Breast Cancer Rehabilitation: How Soon Do I Start?

breast cancer rehabilitation lake city pt

Five times. How can that be?

Just today I heard it 5 times and I wondered how many days before that I heard the same thing.

“I Didn’t Know.”

For me it would be good to never hear that again from any of my patients. According to Dr. Sara Cuccurullo, in the Physical Medicine and Rehabilitation Board Review in 2004 she stated that, “Rehabilitation of the patient with cancer should begin when disability is anticipated, rather than after it has occurred.”

I had always done orthopedic and sports medicine care, but 17 years ago an MD I respected greatly asked me to take a look at a patient of his and determine a plan of care for her.

She was a breast cancer patient and she had had lymph nodes removed with radiation. Her arm was terribly swollen and she was in a lot of pain. Her arm was so heavy she could barely lift it.

I was taken back. I had never seen anything like this before. And from that moment on I decided that no one should ever have to suffer like that. I didn’t want to hear “Well, I just didn’t know.” So I made it part of my mission to care for breast cancer patients, and all oncology patients in my office along with my sports and orthopedic patients.

Does Seeing A PT Right After Breast Cancer Surgery Help

Quickly I realized that if I could see a patient after surgery and once their drains were removed, I could decrease the chance of physical disabilities early on just as Dr. Cuccurullo had reported. Prevention I realized was the key to positive outcomes with people who had cancer. So the quest began to never hear those words again.

Step Forward for Oncology Care is the 4 step program that came out of that process. It is for anyone who has had any type of surgery for oncology care. So as soon as your drains are removed, you need to schedule a physical therapy evaluation, by a therapist who is educated in oncology care, to create a baseline for your health plan.

Ask your MD for a referral. Come and learn the four steps so you know how to be proactive in your health and healing process so recovery is complete. It consists of exercises, special massage, skin care and compression garments (move over Spanxs).

Recovery from Cancer is not complete without physical therapy rehabilitation. Rehabilitation is not only for problems that are already present, but to help prevent problems from ever occurring.


lake city physical therapy sheree dibiaseSheree DiBiase, PT, has been a physical therapist for 30+ years and she is the owner of Lake City Physical Therapy in Coeur d’Alene, Hayden and Spokane Valley. She currently is certified through Stanford University in the LeDuc Method of Lymphedema care for oncology patients. All of her staff is trained in breast cancer and oncology care and is ready to make a plan for you and your oncology needs. Don’t wait, and never say, “I didn’t know”.

Fourth Trimester of Pregnancy: A Momma’s Brain

Fourth Trimester of Pregnancy lake city pt sheree dibiase pt

So I wish I knew what I know now about how a mother’s brain literally changes during pregnancy and afterwards.

We’ve known for years about all the physical changes, but it’s only been in the last few years that research has uncovered powerful evidence of what occurs in a mother’s brain. The level of cognitive changes is incredible and a lead researcher on pregnancy and the brain, Elseline Hoekzema, at Leiden University in the Netherlands states, “I’ve never seen anything like this in any of the data sets I’ve worked with”.

Hoekzema says “In a way, it’s no surprise given the extreme nature of the hormone floods that women are exposed to during this period, but still I hadn’t expected such remarkably robust findings and this degree of differentiation” when describing how much a women’s brain changes during this stage of her life.

Ask any mother you know about the way she felt after having her baby and she will tell you stories of forgetfulness about little things like whether she loaded the laundry into the dryer or whether she ate or slept for two days, but then she will explain how she can sense her babies every need, whether it’s due to hunger or a dirty diaper and she knows the sound of her babies cry in a roomful of other babies without hesitation.

She will become fiercely protective and she will obsess over things she never thought of before, like how to lay her baby down to sleep at night, and what organic food they should eat, so she can ensure her child’s safety at all costs.


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4th Trimester Symptoms: What Mom’s Experience

She will often experience a level of anxiety like she has never felt before when her baby has a fever or can’t sleep at night because they are teething. She can break into a full sweat at the thought of her baby having its first shots or feel a fear beyond belief when she wakes in the night and does not hear her baby breathing on the baby monitor.

