Category Archives: Pelvic Health

Maternity On The Move: Everything You Need To Know About Perinatal Mobility

We love our kids. We love them enough to go through all the difficulties of pregnancy, labor, and childbirth, and we keep loving them for the rest of our lives once they enter the world.

That doesn’t mean we love what pregnancy and the birthing process does to our bodies. It’s a testament to the power of a mother’s love that we don’t look sideways at our little angels when postpartum peezes (pee-sneezes), itching, and stiffness take hold––because really, we know it’s not their fault! 

Still, a lot of new moms or moms-to-be face significant hurdles when it comes to healing after they’ve given birth. If you’re one of these moms, you may worry about some of the changes and potential problems you’ve started experiencing during the perinatal (immediately before and after labor) phase.  

“The fourth trimester” is the 12-week period immediately after you have had your baby. Not everyone has heard of it, but every mother and their newborn baby will go through it. It’s a time of great physical and emotional change as your baby adjusts to being outside the womb, and you adjust to your new life as a bona-fide Mom. Giving birth is as incredible as it is challenging, and giving yourself the tools and time to restore your nutrient levels, hormones, muscles and everything else is going to affect how you experience the early days of motherhood.

As perinatal mobility expert Kristina Hsieh, P.T., said during Restore Motion’s Strong As A Mother Workshop, “as a society, we tend to do a poor job of telling mothers exactly what to expect before and after they deliver.”

We’re hoping to help change that trend––and maybe we’ll help you find a way to escape those dreaded peezes!

From Well Rounded To Well Grounded––How Pregnancy Affects Your Mobility From Head To Toe

Mobility is a term that refers to a lot of different factors, all of which relate to one’s ability to “move and be moved freely and easily.” These factors can be internal––relating to the organs or musculoskeletal system––or they can be external, impacting our flexibility, potential for injury, and ability to engage in normal activities like running or hiking.

Pregnancy is a complex process that takes place across nearly every system in the body. Creating, sustaining, and giving birth to a child is an incredibly delicate dance that relies on collaboration between many different parts. 

Since these parts are all intimately connected, it’s no wonder that many issues with mobility during and after pregnancy have their origin in less-than-obvious places.

For example, as you get close to term, your pelvis begins to shift as your uterus expands and prepares for the birthing process. This can cause pain in your lower back, your perineum (or “pelvic floor,” the group of muscles that extends from the front of your pubic area to your tailbone), or even your thighs, and it also brings on cramps that feel similar to the kind you get while on your period. This common symptom is called pregnancy-related pelvic girdle pain (PGP) or symphysis pubis dysfunction (SPD).

This pain can curb your mobility and make certain activities––such as getting dressed or going to the bathroom––quite difficult. It doesn’t stop there.

Any kind of pain, especially pain that impacts your core and pelvic muscles, not only limits mobility but also saps a great deal of energy and mental stamina. This can be seen in broader studies done on women who have chronic pelvic pain or CPP. While you’re going through this pain, you’re likely to feel lethargic, irritable, and less inclined to face the day’s ups and downs with grace (to put it nicely).

This is normal, and it’s important to respect your body and listen to the advice of your doctors, including a qualified physical therapist. They can advise you on ways to maintain stability, lessen the pain, and make the whole experience easier for you. Bear in mind that pain, especially pain that impacts your overall mobility, brings increased risks for injury and accidents. 

Pregnancy comes with other kinds of discomfort, too, as anyone who’s been pregnant before can tell you. Generalized back pain, bladder discomfort, nausea, stiffness in the hips and legs, and many other symptoms all limit mobility and impact numerous systems outside of your reproductive organs.

Due to the nature of pregnancy, no symptom lives in isolation. You should consider each one as part of a larger picture of what your body is doing and preparing to do, and consult an expert regarding ways to make the process easier, more comfortable, and less overwhelming. 

There are many factors to consider when speaking to this expert. For example:

  • Breast feeding may contribute to postpartum weight loss, but not all nursing mothers have the same outcome. 
  • Relaxin is the hormone responsible for increasing the elasticity and size of connective tissues – ligaments and muscles––and production of this hormone increases during pregnancy (especially as you prepare to give birth.

In practice, these factors will play an important role when you are personalizing your routine. If you find yourself losing weight or you have a history of being underweight, for example, you’ll need to be especially careful when designing a diet and exercise routine. Becoming underweight could seriously impact the quality of your breastmilk and will cause dips in energy, endurance, and your ability to heal from injuries.

At the same time, it is not advised to go right into your pre- baby high intensity workouts of activities. Relaxin can alter your body’s proprioception and risk of injury due to unstable joints. Muscles must be properly “rehabbed” and strengthened after a delivery. 

