Pelvic Health Blog

Rib pain during pregnancy and postpartum

8/31/2022

by Bryn Zolty, PT

Rib pain during pregnancy and postpartum can make everything difficult. Taking care of kids, lifting, carrying, rolling over in bed, getting out of a chair, and even breathing can hurt.

In many cases, this is due to musculoskeletal changes that occur during pregnancy. Your ribs start changing position even before your uterus is large enough to push pressure up into the diaphragm and rib cage. Therefore, it is thought to be hormonal changes that may play a large role in the alteration of the rib cage.

Infrasternal Rib Angle
One of the ways we check rib cage changes is the infrasternal rib angle. Place your thumbs in towards the bottom of the sternum to get an estimate of your rib angle. A normal angle is close to 90 degrees.

Changes During Pregnancy
This angle can increase by 35 degrees during pregnancy (1). In addition, the ribs flare up and out by 10 to 15 cm and chest circumference increases by 5-7cm (1). This means your rib cage is wider.

Muscle Pain
These changes to your ribs cause stretching through the muscles that attach into the ribs, including the intercostal muscles and the abdominal muscles. The stretching can be very uncomfortable and can lead to muscle stretch injury or cartilage stretch injury.

Joint Pain
When inflammation is present between the ribs and the breastbone at the front chest wall, it is known as costochondritis and is tender to touch. At the back of the ribs, women may complain of stiffness, pain, and pressure where the ribs meet the spine.

Rare Musculoskeletal Pain Cause
In rare cases, women will experience transient osteoporosis during their pregnancy. Throughout your pregnancy the amount of calcium transferred from you to the baby increases drastically. It starts at about 2 mg/day and by the 3rd trimester it could be as much as 250mg/day (1)! As with anyone with osteoporosis or osteopenia, there is an increased risk for fracture in your bones including the ribs. A weakened bone can fracture under normal forces, and if you suspect this you should contact your doctor.

Muscle dysfunction, painful joints, stiffness, and trouble with normal daily activities can be treated by a physical therapist. If you are pregnant or postpartum and have a pelvic therapist nearby, contact them and make an appointment. They have additional training to help a woman during and after her pregnancy.

When Rib Pain Is Not Musculoskeletal
There are many causes of chest pain that can occur during pregnancy. These include cardiac causes, clots, pneumonia, heartburn, peptic ulcers, shingles, and more. Your physician will help order any tests needed.

Get Started Before You Make An Appointment
For some women, the musculoskeletal changes that occur during pregnancy do not go away on their own. Here are some ideas to get started in case you are not ready to start physical therapy.

For getting your abdominal muscles fully back on-line immediately postpartum
How to help your abdominal muscles immediately after delivery (connectpt.org)

Improve Mobility During Normal Tasks
If you feel it is difficult to find time to exercise and stretch, start with incorporating lots of movement into your day. Add trunk rotation and side bending into your normal tasks. This will help mobilize the ribs and the spine. It can also help encourage the obliques to mobilize the ribs as well.

when reaching for light objects, reach and twist
carry your baby on a different side to vary movement patterns
if breastfeeding, alternate positions
monitor for movements that you only do on one side consistently and change it up

Breathing Moves Your Ribs For You
To get your rib cage moving better, you need to use it for breathing! Pregnant and immediately postpartum, avoid pushing pressure down and out into the lower abdomen and pelvis when practicing this breathing. Instead of pushing your abdomen forward, as you inhale, feel your ribs move 360 degrees out and up, and as you slowly exhale feel them fall in and down.

See the pictures for hand placement to monitor your breathing. A hand on your chest and ribs can help you monitor what you do during the breathing exercise. Most of the time, we recommend the 360 movement. With both hands placed on the lateral ribs in the lower picture, your hands will appear to be moving your ribs like an accordion.

If your ribs feel wide and “stuck out’, focus on a long, full exhale. And absolutely work this breathing pattern into all kinds of stretches and yoga poses.

If you are pregnant and past your first trimester, it is important to monitor how you feel when laying on your back and limit this position. This breathing exercise can be done in sidelying, sitting, standing, reclined, or any other comfortable position.