This range of emotions can feel frightening and a women can suddenly feel at loose ends. She has so many responsibilities being thrown at her with her new baby and she literally feels, “out of control” with her own emotions.

Research data states that after childbirth the parts of the brain involved in “social processes and the ability to attribute emotions and mental states to other people”, which are key to raising children, increase in activity dramatically.

These changes stimulate a mother to develop a higher level of emotional attachment to their children. These changes in the brain are normal and help a women grow into a good mother. Without these changes in the brain, maternal attachment and nurturing would be much more difficult.

4th Trimester Theory: How The Brain Changes

The brain has two types of matter, gray matter and white matter. They believe the grey matter decreases in size in that region of the brain that relates to socialization and emotions, thereby allowing the white matter in that same region to increase its connectivity which enables a women to become an amazing multitasker in all avenues of her life and form deep attachments to her children.

They relate this idea to the same type of processing called “pruning” that occurs in the brain, during puberty. Only the important process are kept for the progression of life and the others are gotten rid of that do not appear as valuable.

A women needs these brain changes to raise children but it can change a women’s brain so much she barely recognizes herself anymore. This can lead to anxiety, loneliness and a feeling of separation from the rest of the women she knows.

Because many women have no understanding of how the brain will change when their baby comes, they will suffer with mood swings and possible postpartum depression alone and without understanding on how to describe their dilemma to their husband, family, friends or healthcare provider. They often feel ashamed they even have these feelings and will never speak of them to anyone as they see this as a failure in their life.

Recently, the American College of Obstetricians and Gynecologists recommended redesigning Fourth Trimester care to have a more inclusive mental and physical plan of care. This includes a screening and assessment of a women’s emotional health, along with an assessment of their musculoskeletal health by a Women’s Health Physical Therapist trained in postpartum care.

I believe their needs to be more education and understanding about what a mom’s brain and body goes through when having a baby, so that women will be open to sharing their feelings with others and not feel any judgement about their ability to be a good mother.

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lake city physical therapy sheree dibiaseSheree DiBiase, PT is the owner of Lake City Physical Therapy and the mother of three 20 something sons. She and her incredible staff believe Mom’s need to have education and training after having their babies for their physical and emotional well-being.

Please come see us at any of our three offices: CDA (208)667-1988, Spokane Valley (509)891-2623 and Hayden (208)762-2100.

Pelvic Pain After Birth: Finding Body Balance After Baby

Pelvic Pain After Birth

A new baby, there is nothing better!

Snuggling them, loving them and nurturing them becomes your new life. Suddenly the aches and pains of pregnancy and delivery are forgotten. But don’t kid yourself this is no little feat that your body just went through to make this precious new addition.

Your body goes through an amazing transformation to make your baby and if you are nursing them, you will still have hormones in your body after the birth of the baby. No wonder your body seems a little bit different or odd in its behavior.

No wonder you have stiff shoulders, a cranky back or hips that pop around when you move. Maybe your bladder is a little leaky with laughing, sneezing or coughing. Maybe you have pain with intercourse or are completely disinterested in sex at all. Maybe you are constantly constipated after baby and you are wondering why because you never were before. Well we know what it’s like and you are not alone.

What Is The Pelvic Floor

The pelvic floor is an intricate set of muscles. There are layers of them and they perform unique work as the bottom of the abdominal container. They hold the bladder, fertility organs and the bowels, and they need to remember how to work again after having a baby, because these muscles are often overstretched and over worked during pregnancy. It takes time for these muscles to heal along with the abdominal muscles.

These muscles work together with the diaphragm and you can start training them with deep breathing techniques. Take a deep breath to the count of four. Feel the lower lungs fill with air and push the ribs out to the sides. Upon inhalation the floor moves downward. Then upon exhalation count to four and feel the floor muscles contract and draw upwards towards your nose.

