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 www.acog.org.

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.

Physical Performance: Is It Age Related?

physical health is age related

Often we assume our physical abilities and resulting physical decline is merely associated to our respective age. We often feel defeated before we even start exercising, and we wonder if it’s even worth our time. We know that physical performance can decline in middle age, but is all about biological age or a chosen sedentary lifestyle that steals our ability to perform physically?

What Age Do We Start To Become “Old”

According to a group of German physicians who studied the times of over 900, 000 marathon and 1/2 marathon runners, aging did not predict the decline of performance in middle age, only the negative consequences of a sedentary lifestyle was a predictor. In fact, “no significant age-related decline in performance appears before the age of 55”.

In the research study, “Physical Performance in Middle Age and Old Age”, the runners, whose times were assessed, ranged in age from 20-79 years old. They then a analyzed a health questionnaire for 13,171 runners regarding their sports, lifestyle and overall health.

Interestingly enough they discovered that even relative “newcomers” to running, those who only entered the sport in the last 5 years, were able to excel at high levels of performance through regular training, even if they were a non-athlete.

It was also noted that, only a moderate decline is seen after the age of 55, “in fact 25% of the 65-69 year olds were faster than 50% of the 20-54 year olds.” The survey also revealed that 25% of the 50-69 year olds had only started running in the last 5 years.

I think that’s pretty impressive, that these runners were able to excel due to their training regime and that their age had minimal effect on their ability.

How Does Lifestyle Affect Longevity Of Health

We know then that our lifestyle choices are the real link to our declining physical performance. Poor diet, excessive alcohol consumption, smoking, lack of exercise, and obesity are the direct connection to physical decline and there is no getting around it.

Today in the US we have over 51 million people that are 65 years of age and older. It is the first time in the history of our country that we will have this many people in this age bracket. It is not ok to assume that just because they are advancing in their biological age, that they can’t be physically fit.

Physical fitness starts with making good choices everyday for an active life. Walking is one of the easiest ways to start. Even if it’s starting at 3-5 mins and progressing slowly each day with a few more minutes, till you reach 60 minutes a day. One study in the UK revealed that walking decreased blood pressure, resting heart rate, body mass index, increased VO2max, decreased cholesterol, decreased depression and improved overall physical performance.

How Do I Start Making Healthy Choices Now

Please start now. See your MD and your fitness performance physical therapist. In my profession of physical therapy this is what we do everyday. We assess your current physical function and decide how to improve your physical health through specific fitness training for you. Your individualized fitness prescription is what you need.

Evidence states that sedentary lifestyles lead to early decline, and that activity leads to longevity and improved physical performance. Please never give up on your physical health, your body is counting on you. You can do it, we can help!

lake city physical therapy sheree dibiaseSheree DiBiase, PT is the owner of a Lake City Physical Therapy and she and her incredible staff want you to have an active lifestyle. Call us so we can help get you moving, CDA office (208)667-1988, Hayden (208)762-2100 and Spokane Valley (509)891-2623.

What Is The Female Athlete Triad And Why Is It So Dangerous

what is the female athlete triad

Physical literacy is a real need for our young athletes.

Whether you are a female or a male athlete in a highly competitive sport or playing with other friends in your neighborhood, it’s important for parents to know that a woman’s body develops differently than a man’s body, and because of its unique cycles, it can develop other complex issues that need to be talked about and addressed in order for our girls to become healthy women.

What Age Do Women Grow Most

Our young female athletes need to understand their bodies. From the age of 8-25, they experience many unique changes.  Bone growth happens early and they will often have their growth spurt usually,  before their male friends.

A girls feet usually grows first from the age of 8-10 years old.  Their pelvis develops and their hips widen, and their spine lengthens.

Their legs and arms grow quickly between the ages of 9-13 and sometimes they have a gangly stage, where they are all arms and legs. Their peak height velocity is usually reached by 11-12 years old, but their peak bone mass is not reached till approximately 19 years old.

During this time your Women’s Health Physical Therapist can be particularly valuable at helping your young athlete learn how to move in their ever changing body. They can train them to know how to move for their sport as they are movement specialists, and they can help prevent long- term injury, relative to their sport.

What Age Do Women’s Brains Develop Most

Their cognitive brain growth is high during the ages of 9-13. It is often called the “magic window” in time, due to the brain and the nervous system being so active in hard wiring themselves.