If you feel like getting up and moving, some of these yoga poses may help. Combine them with your 360 breathing. Note she is twisting away from her bent knee in many poses to avoid compression in the groin and maintain open space for your baby.

Twisted crane pose

Fan pose

Goddess twist

Seated crossed leg twist

Seated straight leg twist

Make an Appointment

Rib flare left untreated can cause altered function of your core muscles. When you feel ready to attend therapy, your therapist will help customize a stretching, breathing, and strengthening program specific to your body.

Get out of fight or flight with the vagus nerve

4/4/2022

By Karen Bruno, PT

Ever get queasy from a shot or the site of blood? Or experience something and feel like fainting? Sometimes, those feelings are due to the overstimulation of the vagus nerve. And on the other end, the vagus nerve can also initiate relaxation after stress. So it makes sense that when we’re in fight or flight mode, the vagus nerve comes into play.

Fun fact: the vagus nerve is responsible for our “gut feelings”.

So how can we use the vagus nerve to our benefit? Well, once we understand what it is, we can control it to breathe more easily, and control our heart rate when we’re in tense conversations or high-pressured situations at the office.

What is the Vagus Nerve?
The vagus nerve is part of our central nervous system, which is made up of our brain and spinal cord. The central nervous system communicates with the body and processes information. The vagus nerve, also known as the tenth cranial nerve, starts in the brainstem and travels into the neck, trunk and abdomen. Having extensive reach and influence, the vagus nerve is responsible for the functioning of our internal organs and processes such as:

digestion,
elimination,
heart rate,
respiration,
immune health,
inflammation,
physical tension,
our response and adaptability to stress,
and social and emotional engagement.

In short, our vagus nerve has a central role in every aspect of our lives. Our well-being is dependent upon our ability to adapt and on our nervous system’s capacity to function properly. Vagus nerve exercises help us get out of the stress related fight, flight and freeze response and move us into a calmer state of rest, restore, relax and digest. So, whether you have pain, a bowel, bladder or sexual condition, an issue with digestion, anxiety, trauma, or any combination these, your vagus nerve could use a boost.

Sample exercise
There are numerous ways to support optimal function of your vagus nerve. Here is a simple, 2-step exercise you can perform. This technique comes from Stanley Rosenberg’s "Accessing the Power of the Vagus Nerve, Self-Help for Anxiety, Depression, Trauma and Autism."

Step 1 - Place both hands behind your head, right at the bump behind your head.

Step 2

Turn your eyes to the right and hold them there for 30 to 60 seconds OR until you take a deep breath, swallow, sigh, or yawn.
Then, turn your eyes to center.
And finally, turn your eyes to the left and do the same thing, holding them for 30 to 60 seconds OR until you take a deep breath, swallow, sigh, or yawn.

Modifications

If you can't get both hands behind your head, just use one hand behind your head.
You can also do the same exercise with your arms at your side.
A third modification is taking your middle fingers and placing them gently behind your ear.

Here are some practical application suggestions to use the simple vagus nerve exercise.

If you are feeling neck pain, back pain, or pain of any kind, use this exercise.
Use it before doing an exercise routine.
Use it whenever you want to calm and relax your body and mind.
Use it to calm your body when you are experiencing urinary issues such as incontinence, urgency or frequency, or to relax your muscles when you are feeling constipated.
Use it before or after eating a meal to boost your digestion.
Use it before you go to sleep to get to sleep easier.
If you are prone to lightheadedness when you change positions, use this prior to changing positions.
Use it frequently if you experience ringing in the ear (tinnitus).
Use it to calm your nerves before meeting a new person, or engaging in a new activity or if you are feeling anxious.
Use it when you feel frustrated, irritated, angry, stressed, upset or sad.
Use it if you feel a headache beginning.
Use it to shift out of an anxiety state.
Vagus nerve exercises can be used for a rapid heart rate and for high blood pressure
If you get short of breath easily, use it before any activity such as walking up a flight of stairs.

Practice it daily and as often as needed throughout the day.