You can feel these pelvic floor muscles externally by placing your hand besides your sitter bones medially. As you draw the floor upwards think about lifting all the organs inside the bowl-like muscle container. The floor is not flat. The pelvic floor has front and back muscles which have an apex in the middle.

Imagine this apex moving upward as if a string is pulling the floor towards your diaphragm as you contract the floor. This incorporates all the floor muscles to work together, different than the kegel exercise, which concentrates on merely one level of the floor muscles.

The first four to six weeks after having a baby are meant to be a time of bonding, adjusting to your new life and allowing your body to heal. Don’t be hard on yourself and the way you look. Gentle re-training of the floor, abdominal muscles and core can begin once your body has healed and your body will restructure itself with time.

Pelvic Floor Health: How To Get Back To Normal

After your six week check-up with your MD you should schedule your visit with your physical therapist and they will begin training your pelvic floor and core again for daily activities and return to your active lifestyle.

If you have a leaky bladder or bowels that are not working well they can help you re-train them. If you have pain with intercourse you may have muscles that are not working properly and need to re-establish good patterns of floor movement.

If you have never been active, don’t worry they will teach you how to develop a new healthy lifestyle with baby. We look forward to seeing you, your health is your greatest asset.

lake city physical therapy sheree dibiaseSheree DiBiase, PT is the owner of Lake City Physical Therapy, PA and she and her incredible staff take care of our Mom athletes everyday.

Please make an appointment before you head to the gym if you have any concerns, our pelvic health specialists can help:
CDA (208)667-1988,
Hayden (208)762-2100, and
Spokane Valley (509)891-2623.

Core Workouts Pelvic Floor: The Four Muscles That Matter Most

core workouts crossfit lake city physical therapy sheree dibiase pt

Strength is a funny thing. Just because someone looks strong doesn’t mean their muscles know how to fire in the right neuromuscular order. There are muscles that need to have pre-anticipatory ability to fire so everything else can be safe and efficient in the system. For a sport like Crossfit that incorporates heavy weights and speed, these principles are even more important.

Four key muscle elements must exist for the core to have the strength and power it needs. They need to know how to anticipate that movement is coming and set the core up for success. These muscle groups are the diaphragm muscle on top of the canister, the pelvic floor on the bottom, the transverse abdominus in the front of the canister and in the back, the multifidi muscles.

These muscles are the core muscles. They must be in balance. They need to know their job. They are the first muscles to misfire when there is an injury, trauma or swelling to an area. If one set gets off in its signaling, the others can as well. That’s when dysfunction occurs, when muscles forget their job. When it happens for a prolonged period of time, other injuries can occur.

Crossfit Core Wod: The Ultimate Core Muscles List

The muscle that you need for your core to work optimally are:

1) Diaphragm: This muscle is a dome shaped partition that separates the thorax from the abdominal cavity. It is responsible for our breathing mechanism and it works by increasing the thorax capacity and thereby inflating the lungs. It works in concert with the pelvic floor. When you breath in the diaphragm moves down and as you exhale the diaphragm moves up.

2) Pelvic Floor: 14 muscles that are in layers in a bowl like structure in the pelvic girdle. These muscles support all of your internal organs, and the pelvic floor moves up and down with each breath you take. As you breath in, the floor goes down, as you breath out, the floor goes up.

3) Transverse Abdominus: This muscle is the deepest of all the abdominal muscles. It is often called the corset muscle. It acts the stabilize the anterior canister. It needs to be the first abdominal muscle to fire with any trunk work.

4) Back Multifidi: This group of muscles is one of the smallest but most powerful and it runs from your spinous process on your vertebrae to the transverse process of next vertebrae. They extend and rotate the back on a segmental level. They create spinal stability and decrease the likelihood of degeneration at the joints and discs. They work together with the transverse abdominus to stabilize the trunk. When the transverse abdominus fires, the multifidi should know how to fire together with it.