The psychological stress due to so many bodily changes is evidenced. As the  body is growing in all avenues,  their hormones are changing that affect their sexuality.  Around this time they often get their menses.

This affects them psychologically and they can go from being emotionally stable young girls in their daily life, to highly moody young women.  They tend to internalize everything and blame themselves and others, as they don’t feel like themselves, but have no idea it is due to so many physical changes their body is going through.

These physical changes affect the nervous system and they can become especially agitated and short with their parents and friends. They may retreat to be alone or become overly involved in social cliques or groups, with bullying being especially high during this time frame.

Many girls feel left out and have no tribe. Other girls lead the tribe and our inclusive, but some become “mean” girls.  This is a time of great vulnerability and decision  making  for young women.  Their  physical body is affecting their bodies perception of itself and their social network. Girls who have been friends since kindergarten suddenly are no longer friends.

How To Have Conversations With Your Daughter About Body Changes

The family health climate also directly affects these young woman. Positive self image reflection from their parents is necessary to help them adjust to the new physical bodily changes and the changes in their cognitive awareness.

This can be a scary time for young woman and the family, extended family and good family friends can assist in stabilizing their world view of themselves. It is a time where a parents consistent presence is needed, but not often wanted.

Find things that bridge the gap, that you can do together to have common ground, but that give them choices and freedom. Many of our parents are a steady presence at team functions and haul around carloads of girls, quietly listening and directly the next generation of women.

Many of our young women athletes are at high risk, especially in competitive sports,  for the “women’s athlete triad”. This triad consists of low energy levels, low bone mass and no menarche. (Often young competitive athletes do not get their period due to their high level of training, this is not optimal and needs to be addressed with their health care provider).

What Is The Proper Nutrition For Female Athletes

This appears to be the time frame during which nutritional information needs to be discussed with our young women and intervention needs to occur, in order to deter the obsessive compulsive patterns that can elicit a propensity towards eating disorders.  There is a lot of pressure for the young athlete to stay fit, but their is a greater pressure it seems, to have a certain type of body that they see and read about in our social media.

They  need to understand that nutrition is fuel and you can use it to enhance performance. Good eating habits facilitate bone and muscle mass production. Instead when they don’t fit the “right body” type, they feel insecure and afraid and they stop eating foods that provide the fuel they need and they begin habits that can hurt them throughout their lifespan, physically and cognitively.

They can develop iron deficiencies, mood disorders and body image issues to name a few. Research indicates that young women are not learning about these things in school and their parents and medical providers need to become actively involved in this process.

Please don’t wait.  Have conversations with your daughters, the parents of your daughters friends to insure you are caring for your active,  young women athletes correctly. There are many free online medical resources and your health care providers can help to make a long-term difference in the health of our athletes.

lake city physical therapy sheree dibiaseSheree DiBiase, PT is the owner of Lake City Physical Therapy and her amazing staff can help our young athletes have a fun, exciting athletic career.  Please call us in CDA (208) 667-1988 | Hayden (208)762-2100 | Spokane Valley (509)891-2623

What You Need To Know Endometriosis

What You Need To Know Endometriosis lake city physical therapy

Susie woke early one morning with a cramping, pulsing pain in her pelvic and lower abdominal region.

She assumed it was her menses starting, but she noticed it seemed like this pain continued to progress each time she had her period and often throughout the days of her cycle.

Sometimes she had constipation or diarrhea and other times her period was so heavy and irregular that she wasn’t sure what was going on.

She often felt pressure, tugging and pulling when she moved and there went her exercise regime right out the window. She felt like as time went on she struggled to function effectively with her home and work schedule during this time of the month.

She wanted to get pregnant, but it had been a year of trying and she was getting frustrated. Everyone told her to just relax, but how could she just relax, she didn’t feel good, most of the month.

What Is Endometriosis

Endometriosis affects more than 5.5 million women in North America and it is one of the most common gynecological diseases. It occurs when the endometrium, which is the lining in the uterus that is shed during a women’s menses, grows similar cells outside the uterine cavity, often in the abdominal cavity, called endometrial implants.

This growth can occur outside of the uterus, ovaries, Fallopian tubes or intestines. These implants can grow even farther from the uterus and have been sited in the lungs and brain, however this occurrence is very rare.

