, we use a program called Physiotec, where you will be provided an individualized link with your program that has been customized to you. In that program you will be provided with a video of your exercises, description of your exercises and frequency of how often to perform your exercises.

Example of what your home program will look like from MOTI:

Why is your home program important?

The frequency of in person physical therapy is determined at your evaluation, but usually is around twice a week – where the real work comes in is at home! Adherence to your program helps you achieve the goals you have established with your doctor quicker and maintain your gains beyond your discharge.

I was having the hardest time trying to find a way that I could continue to work after my herniated disk. I found that sitting was really painful as well as standing or reclining. Megan then suggested alternating between sitting, standing and lying down, and it was a game changer! I sit until I start to feel some discomfort, and then I stand until I start to feel that same discomfort coming back. After about two rounds of this rotation, I lay down for about 20 minutes. From doing this, I have realized that a lot of my pain was coming from staying in one position (or trying to stay in one position) for too long. I can now also see that reclining in a chaise style seat was causing a lot of unnecessary pain. From moving my body through those three positions (sitting, standing, and laying) I feel that I have escaped the belief that I can’t get comfortable. I can, it just takes some adjusting! –MOTI Patient Alexandra

How do you make your home program a habit?

A challenge that is commonly faced among patients is making the commitment to their physical therapy plan of care, and then the further realization of the necessity to commit to their home program. 

I don’t have enough time in my day?

Be open with your doctor from the start about how much time you have available to do your home program. One major component to success is knowing you can achieve the goals that are being made with you. As your doctor we want you to be successful, we want you to be able to adhere to your program and get back to feeling pain free and stronger than you were before injury!

*Format reference Atomic Habits, by James Clear. 

What’s next? Transition from physical therapy rehab home program to work out program

I get asked by a lot of my patients as they are progressing through their plan of care and getting back to their recreational hobbies and exercises, what can they do to strengthen their core, legs or upper body. My response is you’re doing just that! Typically, the intermediate and advanced exercise progression you are starting to have in your physical therapy plan of care are exercises I (and other Doctors of Physical Therapy) perform in our own daily workout programs to improve the strength, endurance and mobility.

Physical therapy after my knee surgery (ACL, Meniscus) was an eye-opening process for me. My main goal was to get back to surfing, my favorite sport. To protect and rehabilitate my surgical knee, my therapy worked on both of my knees, but also core, back, ankles, hamstrings; everything that played a supporting role in strength and stability. This whole body approach enabled me to “pop up” quicker on my surfboard, stressing my knee less, and I was able to return to surfing after about 1 year. And yes, I’m the guy in the wetsuit doing my hip CARs and child’s pose before I hit the water. It really makes a difference for me and reminds me to use my new technique. After being “released to the wild” and cleared to surf again by my physical therapist, I stayed on with her as a personal training client. I found that it gave me the confidence to keep pushing my recovery and work through minor setbacks as they happen; and they will. It’s also extremely helpful that she knows the history of my injury and recovery. The transition was seamless, and the continuity of care ensures that my process is optimized for my personal situation. -MOTI patient Duke

After hip surgery I spent almost a year working with Megan at MOTI. The exercises she taught me have been integral as a pre-run warmup. At this point in my life I must “pre-hab” before I can jump into running or other sports, and these movements provide that base warmup that I need. -MOTI patient Zach

At MOTI Physiotherapy each Doctor of Physical Therapy will use their expertise to customize a plan of care that will help you achieve and maintain your goals you established at your evaluation. If you are in need of Physical Therapy please contact us!

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Sitting does not directly lead to low back or neck pain but can be an associated risk factor and contributing element to chronic neck and low back pain. The average occupational desk worker sits for over 8 hours a day. The sustained static and awkward seated postures contribute to increased spinal load and shear forces at both the cervical (neck) and lumbar (back) spine. It has been reported that 21-51% off office workers that sit for an extended period of time suffer low back pain. [4]

In this blog post I will be discussing the effects of a slumped seated posture has on the cervical and lumbar spine, standing desk set up and exercises that can help support your spine and posture to improve your endurance with sitting and standing postures.

“When we sit, there is an increase in the forces that travel to the disc and place greater stress on these and other lumbar spine structures. By focusing on trunk stability, active exercise, and time under tension we can create a natural brace that helps to decrease the forces that can cause injury. These tips and exercises should not only be thought of as treatment for an injury, but also as prevention for problems that may arise due to prolonged sitting. I applaud Dr. Megan O’Linn and MOTI for the recommendations and instructions to help prevent problems before they arise.”

Dr. Gene Tekmyster

Slumped Seated Posture effects on the Cervical and Lumbar Spine

The anterior to posterior reaction force at the lower neck and back was highest in the slumped position while sitting. Sitting with a forward head position and rounded low back places more demand on the extensor muscles to hold up the head and maintain an upright posture. It also impacts the joint space and creates more pressure on the disc which can lead to pain and inflammation from joint pain and muscle fatigue. [4]

Standing Desk Set Up 

In the below video I will walk you through step by step standing desk set up, monitor and keyboard position and work cycle settings for standing and sitting work periods.