These four muscle groups allow for you to have a strong powerful base to work off of and that is what a good core should be have. Before you work and train for heavy loads make sure these muscles know their job and if they don’t, turn them on so they do. Engage your brain, to engage your core

lake city physical therapy sheree dibiaseSheree DiBiase, PT is the founder and president of Lake City Physical Therapy. Sheree has been a physical therapist for 33+, a clinic owner for 28+ years and worked as an adjunct professor at Loma Linda University’s School of Allied Health Professions for 7 years. Currently she is doing research on pelvic floor health and its relationship with postpartum and intense exercise. She and her staff help the community reclaim their health at their three physical therapy clinics: Coeur d alene – (208) 667-1988 | Hayden, ID – (208)762-2100 | Spokane Valley (509)891-2623.

How To Train For Crossfit: Train Your Brain, Then Your Body

how to train for crissfit lake city physical therapy sheree dibiase pt

Lake City Physical Therapy and the Hayden CrossFit crew got together for a night of education and hands-on learning. The topic was pelvic health and the athletic woman.

Crossfitters are an incredibly driven group of people and their desire to excel at high levels of physical performance is motivating. Our desire is to be able to teach good muscle motor control patterns so that they are efficient and consistent with no injuries.

The National Institute of Health reported that one-third of all women will have pelvic pain at some time in their life. It will often present with back, hip or leg dysfunction or with issues related to incontinence, bowel constipation or sexual pain.

Crossfitters have an even higher incidence of pelvic dysfunction due to the heavy loads they are lifting and the speed at which they train. Over sixty percent of all women crossfitters reported their bladder leaked while they participated in their sport and they usually didn’t tell anyone.

Crossfit Mental Toughness: How You Think Not What You Think

Here is the thing: we have made this whole muscle training thing too complicated. Really, all we need is a good, healthy brain to tell the muscles what to do. The idea is that the brain is actually the most powerful tool when it comes to training the body. When the brain engages first, the body has this ability to learn easy training patterns that facilitate the necessary motor control patterns for simple to complex tasks.

In Charles Duhigg’s new book “Smarter Faster Better,” he reminds us that managing how you think is more important than what you think. How you think is what determines your course of action. How you see what you will accomplish establishes a successful workout regimen. How you feel will give you the motivation to actually do it without any hesitation. These things make the difference in our everyday life choices.

“It’s easier to motivate ourselves when we feel as if we power the choices we make”, says Duhigg, “you’re in charge of your destiny.”

The same principles apply to training the body. How you train is everything. If there is a weakness, you systematically go back to the basic training, to re-establish the system. How do you do this? By learning the basic principles that establish good movement patterns from people who know and understand them.

Crossfit Movements: Using Kinesiology To Identify Patterns

Kinesiology is the study of movement, and that is what I taught at Loma Linda University, School of Physical Therapy for seven years. You have to know normal patterns of movement first, then observe the patterns you see before you and break them down to rebuild them back up again.

All high level athletes have to do this throughout their training regimes, especially if they add more weight, increase endurance or do more sophisticated patterns of movement.

The brain is a key part here, because the brain can visualize the activity and see the muscle doing its job. You just have to slow down enough to have the brain facilitate it, then you can power back up to speed. So decide now to use your brain power to reboot the system.

lake city physical therapy sheree dibiaseSheree DiBiase, PT is the founder and president of Lake City Physical Therapy. Sheree has been a physical therapist for 33+, a clinic owner for 28+ years and worked as an adjunct professor at Loma Linda University’s School of Allied Health Professions for 7 years. Currently she is doing research on pelvic floor health and its relationship with postpartum and intense exercise. She and her staff help the community reclaim their health at their three physical therapy clinics: Coeur d alene – (208) 667-1988 | Hayden, ID – (208)762-2100 | Spokane Valley (509)891-2623.

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Lymphedema After Mastectomy: Why Swelling Happens and How To Fight It

Lymphedema After Mastectomy

A few years ago at Stanford University I had the opportunity to study with Jean-Paul Belgrado, PT, a leading Belgium researcher from the Universite Libre de Bruxelles in Belgium, in the field of lymphedema.