Endometrial cells are shed during menstruation, however these cells are not located in the uterus, so they have no way to be expelled from the body in the normal fashion.

Therein lies the problem.

These endometrial cells grow, breakdown and attempt to shed but have no where to go. They then cause a chemical breakdown in the region where they are attached and this chemical reaction can cause pain locally and in the surrounding tissue.

Often, there can be large areas of scarring that happens in the abdomen due to the chemical changes that occur in the tissue. When any movements are made a tightness or restriction can be felt especially during the menses cycle. The amount of pain a women feels does not coincide with the amount of endometriosis she has. She can have a small amount with a lot of pain and vice versa.

What Are The Effects Of Endometriosis

One of the common side effects of Endometriosis is infertility. This does not mean you won’t ever conceive. If the endometriosis is mild or moderate in nature up to 70% of the population will take up to 3 years to get pregnant.

This, as you can imagine, can be a huge frustration for women because often they are unaware they even have the disease. Some women will never have any symptoms and don’t know they do until they are trying to conceive.

Endometriosis is most often diagnosed between the ages of 25-35 and can start at the onset of puberty. After menopause, generally the symptoms decrease in nature,however scarring and tissue changes can remain.

How Long Before Endometriosis Goes Away

Endometriosis is a chronic disease. There are a variety of treatments that include the use of hormone therapy ie birth control pills, hormone blocking therapy and surgical interventions.

There are different surgical interventions, and depending on a woman’s age and their desire for children, these interventions need to be discussed extensively with your MD, prior to surgery, to determine what surgery is best for you.

Endometriosis and it’s side effects can be helped with physical therapy. The abdominal pain and scarring pre and post surgery can assist a patient in pain reduction and interventions can be established for a better quality of life. Learning how to live with this disease is part of the wellness See your MD today and start your journey towards healing.

lake city physical therapy sheree dibiaseHi I’m Sheree DiBiase, PT  the owner of Lake City Physical Therapy. My wonderful staff and I specialize in women’s health issues, along with women athlete performance.

Please come see us at one of our locations: Hayden office (208)762-2100 | CDA office (208)667-1988 | Spokane Valley office (509)891-2623.

Does Taking A Break Re-Energize You

taking a break good for creativity lake city pt

Taking a break means something different to everyone. Some people head to see family for their break and relax at grandma and grandpas. Some people hit the beach and sit in the sand and get tan. Some families go on adventures such as skiing, sightseeing in San Francisco, or biking in Moab.

All I know is every once in a while everyone needs a break from the normal routine in life. So if you have decided, this week, to take a break from work, school or your regular schedule, don’t throw out your exercise too. Your heart and lungs are your hardest working systems, and thank goodness they never take a break.

Your muscles and joints can’t take a break, either, because muscles atrophy, or reduce in size in 3-5 days. That is fast. All that hard work in the last four months and all our gains have begun to disappear. Three days and the joints just don’t have the lubrication from the synovial fluid in them that they need, also. Synovial fluid is made when we move our joints, and that fluid is for the joint, like oil is for your car.

Without exercise nothing works quite right. I know some of you never stop training, and you on the other hand might be the one that has been training so much that you now have a tendonitis or a muscle strain or joint sprain.

That happens when we train in such a repetitive way or you have overworked a pattern of movement that causes the muscle and joint to start talking to you everyday. Remember that pain that lasts more than 3 days with training is not normal. Pain when you are training is telling you something and you need to listen to it.

If running is causing your knee to hurt every time you do it, but not when you are walking then something is wrong in your running mechanics and needs to be assessed. This is where your physical therapist comes into the picture. This is the physical therapists expertise.

They know how to assess movements and they are trained in being able to see dysfunctions in your normal movement chain. They see people everyday that have overuse syndromes and they assist people in overcoming these challenges. It may be that the runner with the patellar tendonitis has a hip that is too weak.

It may be they have IT band tendonitis because their hip flexor is too tight. Whatever the mechanics if your training regime includes a pain pattern every time you do it, something is not right. If you have iced and elevated and taken Advil and you still have pain after two weeks, you need a little assistance.

So head in to see your physical therapist. They can evaluate you in an hour and have
you back on the road again, with a home exercise regime of stretching and
strengthening of specific muscles, some kinesiotex taping, laser, ultrasound, etc so
no long-term break is necessary.