Taken together, your P.T. may design a gentler, more gradual routine for you than you might have expected, and you’ll need to trust their judgment and remain informed about the subtler changes happening all across your body. A safe, effective exercise routine and other effective methods will be vital as you attempt to improve and preserve your long term mobility.

Ups, Downs, Sideways, And More––Optimizing Mobility Before After You Give Birth

Since the hips and pelvis are the most immediate priorities before and during labor, these areas tend to be the focus of prenatal exercise classes and other prenatal fitness programs. There is also a great deal of emphasis on proper breathingThe pelvic floor muscles and diaphragm muscle work together to maintain continence and postural stability.  Breathing exercises and awareness of how the pelvic floor and diaphragm work together can help the labor and delivery process., pain monitoring, and other kinds of bodily awareness that can help women spot potential problems and strengthen their overall resilience.

These types of programs are vital, and they should indeed be prioritized as you move closer to your due date. A good prenatal exercise program may be led by a qualified yoga, pilates, or other trainer with advanced training in perinatal exercise (not necessarily a P.T.), a it will include a variety of exercises involving plenty of different types of equipment (such as an exercise ball or roller). The program’s leaders will make great effort to ensure a relaxed, enjoyable atmosphere that both supports you and keeps you accountable as you work toward your fitness goals.

The main focus of most prenatal exercise programs is flexibility and targeted strength training for your pelvic and hip muscles. This type of work creates balanced muscles by prioritizing both flexibility and strength, which in turn allows your body to move and function better as an integrated whole.   

The stretches are likely to be slow and gentle, and most therapists will avoid routines that increase your heart rate above a certain level. Seated or standing yoga exercises, or exercises that have you laying on your side, are popular in these classes. 

Gentle pilates that avoids supine positioning is especially helpful, as it can increase flexibility and strength at the same time. This kind of exercise also teaches you strong breathing techniques and enhances your overall bodily awareness. Yoga is excellent for achieving noticeable results in a short amount of time and is also variable enough that the same routines can be adapted to multiple trimesters and phases of healing.

Whatever programs you choose, just make sure to take things “slow and steady” as you rediscover your body and the baby’s new limits. You probably won’t be able to work out as intensely as you could before the pregnancy (nor should you ever attempt to).

When talking with a physical therapist, ask detailed questions and help them cater an exercise routine to your specific needs. If you find that your pain is focused more in your glutes than your lower back, for example, it might be helpful to develop a routine that emphasizes your piriformis muscle rather than your obliques.

At the same time, don’t neglect the rest of your body in favor of these common target areas. Yes, certain bones, muscles, and systems will play a more direct role in the perinatal process, but that doesn’t mean you should allow your legs, arms, or upper body to deteriorate. A good physical therapist will incorporate these other areas into your routine and advise you on ways to keep them strong and healthy throughout your pre- and post-birth experience. 

If you have access to the right resources, your therapist may advise exercise such as swimming, low-impact aerobics, or monitored use of a stationary bike. They will also tell you which activities to avoid, which can be equally if not more important to your overall experience.

One of the best parts of exercise is its ability to empower you. As you experience this unique phase of life, a good routine can help you to feel confident in your fitness, strength, and ability to handle everything that awaits you and your baby.

Concluding Thoughts––Personalize Your Mobility By Working With Your Own Unique Body, And Don’t Forget Your Mental Health, Either

Whether you’re tightening your pelvic muscles to avoid those infamous peezes, stretching out your hips and lower spine, or developing a truly holistic approach to your perinatal mobility, it’s important to remember that you know your body best. 

While developing your routines, don’t be afraid to change things up and state your opinion about what’s working and what isn’t. A physical therapist––especially one specializing in working with new or prospective mothers––isn’t there to boss you around and tell you what to do. Their job is to work with you, to listen carefully, and to guide you as you figure out what your body and your baby need to stay mobile and healthy.

Along with all of this, you should incorporate mental health into your physical routines. In some ways, this is the most important and the most neglected aspect of your present and future mobility. 

The mind is our body’s farthest-reaching system, and the way you treat your mental health throughout the many phases of pregnancy will determine not only how you handle this nine-month process, but also how you recover once it’s complete. You’re about to undergo some life and body-altering changes, and you and your partner deserve to feel supported as you deal with that. Anxiety and postpartum depression are common in both mothers and fathers alike––and that’s nothing to be ashamed of.

All in all, pregnancy and postpartum life are a marathon, not a sprint. Each step of the journey should be taken with confidence. 

Finally, you should work with someone who teaches you to listen to your body and to trust it––because when it’s finally time to bring that new face into the world, it’s going to be you and you alone at the center of that incredible, miraculous experience.


