Back to a Pre-Baby Body: 5 Essential Tips from a PT

While moderate weight gain is a common concern for women during and after pregnancy, there are many other factors to consider in the 4 to 6 weeks after childbirth. You may want to get back into pre-pregnancy shape immediately, but it is important to make a slow return to full activity. Here are some tips on what you can do in the first 6 weeks after delivery to begin getting your body back into pre-pregnancy shape.

Get Help With Tasks

A new mom needs an ally in the weeks following childbirth. During this time, a woman should not lift anything heavier than her baby, in spite of the temptation. Before your baby arrives, make sure all the heavy nursery equipment is set up by someone else. It’s important now for you to rest and engage in light activities only.

Breathe

Believe it or not, something as natural and instinctive as breathing will require focus after childbirth. This is because the growing uterus pushes the diaphragm upward, causing it to lose its ability to descend during inhalation. Since the diaphragm forms the top of the core muscles, it is important to work with a physical therapist, who will prescribe exercises to help restore your diaphragm function to its full capacity.

Focus On Your Core

A woman’s abdominal muscles undergo a great deal of strain during pregnancy. In fact, separation of abdominal muscles, called diastasis recti, is a common occurrence. Also, engaging in inappropriate exercise, such as sit ups, can worsen the  problem for some women. A physical therapist can prescribe exercises to help “close the gap” between muscles. Complete gentle exercises to strengthen the core. This will pave the way for more vigorous abdominal exercises 6 or more weeks after delivery.

Strengthen Abdominal & Pelvic Floor Muscles

Physical therapists recommend that immediately post-partum, women focus on exercising the abdominal muscles and the muscles of the pelvic floor. During pregnancy, these muscles often are stretched and weakened. Strengthening them gives women a strong, stable base from which to work and move. This can alleviate pain later on, and makes much simpler such tasks as carrying the baby, getting in and out of the car, and lifting , whether the birth was vaginal or by caesarian section.

Women who have had a caesarian section should be watchful of discomfort during abdominal exercise. Pain could indicate that the exercise is being done too soon, incorrectly, or too  vigorously. Fortunately, women can do gentle Kegel (pelvic floor) exercises immediately after child Kegels can be done during everyday   activities such as nursing or feeding the baby. Strengthening the pelvic floor also can improve sexual satisfaction and help prevent incontinence. Physical therapists can recommend  several types of Kegel exercises—for endurance, (in which the woman contracts or lifts the pelvic floor muscles and holds them for  5 to 10 seconds) and to produce quick, brisk muscle contractions.

Every Minute Counts

Over time, a woman may begin incorporating fitness into her everyday routines—such simple activities as taking a family walk around the neighborhood or participating in a fitness group with other new moms. Remember to go at your own pace. New moms should sleep whenever they have the opportunity.

Reprinted from MoveForwardPT.com

Acknowledgement: Marianne Ryan, PT, OCS

 

Decisions about Screen Time

decisions about screen timeChildren and Screen Time

With all of the technology advances being made it can be challenging to make decisions about how much time your child spends in front of a screen. Watching TV, playing video games, playing on the computer, or even using an iPhone are all considered screen time activities.  Are you concerned about how much time your child spends in front of a screen? The effects of children and TV have been linked to obesity,  irregular sleep, behavioral problems, impaired academic performance, and decreased play time.  Research has found that television plays a limited role in learning. This is because children learn best from interactive, hands-on experiences. Specifically, touching, feeling, shaking, stacking, and problem solving with other people.

Screen Time Recommendations

The American Academy of Pediatrics recommends no television or screen media should be provided to children under the age of two.  For children over the age of 2, the recommendation is 1-2 hours per day.

Research finds that television programs can even be detrimental. An article in TIME Magazine titled “Baby Einstein: Not So Smart After All” (Aug 6, 2007) discusses studies completed at the University of Washington.  These studies found that “with every hour per day spent watching baby DVDs and videos, infants learned six to eight fewer new vocabulary words than babies who never watched videos.  These products had the strongest detrimental effect on babies 8-16 months, the age when language skills start to form.”