Sheree DiBiase, PT is the owner of Lake City Physical Therapy and she and her staff
can be reached at (208) 667-1988 for an evaluation, education and instruction so
you can be back out on the road again in no time. No break necessary.

How Acknowledging Blessings Betters Mental Health

How Acknowledging Blessings Betters Mental Health lake city pt

Miracles are all around us.  Some are big and some are small.  Some seem like your heart just grew a million sizes in one moment, just like the “Grinch”.  Some are just tiny wonders, like the melting of your heart when you see the joy of your family all together at the Holidays.


Miracles are defined by “a surprising and welcoming event that is not explainable by natural or scientific laws and is therefore considered to be of a divine nature.”  Words, such as, wonder, marvel, sensational, spectacular and mystery come to mind. These extraordinary events are beyond my comprehension.  I consider them miracles that you and I will never explain.


In my profession of physical therapy, I see these miracles all the time.  My patients’ bodies heal from injuries that often are so debilitating that I am shocked at their resilience.  Clearly the body was broken and now it is well. Clearly death knocked on the door and they were healed.  I can’t even understand it, but the human spirit is so powerful and strong I am overwhelmed.


This time of year I have seen so many miracles that I often wonder why right during the Holidays?  I can never begin to explain these incredible phenomena at all but I know that they are all around us.  I was just reminded of an incredible story this past week of a dear family to my whole office.  The beautiful Mom went into labor on Christmas day and she had some complications and ended up in Spokane with her new baby.  The baby was at high risk.  They were told that she would not make it.  They were told she would have developmental issues if she did make it.  The doctor told the family and the grandparents to prepare to bury their baby.  The family said no to this idea and they said they couldn’t accept that verdict.  They called out to everyone they knew at church and in our community and all over the country to pray, to reach out, to tell everyone they could think of that they needed a Christmas miracle!!   She was a Christmas baby and she needed divine intervention.

Everyone prayed, waited, believed and the family rallied at the hospital meanwhile loving all the other families with sick children on Christmas on their hospital floor. People donated gas cards, vouchers for everything from electricity, food and toys for other families and kids on the floor.  She was released from the hospital 3 weeks later.  This year she will be 2 years old on Christmas with no visible signs of any health deficits. She walks, talks and gets into everything.  As you can well imagine, we are all still in awe. It was a Christmas miracle right here, right in front of us, right before our eyes.


As you start this crazy, wild Holiday Season I would challenge you to look for the miracles all around you everyday.  I know sometimes it doesn’t seem possible or probable but I am here to tell you they happen.  We see them in our clinic all the time.  Like the man whose lower leg was shattered and they said he would never use it again and now he climbs ladders with no brace and works like a wild man. Like the lady whose family thought she would never wake up after having a terrible stroke and now she snowshoes and hikes with her family.  Like the teenager who blew out his knee and they said you will never pitch again and he does.  Never doubt the human spirit, never stop believing in the physical healing available for your health issues, and never ever give up on the amazing gift of your life.    Watch for the miracles this Holiday in the hustle and the bustle, little and big, you will be amazed.


Sheree DiBiase, PT and her staff believe in the amazing potential in the body to heal itself and often it just needs a little help and direction in physical therapy, so let us be part of your healing team this Holiday Season and throughout the year. If you have a miracle to share please email us at shereelcpt@gmail.com.  We can be reached in our CDA office at (208) 667-1988 and in our Spokane valley office at (509) 891-2623.



Postpartum Moms Study

Study starts October 1st

Average time to finish form: 9.2 minutes

We’re so excited and thankful to have you involved in this study.

All the data collected below will be kept confidential.

We are collecting this data about postpartum health so we can make the lives of Moms better after babies and for better long term outcomes for their quality of health.


Hiring Physical Therapist

Looking for Women’s Health Physical Therapist to join our team. Exp preferred, but willing to develop long-term employee who displays commitment,dedication to our profession. Speciality in women and men’s care throughout their lifespan from orthopedic, sports medicine, PRP, anti-aging, pelvic, oncology and lymphedema health issues. One hour evaluations, 45-60 min RX. Competitive compensation with opportunity for growth and benefits for over 32 hours a wk. 3 practices in Hayden,CDA and Spokane Valley.