References:

Rosenberg, Stanley, Accessing the Power of the Vagus Nerve, Self-Help for Anxiety, Depression, Trauma and Autism (Berkeley, California: North Atlantic Books, 2017).
Front. Psychiatry, 13 March 2018 | https://doi.org/10.3389/fpsyt.2018.00044
Tap Into Your Vagus Nerve’s Healing Power to Rewire Your Nervous System for Optimal Health, Energy Medicine to Restore Your Physical, Mental and Emotional Wellbeing, with Dr. Melanie Smith/Theshiftnetwork.com

Fall season immune booster: downward-facing dog

11/16/2021

By Marzena Bard, PTA

Downward-facing dog offers many benefits:

provides natural and lymphatic drainage - the key to a strong immune system
slows down the heartbeat
calms down the brain and gently stimulates nerves
helps to relieve stress
stretches the entire body, especially the back, calves, and hamstrings
strengthens the core, upper body, and foot muscles
reduces stiffness in the neck and shoulders
stimulates blood flow
improves posture
decompresses, energizes, and neutralizes the spine
helps prevent hot flashes in menopause
regulates heavy menstrual flow
helps with prolapse management

Perform this fall season's immune booster exercise safely at home:

Start on all fours.
Place your hands directly under the shoulders, knees under the hips, and tuck your toes.
Take a deep breath in and while exhaling, lift your hips up to the sky.
While up there, move your body weight towards your heels.
Your body will have an inverted letter “V” shape.
Let your head and neck go, and feel your shoulder blades spreading across your back.
Keep lengthening your spine while sending your hips up and your bodyweight all the way back.
(For an extra release, add gentle rocking to your hips or bending of one knee then the other.)
Make sure to breathe calm and deep breaths. Peace, strength, and vitality with each breath.

Dolphin on the table & skier stretches

1/14/2021

Beat those winter blues by getting up to stretch with Marzena Bard, PTA. When you can't get to the gym, these easy stretches are great to begin and end the day or to break up sitting all day at the computer.

"Dolphin on the table" is a feel-good stretch for anyone who has tightness in the back, shoulders, or hamstrings. It increases the length and blood flow of these muscles.
"Skier" stretch is helpful for those with pelvic tension and pain. It helps to stretch the inner thighs and the entire groin area, which also improves blood flow to the pelvis.

Watch the video tutorial below.

Self-compassion and pain management

9/9/2020

By Karen Bruno, PT

Can self-compassion really help when you are in pain?
Let’s explore this. First, what is self-compassion? Self-compassion is giving yourself kindness, forgiveness and understanding when confronted with personal failures or discomfort. Basically, it means giving yourself the care and gentleness that you would give to a beloved friend or a child who is in need of support. In the words of Dr. Kristen Neff, a self -compassion expert and teacher, "Instead of mercilessly judging yourself for various inadequacies or shortcomings, self-compassion means you are kind and understanding when confronted with personal failings – after all, who ever said you were supposed to be perfect?" (1) It is an acceptance of your humanness even when things don’t go your way.

So, what does self- compassion have to do with chronic pain? Recent research suggests that self-compassion is associated with better outcomes, such as lower levels of depression, pain-anxiety, physical and psychosocial disability, and higher levels of pain acceptance. Higher levels of self-compassion supports engagement in meaningful activities and use of pain coping strategies. (2)

What does that mean for you?

Lower levels of depression, sadness and anxiety.
Less physical and psychological stress.
Higher levels of pain acceptance and engagement.
Improved ability to perform meaningful activities and use pain coping skills.
Better overall outcomes, function and quality of life.

Self-compassion has been found to be beneficial in situations related to the ineffective way we respond to things, how we talk to ourselves and the behaviors we engage in. So, when you notice yourself worrying, thinking or talking negatively, isolating yourself, or beating yourself up, choose to use a better approach of treating yourself with care, gentleness and kindness. (3)

What can you do?

