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.

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.