He presented at the Breast Cancer Conference the possible reasons why lymphedema occurred after surgery.

What Is Lymphedema

Lymphedema is the accumulation of protein-rich fluid that normally the lymph system can easily transport out of the system, but for some reason the transport system is damaged and there is a backlog of this fluid that fills up in the outer layer of the tissue.

It was a common idea for years that you would you be at risk only if you had more than five lymph nodes removed and had radiation, but now we know that this is not the case.

Patients who have had an axillary lymph node dissection have a lifetime risk of 15 to 25 percent of occurrence. Even if the patient only had the sentinel node removed (which is considered anything under four lymph nodes) and no radiation, there is still a six percent chance of occurrence.

Because of this a physical therapy evaluation by a trained breast cancer specialist is the key, because there you will receive education, precautions and prevention techniques to allow you to return to your active lifestyle with no worries about whether or not you are at risk.

Here are some of the possible reasons why lymphedema can happen after breast cancer.

Lymphedema Breast Cancer

1. Surgical Intervention — What type of breast cancer surgery did they have? Was there an axillary resection with lymph nodes removed? Or was it only a sentinel lymph node? If there was an axillary dissection performed, was the sheath of the axillary vein compromised when the nodes were removed? Where are the scar lines located? Are there multiple scar lines blocking the fluid flow patterns?

2. Chemotherapy — They have evidenced that certain drug interventions produce an inflammatory response and this increases the possibility of lymphedema. A physician in the EU has recently documented a list of meds that have been noted to increase this level of edema.

3. Radiotherapy — It has been seen that with radiation of the breast tissue and the axillary region you can compromise the fluid movement patterns. All patients who have had radiation need to have an evaluation to determine skin integrity and scarring in the area of radiation and surrounding tissue to determine lymph flow health patterns.

4. Scar tissue — The scar lines are significant in how the pattern of fluid can move. If they are restricted, thick, hard and immobile, then back flow of the fluid can occur around and behind the scar lines.

5. Genetic — It has been evidenced that there is a genetic tendency towards edema in certain groups and populations.

6. Physical Activity — What is your level of physical activity at work, home and in you community life? There must be a balance in your activity level where you are activating the muscle pump but not increasing the level so high, with such repetitive activities, that you create an inflammation.

7. Body Mass Index — The level of obesity affects the amount of fluid that might occur. The higher the BMI, the greater the likelihood of edema that can occur especially if their BMI is over 30 percent.

The above list needs to be considered and looked at to determine if you are at risk for lymphedema. Because of this, all breast cancer patients should have a baseline examination with a physical therapist specifically trained in breast cancer management, as soon as their drains are removed, or twelve to fourteen days after surgery, to establish a plan of care for their musculoskeletal management and to see if they are at risk for lymphedema and venous issues.

These issues can be prevented and cared for early on if they are at risk and their quality of life can be insured.

lake city physical therapy sheree dibiaseHi I’m Sheree Dibiase, PT owner and founder of Lake City Physical Therapy. I’ve been in PT for 35+ years and am so lucky to be able to share what I’ve learned through my career.

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Fourth Trimest for mom Lake City Physical Therapy

If you are a Mom or know a Mom who has had a baby in the last 10 years, whether by vaginal delivery or C-section, we need you now.

Lake City Physical Therapy is doing a community-wide “Postpartum Moms Study” to determine how moms are doing after having their babies and if they need more help with postpartum care so they can feel better, faster. The American College of Obstetricians and Gynecologists (ACOG) is calling this postpartum time frame the “fourth trimester.” They released new information in April 2018 because they recognized the needs of women after having a baby were not being met. They stated that they felt physical therapists would be an integral part of this new plan of care for postpartum women.

Postpartum Care For Mom

Lake City Physical Therapy began its data collection for our Postpartum Moms Study in December of 2017, as we had already recognized that the women of our community needed earlier intervention for better long-term quality of life outcomes after having their babies.