Meditate. Practices such as mindfulness, breath meditation or any other physiological quieting methods help us to reduce tension and train us to tune into our needs to better take care of ourselves. Here is a link to some guided meditations: https://self-compassion.org/category/exercises/
Consider treating yourself the way you would treat a close friend or a small child. How might you respond to them with kindness and gentleness?
Remind yourself that you are worthy of kindness and compassion.
Take a self-compassion break. What do you need to hear? What do you need to give yourself? How can you encourage yourself and be patient, kind and forgiving to yourself?
Explore self-compassion through writing. Start by writing about your concerns. Next, write yourself a letter from the perspective of a loving friend. The last step is to let yourself receive those kind words, allowing love and compassion to soothe and comfort you.
Practice supportive touch.
1. Putting your hands on your body and taking some conscious breaths can be relaxing.
2. Place your hands over your heart and breathe comfortably. Notice the rise and fall of your chest as you breathe. Do this for as long as needed to calm your nervous system.
3. If it is convenient, put your hands over the area of pain and breathe love and nourishing oxygen into the region.
4. Place one hand over your heart and one hand over the abdomen. Breathe gently and consciously- 4 seconds in and 4 seconds out. This is a great way to relax as you drift off to sleep.

This PDF download summarizes the relationship between self-compassion and pain.

Self-care is also an integral component of self-compassion.
We have heard it before from the airlines, "“put your own mask on first, then help someone else." Remember that you are your own best advocate and as you care for yourself, you model for others how to care for themselves, you teach others how you want to be treated, and you harness the resources to be of service to others. Just do it! You are worth it.

"Life is full of disappointments, failures and setbacks. None of those things can permanently stop you. You have the power within you to overcome anything that life throws at you. There is nothing more powerful than a made up mind. Surround yourself with people who remind you that you matter, and support you in ways that matter most to you. No person, situation or circumstance can define who you are. Don't give up, cave in or stop believing that it's possible. It's not over until you win."
-Unknown

Notes

Website: selfcompassion.org
Paper: The relation of self-compassion to functioning among adults with chronic pain. Eur J Pain. 2019 Sep;23(8):1538-1547. doi: 10.1002/ejp.1429. Epub 2019 Jun 11.
Audio: Integrative Pain Science Institute podcast

Connect PT's exercise hack for the obturator

3/20/2020

By Marzena Bard, PTA

If you have a tight obturator internus, here are two go-to exercises for a release of that sneaky muscle.

Fan Pose
Keep your feet wide apart, turning your toes inward. Exhaling gently, hinge in the hips forward. Place both hands on a yoga block in front of you. Take a breath and exhaling again, lift up one arm up towards the ceiling. Stay there for a few deep breaths. Repeat on the other side.

Frog pose
Position yourself on the floor with knees wide apart and feet to the sides. Be gentle and don’t feel you have to achieve the angles that are presented in the picture. Place your hands flat on the floor, about shoulder-width apart. You may add a slow, unwinding, rocking movement back and forth, coordinating it with your breath. Inhale rock back, exhale rock forward.

Patient cheat sheet of our most common exercises

1/7/2019

Our dedicated team of therapists are constantly creating ways for patients to stay compliant with their home program. Many people are confident in their exercise form at the office, but sometimes the knowledge seeps out after they walk out the door…

Check out our refresher videos on our patient's section (scroll down to the bottom). Marzena Bard, PTA, CYT, demonstrates your favorite exercises like “cat-cow” and “thread the needle”--you won’t forget them again!

In the community: therapeutic yoga comes to the East Windsor Senior Center

5/24/2018

In May, Marzena Bard, PTA, CYT presented “Yoga in Physical Therapy for Women’s and Men’s Health” at the East Windsor Senior Center and led participants through gentle yoga poses that can be used in rehabilitation.

Yoga During and After Pregnancy

11/8/2017

Written by Michelle Dela Rosa, PT

Anxiety and depression in women can be common before or after giving birth, with rates around 10% and 20% respectively. These disorders can make it hard to care for yourself or your new baby.

Medications, while sometimes effective, have the risk of side effects for you and/or developing baby. Why not try an alternative treatment, like yoga, which has been shown in the general population to help mental health and well-being?

A 2015 systematic literature review showed that yoga was not only effective in decreasing depression and anxiety in perinatal women, but also improved: pain, anger, stress, gestational age at birth, birth weight, maternal-infant attachment, optimism, and well-being. If you are pregnant or just had a baby and are unsure how to progress with exercise, our therapists who are also certified yoga instructors can help you make the leap into fitness.