In an article in the New York Times “Toddler’s Favorite Toy: iPhone” Jane M Healy, an educational psychologist in Vail, CO said: “Any parent who thinks a spelling program is educational for that age is missing the whole idea of how the preschool brain grows.  What children need at that age is whole body movement, the manipulation of lots of objects and not some opaque technology.

You’re not learning to read by lining up the letters in the word ‘cat’. You’re learning to read by understanding language, by listening.”

Good and Bad TV: Research has also found that some children’s shows  (such as Arthur, Clifford, Dragon Tales, Dora the Explorer, and Blue’s Clues) can have positive effects on children’s learning, however, other popular shows (like Teletubbies or Barney & Friends) do not.  In general it is best to look for programs, which include:

  • Television characters that speak directly to children occasionally
  • Television characters that ask children to participate by repeating words
  • Shows with a strong storyline which have a beginning, middle, and end

What You CAN Do:

  • Talk about the program with your child.  Ask what 2-3 year-olds liked or disliked, how it made them feel, and what they thought the show was about.
  •  Answer children’s questions.   Sometimes children need help    understanding new concepts to make sense of what they are seeing.
  •  Point out and name things they see on the screen.
  • Be active while you watch – dance, hop, sing, jump or act like the   characters.
  • Connect what the child sees on TV to “real life” – “remember the garbage man on the TV show, here comes ours!”
  • When the show is over, turn off the TV and act out the story.

Don’t use TV or videos to put your child to sleep. This makes it more difficult for them to learn how to fall asleep on their own. Young kids need love, safety and security that come from your routines (stories, back rub, songs). For more information to help you make decisions about screen time, check out this blog about how screen time affects language development.

Workstation Ergonomics

Pain and Your Workplace

Physical therapists treat many patients each year for neck and shoulder pain, low back pain, and wrist/forearm pain.  Many times it is related to overuse of muscles in the same  positions (repetitive use injuries). Moreover, it can be due to the setup of a person’s workspace. The Occupational Safety and Health Administration (OSHA) reports 1.8 million workers have to deal with some sort of musculoskeletal disorders (MSD) each year.

The Cost of Ergonomic Injuries

Ergonomic injuries cost an average of 15 billion to 20 billion annually for workers compensation.  Costs are 30 billion to 40 billion in other expenses such as medical care. The Bureau of Labor Statistics’ (2008) indicates over a million nonfatal injuries/illnesses involving days away from work occurred in private industry. These statistics are over a one year span. Of those one million incidences, 26% of them required the worker to miss 31+ days of work. Additionally, 38.6% of them were due to a strain or sprain.

Prevention Methods

Many strains and sprains are preventable. Maintaining proper positioning and posture at workstations, taking breaks when performing repetitive tasks, and staying active with strength and stretching exercises specific to a  person’s line of work are some of the ways to prevent these occurrences. Specifically for  people who use a computer workstation, there are key positioning points of which to take note.

Proper Computer Positioning:

  • Ears, shoulders and hips should be in line with each other to ensure proper posture.  Adjusting the back support of your chair is also beneficial if you cannot align your ears, shoulders, and hips.
  • The best positioning includes, relaxed shoulders, elbows bent to a 90° angle (or slightly more) while typing, as well as hips bent at an angle slightly more than 90°.   Having your feet flat on the floor at all times after these alignments are in place is also beneficial.  A chair that is adjustable for height will help to achieve this position. If your feet are still unable to reach the floor after making adjustments, you can use a foot rest fashioned. This can be fashioned from a small piece of wood or a phone book to support your feet.
  • Position your eyes level with the top 1/3 of the screen, about 18-24″ away from the screen.  This helps to avoid improper neck positioning and eye strain.
  • The computer keyboard should be an inch or two lower than the level of the elbow to maintain proper bend at the joint.  When using a laptop, use a laptop stand to achieve proper screen position according to eye level.  To prevent carpal tunnel or other repetitive writs/forearm injuries, use a seperate keyboard and mouse (positioned appropriately).
  • Take breaks and move around!  When performing tasks that require you to maintain either a sitting or standing position for long periods of time, take rest breaks. You can also perform stretches to keep your muscles from getting strained.