The first step in the study is for each Mom to fill out our private medical survey. Please go to our website,, and fill out the survey there. Then you will be sent an email to sign-up for a physical therapy screening. After the screening you will be given a set of exercises to follow on your electronic device for three months from a free app portal. Some of the Moms in the study will be asked to participate in once-a-week classes as well. At the end of the three months, everyone will be re-assessed.

We already have some preliminary data from our online survey, and it appears we have work to do in our medical community to make the lives of our moms better. Bladder emptying issues were logged in at 25 percent, inability to stop the flow of urine 36 percent, pelvic/genital pain was at 35 percent, painful bowel movements 21 percent, painful intercourse 42 percent and painful periods at 52 percent — and all of this occurred within 10 years of having children.

We are hoping to get more women involved in our Postpartum Moms Study by the end of September. If you are a medical provider or a possible participant, please feel free to contact me at shereelcpt at with questions. Otherwise, go directly to our website to sign-up. We will be using some new technology in the physical therapy screening to be able to assess and train the pelvic floor through the abdominal region.

Even if all you can do is fill out the medical survey, it will at least give us a better idea of where our community is at with women’s health care, and what we need to do to make a difference.

If you can make the three month commitment to be part of the exercise component of the study that would help us even more. Then we can continue to refine and further develop a solid postpartum program for our community.

This is an exciting time in women’s health care in our community, and you moms can make a difference for the future of all women. Please consider being part of Lake City Physical Therapy’s Postpartum Moms Study and help us move forward with education and training to elevate the lives of women in our region.

Why Sooner Is Better For Mother’s Postpartum Care

Postpartum Care lake city pt physical therapy spokane

Why Moms Need Postpartum Care

Our bodies are ever changing, regardless of our age, but for women in the child bearing years it can be especially challenging. The body goes through so much during pregnancy and a Mom has such limited time frames to take care of themselves. The demands of motherhood, family and work life mean that women are particularly susceptible to health issues, after pregnancy. After pregnancy however it is vitally important to retrain the core muscle system, due to the anatomical changes and forces that have occurred during this time pregnancy.

During pregnancy, all the abdominal muscles are overstretched, the abdominal contents are pushed up under the ribs and out to the side. The pelvic girdle is spread apart up the as the developing baby is demanding more room.

How Does Your Body Change During Pregnancy

During the 4th through the 6th months of pregnancy, the joints of the pelvic girdle become overly relaxed due to the body’s hormonal changes. The sacro-iliac joints and the pubic symphysis are greatly affected and the “pregnancy spread” occurs. The pelvis and hips become wider and the need for women to be physically stronger in their core increases due to the increased load factors, whether during pregnancy or after, do to the need to carry, feed and handle their babies all day long.

These bodily changes our normal for women during the child bearing years, but research done by Wu et al 2004, stated that 45% of women will have low back and pelvic girdle pain during pregnancy and 25% will have this same pain postpartum. This pain in the back and the pelvis appears to be made worse by daily activities, such as transitional motions like rolling in bed, sitting to stand, prolonged sitting, standing and walking, and often during to return to sport activities.

Women’s health physical therapy becomes a key component during this time frame, especially if back and pelvic pain are present during or after pregnancy. Research indicates that often back and pelvic pain proceed pelvic floor dysfunction.

When Does Pelvic Floor Dysfunction Happen For Moms

Pelvic floor dysfunction may include poor muscle coordination during daily activities, urinary incontinence, bowel constipation, and sexual dysfunction. As a result our Moms our at risk for pelvic floor dysfunction, if they had back or pelvic pain during or after pregnancy and early intervention is needed before the pelvic floor then becomes a problem.

During pregnancy multiple areas in the body experience changes. These changes can occur in the muscles, ligaments and fascia. In the abdominal region, often the linea alba line, which is the middle line of your six pack, will overstretch. If this linea alba is overstretched it can’t generate good control of the rectus abdominus (RA) muscles. The abdominal muscle called the Pyramidalis, which base attaches to the pubic crest and symphysis and goes into the RA muscles, will often be disrupted due to pregnancy loads and widening of the pubic symphysis. Normal widening occurs at pubic symphysis of 5 mm during pregnancy. In order to effectively function with your core, the body needs to be able to generate tension along the linea alba line, so that the RA and the other muscles can assist in stabilizing the low back, pelvis and the low thorax during all activities. According to Lee “the sooner an optimal strategy for transferring loads between the thorax and the pelvis is restored, the better” for women after childbirth.