Sheffield KM, Woods-Giscombé CL. Efficacy, Feasibility, and Acceptability of Perinatal Yoga on Women's Mental Health and Well-Being: A Systematic Literature Review. Journal of Holistic Nursing 2015:34(1)64-79.

The Deep Squat Stretch

11/2/2017

Written by Marzena Bard, PTA

The deep squat is one of our favorites for pelvic floor tightness. If you have pelvic floor tightness or spasms, this is one of the few positions that makes it difficult for the pelvic floor to tighten.

Squat with your feet about two feet apart. (Keep your heels on the floor if you can; otherwise, support them on a folded mat). You can use the wall to support your back.
Separate your thighs slightly wider than your torso. Exhaling, lean your torso forward and fit it snugly between your thighs.
Press your elbows against your inner knees, bringing your palms together, and resist the knees into the elbows. This will help lengthen your front torso.
Breathe deeply and slowly, allowing the pelvic muscles to let go.

Yoga Tip: Downward-facing Dog

8/30/2017

Written by Marzena Bard, PTA

Start your day with this energizing pose in sun salutations, or use it in the evening as a calming, gentle pose.

Pelvic benefits include: decompresses and neutralizes spine, reduces heavy sensation associated with menopause, relaxes pelvic floor, helps with organ prolapse management.

Start on hands and knees.
Make sure your hands are positioned in a straight line, fingers slightly spreading.
Feel your mat mostly under your index fingers and thumbs.
Take a deep breath and while exhaling, lift your hips up, then shift your body weight back.
You can move your feet farther back, and/or further apart, but keep the hands in place.
Relax your head and neck completely, letting them hang down freely. Your body should be like an inverted letter "V."
Breathe slow, and breathe deeply.

Did you know: yoga during pregnancy

12/8/2016

Connect PT therapists incorporate yoga into physical therapy for expectant mothers. Yoga is a well-known practice that provides exercise and mindfulness. A systematic review by Curtis et al (2012) suggests that yoga during pregnancy can lead to better outcomes for pregnancy, labor, and birth. The study reports that it may improve a mother’s “stress levels, quality of life, aspects of interpersonal relating, autonomic nervous system functioning, and labor parameters such as comfort, pain, and duration.”

Kathryn Curtis, Aliza Weinrib, and Joel Katz, “Systematic Review of Yoga for Pregnant Women: Current Status and Future Directions,” Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 715942, 13 pages, 2012. doi:10.1155/2012/715942.

What's New: Gentle Yoga Class

6/10/2016

Gentle Yoga Class - Tibetan singing bowl

Connect PT is excited to offer our new Gentle Yoga class, accompanied by guided meditation and relaxation to the sound of Tibetan singing bowls. The bowls create sounds to restore normal vibratory frequencies in the body. The harmonic vibrations of the Tibetan singing bowls engage the relaxation reflex, slow down the respiratory and heart rates, and disrupt the pain reflex to promote a positive sense of well-being.

The Gentle Yoga class with meditation is taught by Marzena Bard, PTA the first Thursday of each month.

What the research says: yoga for low back pain

9/7/2015

Yoga can offer safe and effective treatment for the rehabilitation of low back pain. Cramer et al (2013) showed “… strong evidence for short-term effectiveness and moderate evidence for long-term effectiveness …” in a systematic review and meta-analysis of yoga and low back pain in 10 randomized controlled trials. There were no reports of serious adverse effects.

Cramer H, Lauche R, Haller H, Dobos G. A systematic review and meta-analysis of yoga for low back pain. Clinical Journal of Pain. 2013 May:29(5):450-60.

Spring 2014 event recap: children's yoga

4/2/2014

Connect PT hosted Yoga for Kids with Special Needs on March 22 and May 31. Marzena Bard, PTA, enjoyed teaching kids and parents fun and exciting ways to exercise with yoga.

For children with special needs, yoga has been shown to: improve attention through breathing and relaxation, facilitate sensory integration, reduce anxiety, and enhance self-esteem.

BLOG