How Long Should I Wait To Exercise After Pregnancy

How Long Should I Wait To Exercise After Pregnancy lake city pt sheree dibiase

We Mom’s have a lot going on everyday. Kids, husband, work, errands, laundry, spit ups, food fights and then the end of the day rolls around and we are exhausted. We lay in bed at night and think, “Did I even do one thing toady, that took care of me?”.

Often the answer to this question is no, but in our heart, we know we really need too and we really want to be better at taking care of ourselves. So where do we start and what do we do?


The Importance Of Learning How Our Bodies Work

How Long Should I Wait To Exercise After Pregnancy lake city pt sheree dibiase 1

Recently a study was released on the importance of education and how teaching people how the body works actually trains the brain to see things differently. The study revealed that even if all we did was learn about what the body did during a normal movement pattern, that it helped our brain re-prioritze itself and re-set its neural input structure.

I’m not saying you don’t need to do your exercise, because in my profession of physical therapy we know this is necessary, but what I am saying is that once the brain understood what the body was suppose to do, it was able to re-establish a powerful, healthy pathway that could make it more successful before even doing it.

I have been mesmerized by this idea, as sports psychology has always played a huge role in my athlete’s long-term success. Well it’s no different for us as postpartum Mom’s. We are all athletes. Any woman who has worked over 9 months growing a baby and then delivered a baby by vaginal or C-section has done an incredible feat from the physical and mental prospective.

Her body has been transformed to into a factory to make another human being and every cell in her system is working at maximum capacity. She has increased blood volumes, heart and lung capacities and hormones. She is one tough cookie.

A sweet baby is here now and a different type of exhaustion can happen and we Mom’s are left with trying to figure out how to put this amazing body back together. Birthing a baby is an athletic event.

The body delivered, whether through the vaginal floor or abdominal cavity a baby, and it has forever changed the physical self we once had. Each way of birthing has its challenges, physically and emotionally. Depending on baby size and a mother’s body structure, the physical system has changed and we must be willing to accept and re-train the physical system so it is once again be at full strength.

How Do Pelvic Floor Muscles Work

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The first thing to understand is the relationship of the pelvic floor and the abdominal muscles. Both have taken on a lot of challenges throughout this pregnancy. They have been overstretched, weighed down and every organ in the abdominal cavity re-arranged. Our bladder and bowels have had new pressures and been strained with night time voiding and days of constipation. Our back and diaphragm muscles, which are also part of the core muscles, have been overworked and stressed out as well, due to the load of carrying a baby. So where do we start?

The first place to start is to be easy on yourself and let your body heal, allowing your hormones to adjust and your sweet baby and yourself to get in sync together. In the first 4-6 wks, you can begin with daily pelvic floor and abdominal isometric activation with contract and relax patterns. This means gentle contractions, not maximal contractions are needed and they can be done simply, in multiple positions, whether laying down, sitting or standing.

The pelvic floor muscles are striated muscle just like the ones in your leg or arms. If you don’t use them for 3-5 days, they atrophy. If they have any trauma during delivery, tears in the pelvic floor muscles that had to be repaired or a C-section surgery, all these muscle will take longer to heal up to 2-4 wks.

The external pelvic floor muscles that you can see are shaped like a diamond. They go from the bones on either side that you sit on, to the pubic bone in the front of the floor to the tailbone in the rear. These muscles are responsible for opening and closing the urethra which controls your bladder voiding, the anal sphincter that controls you bowels and the closing of the vaginal doors, along with sexual pleasure.


What Is A Kegel

These are often the muscles we are using when we do the traditional “Kegel”, which is to start and stop the flow of urine midstream. Do not do a traditional Kegel as when you stop the flow of urine midstream it confuses the delicate biofeedback loop of the system.

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The deep internal muscles look like a large bowl or hammock, that hold your bladder, vaginal, uterus and ovaries and rectum. They lift and support all the these structures and they are essential for long-term health of the pelvic floor as well. These deep muscles of the floor, you are unable to palpate, unless you go in vaginally or anally to examine them.

These floor muscles can be activated regardless of the position you are in and they need to be activated daily as is any other muscle in the body, especially following having a baby. The imagine to conjure up with these muscles is to think of a basket of fruit and as you contract them it is like you are lifting them up from the floor to the table. These muscles work with the external muscles but it helps to think of them elevating the fruit basket up towards your nose.