What comes after the PSA (Prostate-Specific Antigen)? The next steps

I had a conversation with Dr. Harold Frazier ( ) the other day about some alternative testing when Prostate Cancer is suspect.  This would be the next step after the initial screening with the PSA if it shows an elevated level.  In the past, a biopsy would be the next step.  This however can pose a number of risks to the patient, infection, bleeding, and just being plain unpleasant.

We talked first about a blood test that I had heard about from the Cleveland Clinic called the 4Kscore test.  This one combines four prostate-specific results with clinical information into an algorithm that calculates the individual’s risk for aggressive prostate cancer.  It has good clinical confirmation behind it.  

He also talked about another test that was not a blood test, but a urine test called SelectMDX.  It measures the mRNA levels of two biomarkers and helps determine if the possibility of a more aggressive form of cancer is likely and if a biopsy is therefore warranted.  Good news if you don’t want to go through another blood draw!

The downside is the expense of the test and the possibility that insurance may not cover the tests.  The upside is that there are more options to help detect prostate cancer and the options are simpler and more effective than ever before.

As with all methods of prostate screening, a good dialogue with your doctor, your risk factors, and age should always be taken into consideration before proceeding.



By: Patrick Wenning, PT

Photo Credit:

New Prostate Screening Recommendations 2018: Rethinking the use of the Prostate-Specific Antigen (PSA) test

Men need to be proactive about their health.  Cardiovascular fitness and blood pressure screening are often part of the regular check ups with their primary care physician.  In the last few years, Prostate Cancer screening is becoming part of this proactive approach.

There has been some controversy over the past few years about when and how to screen for prostate cancer.  What age do I start? What type of tests are there? Am I more at risk? Do I have to have an “uncomfortable” manual exam?

In the past, there were concerns about “over diagnosing”, “false positive” tests, and unnecessarily scaring men about the threat of prostate cancer; and as a result, the PSA (Prostate-specific antigen)-based test was not part of the proactive strategy.  But there are now newer guidelines for men to follow about the PSA-based test to help men determine their risk factor.

The US Preventative Service Task Force (Independent volunteer experts in evidence based and preventative medicine who work to make recommendations about prevention.)  have set forth the following guidelines for use of the PSA by men:

  • Men age 55-69: individual decision on Prostate-specific antigen (PSA) based screening test. Need to discuss potential benefits and harms with their clinician.
  • Men age 70 – older: No PSA-based screening.
  • African American Men: Unable to make a recommendation.
  • Men with family history: Unable to make a recommendation.

There is a similar point of view now from the Prostate Cancer Foundation  on when to begin screening and if the test is appropriate for you:

  • 40 ➣ If family history
  • 45 ➣ If African American
  • 50 ➣ If no history and not African American
  • 55-69 ➣ Discuss with your Doctor
  • Over 70 ➣ Not recommended

Often, Men start thinking about how their health is changing somewhere in their early 50s.  This is when prostate cancer screening should be considered.  Something simple to keep in mind when considering those long term health choices.


By: Patrick Wenning, PT

Photo Credit:

Playing for Two

There are moments in an athlete’s career that are life changing; winning your first title, becoming world number 1, or finding out you are going to be a mother.  For some female athletes, motherhood can be an exciting time; for others finding out you’re with child can leave more questions than answers.  How will this impact my professional career? My lifestyle? Or even my training? Can I still compete while pregnant? For a long time, the American College of Obstetrics and Gynecology (ACOG) has recognized the importance of exercise during pregnancy.  Unlike old beliefs, exercise is now known… For more information, click on PhysicallySpeaking-Playing for two


Written by: Reshma Rathod, PT and Thu Tran, MD for WTA (Women’s Tennis Association)

MAPP: Multi-Disciplinary Approach to the Study of Chronic Pelvic Pain

Malassezia spp. Skin Microbiome.

MAPP (Multi-Disciplinary Approach to the Study of Chronic Pelvic Pain) Finds That Fungus In Urine Might Be Linked to Urgency and Pain.

One of the most promising lines of research in urology today is the study of the biome, the diverse population of bacteria and fungi that live harmoniously in the human body. In previous MAPP Research Network studies, IC patients were found to have high levels of candida/fungi in their urine during flares (1). Another found that IC patients are deficient in some important bacteria in our bowel while having higher levels of other harmful bacteria (2). This latest MAPP Research Network study now links changes in fungal communities with the symptoms of urinary urgency and pain (3).

Researchers obtained urine specimens from 12 IC patients, 17 Over Active Bladder (OAB) patients and 14 patients without urinary symptoms. DNA was extracted, deep sequenced and compared to multiple fungal sequence databases. They found that patients with more severe symptoms, regardless of the symptom type, had decreased fungal diversity. Individual symptoms were associated with distinctive species of fungi. Patients with severe bladder pain had altered levels of Malassezia spp. composition while patients struggling with incontinence were inversely correlated with Wickerhamomyces spp.