Key take aways:

Monitor: Eye level or slightly below

Keyboard: wrists neutral, elbows slightly extended past 90 degrees and arms in line with your body; use a detachable key board if you are working on a laptop to allow for proper screen height

Lower body set up: standing- feet hip width apart, standing about a foot away from the computer. Sitting– hips higher than knees, knees at 90-degree bend and feet slightly wider than hip width apart.

Work Cycle: Change positions every 30 minutes, take a 10-15 minute work break after 3-4 work cycles

Exercises to help improve postural strength and endurance for the work day

1. Chin tuck for deep neck flexor endurance 
Perform: 3×10, with 10 second hold each repetition
Form: lay on back, pillow under head and knees bent. Nod your head downward by gazing your eyes over your knees and hold, then return head to midline looking at ceiling. Head should remain on pillow at all times and shoulders relaxed on ground.

2. Trunk Stabilization and breathing
Integrated spinal stabilization is the coactivation of the deep cervical flexors, diaphragm, pelvic floor, all sections of the abdominals and deep spinal stabilizers to provide spinal elongation and postural stabilization

         Perform: 4 rounds of 10 repetitions [1 second inhale: 2 second exhale]

Form: same set up as exercise 1, lightly draw rib cage in towards abdomen, belly button drawn down and lower abdominals engaging outward into pelvic bones. Bring legs up into table top position – knees over hips, slight external rotation of hips with heels inward        but not touching and toes pointing upwards towards your nose. Do not let low back or head arch. Abdomen should feel flat without doming. Breathing is in/out through the nose.

3. Standing T
Perform 3×10
Form: Hold the band in each hand, maintain abdominal activation and chin tuck from exercises 1 and 2, thumbs pointing back and arms in a 120-degree angle. Pull band back slightly, then return to midline while keeping shoulders out of ears. Do not let head drop or back arch when pulling band. Should feel muscles at center and lower shoulder blades.

• 

• 

4. Standing Y
Perform 3×10
Form: Hold the band in each hand, maintain abdominal activation and chin tuck from exercises 1 and 2, thumbs pointing back and arms in a 90 angle out to side. Pull band back slightly, then return to midline while keeping shoulders out of ears. Do not let head drop or back arch when pulling band. Should feel muscles at center and lower shoulder blades.

• 

• 

Perform each exercise 2x/day. Adherence to a 6-week program can lead to improved strength and endurance to maintain upright posture and reduce incidence of low back and neck pain. [5,6,7,8]

If you have any further questions or have been struggling with neck or low back pain, please contact MOTI Physiotherapy at either our Los Feliz, (323) 912-9166, or Highland Park, (323) 503-1414, locations. We would love to get you scheduled for a personalized evaluation with one of Doctors of Physical therapy that are movement experts and will help you achieve your goals! 

By: Dr. Megan O’Linn, PT, DPT, OCS, CSCS
Clinic Director MOTI Physiotherapy Los Feliz
Megan@motipt.com

References: 

1. Bontrup, C., Taylor, W., Fliesser, M., et al. 2019. Low back pain and its relationship with sitting behavior among sedentary office workers. Institute of Biomehcanics. Applied Ergonomics. 81.
2. Lis, AM., Black, KM., Korn, H. 2007. Association between sitting and occupational LBP. Eur Spine J. 16:283-298.
3. Mahmoud, NF., Hassan, KA., Abdelmajeed, SF., et al. 2019. The Relationship between forward head posture and neck pain: a systematic review and meta-analysis. Current Reviews in Musculoskeletal Medicine. 12:562-577.
4. Kwon, Y., Kim, JW., Heo, JH., et al. 2018. The effect of sitting Posture on the loads at cervico-thoracic and lumbosacral joints. Technology and Health Care. 26:S409-S418.
5. Falla, D., Jull, G., Russell, T., et al. 2007. Effect of Neck Exercises on sitting posture in patients with chronic neck pain. Physical Therapy Journal. 87:408-417.
6. Ekstrom, RA., Donatelli, RA., Soderberg, GL. 2003. Surface Electromyographic Analysis of Exercises for the Trapezius and Serratus Anterior Muscles. Journal of Orthopedic Sports Physical Therapy. 33: 247-258.
7. Rahimi, NM., Mahdavinejad, R. Hosseini, S., Negahban, H. 2019. Research Paper: Effect of Dynamic Neuromuscular stabilization breathing exercises on some spirometry indices of sedentary students with poor posture. Physical Treatments. Vol 9. Number3. 170-176.
8. Frank, C., Kobesova, A., Kolar, P. 2013. Clinical Commentary Dynamic Neuromuscular Stabilization and Sports Rehabilitation. The International Journal of Sports Physical therapy. Vol 8, Number 1. 62-73.

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