The endopelvic fascia is a complex mix of connective tissue, that is actually a fibromuscular system that supports the urethra, the vaginal walls, and the rectum according to Cundiff. It supports all the pelvic organs and is often adversely affected during vaginal delivery. This system being intact ensures a decrease in the likelihood of pelvic organ prolapse. As a result if there is disruption of the endopelvic fascia, pelvic organ prolapse becomes more common and resulting surgical intervention is necessary, such as cystocele, rectocele etc.

How Much Do Muscles Stretch During Delivery

Often over stretching of the pelvic floor muscles occurs during delivery. According to DeLancey, the pubovisceral muscle, actually elongates 3x it’s normal resting length during the second stage of labor. It is often that muscle that tears, and then it’s lack of support directly affects a women’s continence after delivery and beyond.

As you can quickly surmise, education and prevention are needed throughout pregnancy and postpartum. The ability to teach good integration and coordination of the muscles of the core is vital. It is necessary to ensure that the pelvic floor muscles and fascia are healthy enough to sustain load and if they are not, it is important to learn how to protect and train them. The outcomes for women’s health during their childbearing years improves steadily the sooner intervention occurs.

lake city physical therapy sheree dibiaseSheree DiBiase, PT is the owner of Lake City Physical Therapy and she and her amazing staff are here for you during pregnancy and beyond, to ensure you have the quality of life you desire. Call us in our Hayden office (208) 762-2100, CDA office (208)667-1988 and in our Spokane Valley office at (509)891-2623.

How Moms Retuning to the Gym Can Check For POP Symptoms

How Moms Retuning to the Gym Can Check For POP Symptoms

This past week alone I’ve seen multiple women in my private outpatient physical therapy practice, Lake City Physical Therapy, with Pelvic Organ Prolapses (POP) .

I know it seems difficult to imagine, but’s this can happen at all stages of our lives. Any woman who has ever delivered a baby, whether by vaginal or C-section delivery, has the potential risk, at some time or another, of having a POP. No matter if you are a new Mom, or a Mom of 4 small children, or a grandmother of lots of grandchildren, you need to know this could occur.

Research indicates this can occur through the natural labor and delivery process, with a higher prevalence for those with vaginal deliveries, multiple births and any trauma, which may or may not include forceps or vacuum assisted delivery. That being said, it is the resulting symptoms that can occur immediately or over the course of years that are what we are concerned with in pelvic health.

When Does A Pelvic Organ Prolapse Happen

A Pelvic Organ Prolapse (POP) can occur when there are changes in the muscles and connective tissue structures which supports the internal organs of the pelvis, allowing the internal organs of the pelvis to descend out of their normal position.

These internal organs are the bladder, vagina, uterus and bowels. Often my patients describe a feeling heaviness or pressure in the floor. Quite frequently they say they feel a bulge or fullness in the floor and they can see something there, that they couldn’t see before.

According to the American College of Obstetricians and Gynecologists prolapses are described by the organ and tissue that has changed in the floors alignment. You can see example videos of this by going on their website

Cystocele – is the bladder falling into the vaginal vault.

Rectocele – is when the rectum drops forward and down into the vaginal canal.

Uterine prolapse –  is when the uterus drops down into the vaginal canal.

Uterovaginal prolapse – occurs when both the uterus and vaginal tissue begin to fall.

Urethrocele – is when the urethral tube from the bladder begins to fall into the vaginal region.

Vaginal vault prolapse – can occur when the vaginal tissue begins to fall out and this often causes the bladder and rectum to come with it.