How Concentrated Breathing Helps Strengthen Your Pelvic Floor

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A great way to activate all layers of the pelvic floor muscles together is by utilizing your breath. The easy way to learn this is lay flat on your back. Take a deep breath in and feel your diaphragm inflate as all the air fills your lungs and your belly rises. Imagine all your abdominal internal organs sliding and gliding in the downward direction (one study sited that the kidneys actually glided down 3 cams with deep inhalation), and your pelvic floor actually relaxes and elongates.

Then imagine as you exhale all that air, the pelvic floor contracts and shortens as the diaphragm springs backup. The external diamond shaped muscles and the deep bowl muscles need to have some mental pictures to help them contract more efficiently.

So think of the large diamond shaped external muscles coming to midline towards the vaginal opening. The muscles around the cliterol region pull down towards the vaginal opening, the vaginal opening shuts like the doors of an elevator and the anal opening does a wink as it shuts. You have now contacted the external layers. Now imagine that all of these muscles will lift with the internal deep bowl muscles, all the organs up towards your nose.

You can hold this contraction for 5 and then a 10 count and you can practice doing these contractions at 25-50-75% of maximal. Your repetitions needs to be done throughout the day. The relaxation of the floor on inhalation when you are breathing is just as important as the contraction part.

You do not want to overwork the floor as it is like any other muscle, it can get too short and fatigued. So pay attention and listen to your body. If you are unsure how to do this, please see your Pelvic Health Physical Therapist as they do this work everyday and they can help you.

Your abdominal muscles are also an integral part of your pelvic health. All four layers of your abdominal muscles help your pelvic floor work more efficiently and you will not be able to strengthen the pelvic floor well unless you engage the abdominal muscles together with the floor. They are a team! The stronger the abdominal muscles, the stronger the floor and vice versa.

The transverse abdominus is the under layer and it wraps the abdomen like a present. You can feel it contract as you put your hands in your pants pockets. Then draw your tummy in towards your spine. The long rectus abdominus or “six pack” has really been overstretched during pregnancy and when you pull it in towards your spine remember to pull the long line in the middle of the six pack in towards your spine too.

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Don’t let it “pooch out” when you contract. Pull it in. Then remember your outer abdominal muscles, the obliques, they wrap around your abdomen to give us a nice curve at the waist. The abdominal muscles relax as the floor relaxes with inhalation of our breath and then they contract as we exhale. As you blow out, think of expelling all the air out of the lungs and all your organs moving upwards. The floor helps you do this. Do not bear down or push down, lift up the container with the help of the pelvic floor muscles.

This all happens together as you do not want to overtrain the abdominal muscles without the floor onboard. In over trained abdominal muscles with poor pelvic floor contraction you will often push the organs- bladder, bowel and vaginal tissue south. This causes “peeing” with exertion, pelvic prolapses and bowel issues.

Cross fitters beware, “peeing” is not a good indication of strength and health, it actually means that the container is not properly firing with good integration of pelvic floor and abdominal muscles and there is a abnormal pressure that is occurring due to weakness patterns or overactivity of other muscles.

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Walking is also a great way to begin integration of the pelvic floor and abdominal muscles. Begin slowly with 10-15 mins and progress to 30-60 mins a day. As you are walking you can practice gentle, light abdominal and pelvic floor contractions as you go. The pelvic floor has 70% slow twitch muscle fibers and 30 % fast twitch muscle fibers, so it takes time to re-set these muscles.

Your quick contractions can be done by seeing how many contractions you can do in a 10 count to start with and then progress from there. Do not get discouraged and if you need assistance please contact your local Pelvic Health Physical Therapist, we are here to help. In France you always have visits with the Pelvic Health Physical Therapist after having a baby. I am hoping that this will be the norm soon in the US as well.

Sheree DiBiase, PT is the owner of Lake City Physical Therapy and she and her incredible staff feel strongly that Women’s Health is important and necessary for postpartum Mom’s and Mom’s of all ages. Please come see us for all your Women’s health needs. We are here to help you achieve your lifestyle goals with good pelvic floor and abdominal muscle strength. Hayden (208)762-2100, CDA (208)667-1988, Spokane Valley (509)891-2623.