When to Contact a Physical Therapist

If you begin to notice and ache or pain that lasts more than a day and it is an area of the body that can be strained by your work duties, don’t hesitate to contact a physical therapist before it gets worse. Repetitive use injuries can take a long time to heal when they are ignored for too long. Your physical therapist can offer suggestions for workstation adjustments, exercises and stretches specific to your situation, and tips and tricks to keep your body healthy and pain-free

Preventing ACL Injuries in Girls

You hear it all the time. Another girl tore her ACL.  It’s becoming an epidemic. But what is an ACL?  Why do girls have 2-8 times higher ACL rupture rates?2  Most  importantly, can we do anything to lower their risk?

What is an ACL?

The ACL, (anterior cruciate ligament) is a band of connective tissue within the knee joint. The ACL helps to stabilize the knee.  There are a few theories as to why girls are more likely to tear their ACL.  Firstly is anatomical differences.  Females are built differently than males. They have wider hips and possibly thinner ACLs. Secondly, is physiological differences. Female hormones have the potential to cause loosening in the structures that stabilize joints. This includes the knee. Thirdly, is musculoskeletal differences.  Many studies are finding that females who suffered ACL tears exhibited more trunk sway than men or uninjured women after landing a jump or completing a plant to switch directions. This suggests that girls (or boys) who have more difficulty controlling their trunks during acceleration and deceleration are at a higher risk for rupturing an ACL.

Preventative Measures

Trunk control is something that can be trained. Programs run by athletic trainers and physical therapists that focus on proprioceptive training, balance, and core strength are becoming more and more popular as a way to minimize any athlete’s risk of ACL injury.  By training the muscles around the knee, hip, and core, the amount of trunk sway that occurs during jumping, landing, and cutting movements can be decreased. In turn, the risk of suffering a lower extremity injury, including an ACL tear, is reduced. These programs begin when kids are young and help to identify kids who are at higher risk. The programs can then grow to specifically address each person’s needs.

 

1. Children’s Hospital Boston.  Sports Injury Statistics.  August 2011.  Available at:  http://www.childrenshospital.org/az/Site1112/mainpageS1112P0.html

2. Souryal, Tarek O and Consuelo T Lorenzo, Consuelo T.  June 29, 2011.  Rehabilitation for Anterior Cruciate Ligament Injury.  Available at:  http://emedicine.medscape.com/article/307161-overview#a0199.

Potty Training

Before your child is even ready to use the toilet, you can “start” potty training.  Let your child watch you use the toilet.  Although the bathroom may be your sanctuary, the one spot you get 2 minutes of peace, letting your child watch you go and verbally explaining what’s happening is incredibly helpful.  Be explicit and go through every step of the process.

Books are great resources, fine ones that explain potty training.  We like those that are gender specific.  Use your family’s own designated words for body parts, urine, and stool when reading the books and talking about toileting.

Get a potty chair that works for your child and family.  If you want your little boy to sit, it’s  helpful to get one with an enhanced splash guard in the front.

Use stuffed animals or dolls to make toilet time fun, and, again, talk about what’s happening.  “Dolly has to go potty.  Since you’re Dolly’s mommy, please help her go.”  Your child can take turns with toys on the potty.  Remember, the first step is just tolerating the toilet or potty chair.  Sit and read books, play with toys, even eat snacks.

When is your child ready?

  • Is your child aware of the difference between being wet and being dry?  Does he tell you when he needs his diaper changed?  Does he express discomfort when his diaper is wet or dirty?
  • Can your child stay dry for at least 2 hours at a time?  Start a log of when he’s dry and when he’s wet.
  • Can your child sense when he needs to urinate or have a bowel movement?  Does he go in the corner or quiet place when it’s time to have a bowel movement?  Does he cross his legs when it’s time to urinate?
  • Can he reach the potty chair or toilet in time to use it?  He may still need your help with this step but should be able to hold it for a few seconds while you make the mad dash to the nearest bathroom.
  • Can he undress and dress himself, particularly his bottom half?
  • Is he motivated to be more independent and to take the next step?

Remember not all children are ready at the same time!