The researchers concluded that the urinary microbiome is altered inpatients struggling with lower urinary tract symptoms, and that the loss of diversity in the microbiome correlated with worsening symptoms. Specific fungal patterns were found in patients with the symptoms of bladder pain and urinary urgency but interestingly this did not correlate with a diagnosis or medical condition. The researchers concluded, “These results suggest the intriguing possibility that particular microbial patterns maybe associated with specific symptoms, not necessarily diagnoses. This could lead to new diagnostic and treatment algorithms for patients struggling with lower urinary tract symptoms.” Clearly, there is a need for greater testing for fungi in urine screening.   Bacteria may not be the root problem in some patients. It is time to consider the roll of fungus in bladder dysfunction.

Adapted from Jill Osborne 8/10/17 Interstitial Cystitis Network Blog, Research



  1.  Osborne J. Could IC Flares Be Caused By Candida – New research study finds higher rates of candida rather than bacteria during IC flares. IC Optimist Winter 2016.
  2. Osborne J. The DIPP Mystery – Why are IC patients deficient in some good bacteria. IC Optimist Summer 2016.
  3. Journal of Urology, April 2017 Abstract MP29-10 Alterations in the Urinary Fungal Mycobiome in Patients with Bladder Pain and Urinary Urgency

Postpartum Pelvic Health: Vol. 1.

During pregnancy and delivery, natural changes occur that impact your pelvic floor and abdominal wall. These changes can cause pain and discomfort for many women during pregnancy and/or after delivery. Childbirth takes a toll on our bodies regardless of the method of delivery.

The toll of postural changes and weight gain on the body can lead to conditions such has back pain, abdominal separation (diastasis recti abdominis), urinary urgency and leakage. It is a misconstrued notion that these symptoms are normal because they are common. Common is not the same as normal. Many women need assistance treating these symptoms so they do not deal with life-long consequences. The good news is therapists at Restore Motion are skilled in treating both pre and postpartum symptoms.

Physical therapy can help pregnant women be strong and fit while decreasing complications during delivery and improving the birth experience. Physical Therapy can also assist postpartum women in regaining their pre-pregnancy body.


Constipation: What is it and how can physical therapy help?


According to the National Digestive Diseases Information Clearinghouse, someone is constipated if they have a bowel movement less than 3 times a week. This leaves a large range for what is considered “normal” frequency of defecation, from going three times a day (after every meal) to three times a week.

All of us will likely experience constipation at one time or another in our lives. Constipation just means that our food has spent too long in our colon, so more water than usual has been absorbed from the stool leaving it dry and hard to pass. This can be a frustrating symptom, leading to abdominal bloating, gas, increased pressure on the pelvic floor and surrounding organs and back pain. The best treatment is to be aware of the contributing factors and make daily lifestyle changes as needed.

What can lead to constipation?: Factors that may lead to constipation:

  • An imbalance in soluble and insoluble fiber intake, or lack of fiber in your diet
  • Not drinking enough water
  • Not enough physical activity
  • Changes in routine (irregular meal intake, traveling, unusual stress)
  • Ignoring the urge to go to the bathroom
  • Overuse of laxatives
  • Pelvic floor muscle dysfunction (we’ll come back to this later in the post)
  • Sometimes, constipation is a symptom associated with a specific condition such as from suffering a stroke, rectal prolapse, and irritable Bowel Syndrome or IBS. Constipation is common during pregnancy as the abdominal contents must shift and compress to accommodate a growing baby.

Physical therapy for Constipation

  • Help your pelvic floor muscles relax during defecation

When you go to the bathroom, your pelvic floor muscles should relax to “open the gates” and allow passage of stool and urine. Some people lose this normal coordination if they hold tension in their pelvic floor from life stress, or if they’ve had trauma to the pelvis, back, abdominals, or hips (childbirth and surgery). A pelvic floor physical therapist can help your body re-learn proper pelvic floor muscle coordination with biofeedback, manual therapy, and postural education.

  • Perform and teach you manual techniques to stimulate movement through your Intestines

In some cases, performing an abdominal massage can stimulate a bowel movement. Your physical therapist can teach you the massage sequence and appropriate amount of pressure. He/she can also perform visceral manipulation, techniques to restore normal movement in your abdominal organs.

  • Help you become more physically active

Your physical therapist can prescribe exercises to improve your flexibility and strength so that you can be physically active in the community without pain. Establishing a daily exercise routine is an important step in reducing constipation.




Written by: Claire Agrawal, PT
Edited by: Miriam Graham, PT