The severity of a prolapse is determined by how far the tissue has descended and how close it is to the hymen near the vaginal opening. Grade 0 is no change. Grade I is a mild prolapse and the tissue is greater than 1 cm from the hymen, vaginal opening. Grade II is within 1 cm of hymen, vaginal opening and a Grade III and Grade IV means the tissue has descended below the hymen, vaginal opening area.

How To Check For A Pelvic Organ Prolapse

Please do not be alarmed when you examine yourself. The prevalence of this postpartum is to be expected and you will not be examined by your MD generally till 6 weeks after labor and delivery. These tissues take time to heal and they must be given adequate time postpartum, especially if you are nursing. It is the symptoms post 6 weeks we are most concerned with in the pelvic health arena, if they persist with no improvement, they can become a long-term health issue.

If you have a prolapse, it does not mean you will have symptoms, but it does mean you should have the understanding and know the necessary interventions that should be done for the pelvic floor muscles and their corresponding connective tissue, to prevent further disruption, whether for exercising at the gym or another pregnancy.

If you have symptoms then you definitely need intervention. Symptoms may include pelvic, low back or hip pain at rest or with activity, urinary frequency greater than every 2-4 hours, urge with urinary leakage before you get to the bathroom, stress incontinence, with coughing, sneezing, laughing, bowel disruption, whether leaking or constipation, pain upon sexual intercourse, immediately or that lasts for 2-3 days.

How To Know If Symptoms Are Signaling A Prolapse Or Not

Please do not assume if you have this symptoms you have a prolapse. You may have an overactive pelvic floor which leads to myalgia which can occur in any of our athletes and our moms returning to the gym without proper instruction on pelvic floor contract relax integration.

Here is where good abdominal and pelvic floor function needs to be addressed. An overactive external oblique abdominal muscle can cause a downward pressure to the floor making a POP worse or other of the above listed symptoms. Many of our elite and high functioning athletes, women and men alike, have an overactive pelvic floor.

Moms, here are the key points you should be able to demonstrate before returning to the gym or any work out regime no matter your age:

1) How to do a full pelvic floor contraction-(please note it is not a traditional Kegel and please do not stop and start the flow of urine why you are voiding as it confuses the biofeedback loop of the bladder) the pelvic floor muscles are shaped like a diamond- close all the openings in the pelvic floor and then lift the diamond upwards. Knowing how much muscle tone the floor needs with walking vs lifting loads ie baby or weights via the gym is important. These muscles also need the ability to fire quickly as well,due to 30% of them being fast-twitch muscle fibers. With quick heavy loads at the gym they need to be trained to do this work, so no lift voiding occurs.

2) How to integrate your breathing mechanism into assisting the pelvic floors to contract. “Blow” before you go with any and all loads, as exhalation aids in floor contraction and function. No bearing down with lifting weight loads, as this pressures pelvic organs inferiorly and can make a mild prolapse worse.

3) How to turn on all you Core muscles so they integrate appropriately. Your abdominal muscles are a powerful tool in lifting the pelvic floor during its contraction but they must be used in the right order to provide lift and protection of the floor esp with weight lifting. It’s like listening to great music, it only sounds wonderful if everyone is playing in the right order.

4) How to use aerobic exercise to increases pelvic floor health. A recent study indicated that daily walking increased blood flow to the floor and was successful at decreasing symptoms of pelvic floor dysfunction.

Please before you return to the gym or to your workout regime, know your own body. If you are having any of the above symptoms, or you are symptom free but not sure with your current workout you are progressing as you should be, please see your MD, OB/GYN for an exam and your pelvic health physical therapist to have a musculoskeletal evaluation for education, training and correct integration of core health. You only get one body, please take care of it, it’s a powerful gift.

lake city physical therapy sheree dibiaseSheree DiBiase, PT is the owner of Lake City Physical Therapy, PA and she and her incredible staff take care of our Mom athletes everyday. Please make an appt before you head to the gym if you have any concerns, our pelvic health specialist can help:
CDA (208)667-1988,
Hayden (208)762-2100, and
Spokane Valley (509)891-2623.