Ideally, you should answer yes to all of these questions before beginning potty training.  If you push potty training before your child is ready, you will ultimately engage in a power struggle and you will lose.  Excreting waste is one of the few things your child has control over, you do not want your child with-holding stool just to feel empowered.

If you start potty training and find yourself fighting with your child, holding him on the potty, forcing her to sit for 2 minutes, stop!  Take a break for a few days, a few weeks, or a few months until your child is ready to start again.  Your child will eventually learn to use the potty but you cannot force it to happen.

How exactly does this work:

Make it fun!  Celebrate EVERY success.  He sits on the potty for a few minutes?  Have a dance party!  She gets half of the urine or bowel movement into the toilet?  High fives!  He simply attempts to make it to the potty but utterly fails?  Hugs!  It can be tempting to scold your toddler for urinating all over the floor but try not to.  Celebrate the fact that he went someplace other than his diaper and help him understand that next time, he should try to do it in the potty.  Potty training must be enjoyable for you and your child for it to be successful.

Practice at key times: Sit on the potty before and after sleeping, and before and after meals.  These are the most likely times that your child needs to use the toilet.

Go every 2-3 hours at first.  In addition to  the times  mentioned above, try to get your child sitting on the toilet every few hours.  A potty watch is particularly helpful with this step.  She may insist that she does not have to go but encourage her to sit and try, even for a minute.  You can model this behavior by saying, “Mommy doesn’t really have to go potty but since we’re going on a trip, I will try to go now.”

Do not punish. It may be tempting to punish accidents but research has shown that punishing during potty training is not effective.  Your child needs to want to use the toilet and needs only encouragement from you to make it happen.  Focus on every positive experience and celebrate every little triumph.

What about kids with special populations?

The above information still applies for kids with special needs with some adaptations.  An occupational therapist can assist you in knowing what adaptations your child will need for successful potty training.  There are also several books specific to children with special needs that can assist you as well.

What if you are having no success?

Sometimes, your child needs professional help to be successful with toileting.  Bedwetting until age 6 is considered within the normal range.  If your child is still having issues with this past age 6, our skilled physical therapist, Amanda Fehrer, DPT can help.  She can screen your child to determine if it’s a muscle or coordination issue.  Amanda can also assist with relieving constipation, another common obstacle to successful potty training.

Pediatric Feeding and Swallowing Disorders

The challenges of getting a child to eat can sometimes be daunting. It may simply be due to pure stubbornness, or a symptom of a feeding or swallowing disorder. Pediatric feeding disorders include  difficulty moving food to the mouth and getting ready to suck, chew, or swallow the food.   Children with feeding or swallowing problems exhibit a variety of symptoms that are different for every child.

Common symptoms include:

  • Arching or stiffening of the body during feeding
  • Irritability or lack of alertness during feeding
  • Refusal of food or liquid
  • Failure to accept different textures of food (e.g., only pureed foods or crunchy cereals) 
  •  Lengthy feeding times (e.g., more than 30 minutes)
  • Difficulty chewing
  • Difficulty breast feeding
  • Coughing or gagging during meals
  • Excessive drooling or food/liquid coming out of the mouth or nose
  • Difficulty coordinating breathing with eating and drinking
  •  Increased stuffiness during meals
  • Gurgly, hoarse, or breathy
  • Frequent spitting up or vomiting
  • Recurring pneumonia or respiratory infections
  • Less than normal weight gain/growth

Children with swallowing or feeding disorders are at risk for dehydration, malnutrition, aspiration, upper respiratory infections, and isolation in social situations that involve eating.

The treatment used for feeding and swallowing disorders vary depending on the diagnosis of the underlying problem.  An evaluation is completed by a speech-language pathologist or occupational therapist to help determine the exact cause.

Based on the results of the feeding or swallowing evaluation, a therapist may recommend any of the following:

  • Medical intervention (e.g., medicine for reflux)
  • Direct feeding/swallowing therapy
  • Nutritional changes (e.g. different foods, adding calories to food)
  • Increasing acceptance of new foods or textures
  • Food temperature & texture changes
  • Postural or positioning changes (e.g., different seating)
  • Behavior management techniques

Referral to other professionals, such  as a psychologist or dentist