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Back Bridge Initiated: Week #1. Exercise Technique Description : Instruct the client to assume a supine posture with the hips and knees in a hooklying position (hips flexed to 45 1 and the knees flexed to 90 1 ). The feet should be positioned flat on the ground shoulder width apart. Instruct the client to squeeze the glutes and lift (bridge) the hips toward the ceiling. The client should raise the hips to the point in which the thighs, hips, and back are all in a straight line.
Source publication
The purpose of this case report is to present a return to running program for a postpartum client who had delivered via cesarean section. The client, a 29-year-old female health care professional who was 8 months postcesarean section, was referred to physical therapy for a return to running exercise program. The client had three live births during...
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ntroduction: Cesarean Section is a surgical pro-cedure which can be life saving and necessary in some circumstances. Nonetheless, Cesarean Deliv-ery continues to result in increased complications for subsequent deliveries as well as increased financial costs. This phenomenon raises concerns over the growing rates of Cesarean deliveries among women...
Citations
... These factors have only been studied in a limited capacity in the postpartum running population. Two peer reviewed case studies investigating postpartum runners [26,27] reported the findings of abdominal and hip weakness in the postpartum runners. A recent survey [3] reported 19% of postpartum runners had stress urinary incontinence up to two years postpartum and 27% up to 10 years postpartum, supporting pelvic floor weakness as a strength impairment. ...
... however not present in another [26]. Hip flexor tightness (and lumbar extensor tightness) has been hypothesized to result from postural changes that may take place during pregnancy [39]. ...
... The following alignment impairments met consensus for postpartum runners and had conflicting reports in the literature: Trendelenburg sign, dynamic knee valgus, increased lumbar lordosis, overpronation and thoracic kyphosis. In case studies investigating postpartum runners, knee valgus and Trendelenburg sign were supported during functional testing (single leg squat and lunge) in one case study, [26] and increased lumbar lordosis and thoracic kyphosis were noted in one case study [27]. Changes in multiplanar knee laxity have been documented during pregnancy and up to five months postpartum [43]. ...
Background
Postpartum runners report musculoskeletal pain with running. Because of inadequate research, little is known about the origin and pain-related classification. Through expert consensus, this study is the first attempt to understand the musculoskeletal impairments that these runners present with. The objective of this survey was to gather expert consensus on characteristics of reported impairments in postpartum runners that have musculoskeletal pain.
Methods
A web-based Delphi survey was conducted and was composed of five categories: strength, range of motion, alignment and flexibility impairments, as well as risk factors for pain in postpartum runners.
Results
A total of 117 experts were invited. Forty-five experts completed round I and forty-one completed rounds II and III. The strength impairments that reached consensus were abdominal, hip and pelvic floor muscle weakness. The range of motion impairments that reached consensus were hip extension restriction, anterior pelvic tilt and general hypermobility. The alignment impairments that reached consensus were a Trendelenburg sign, dynamic knee valgus, lumbar lordosis, over-pronation and thoracic kyphosis. The flexibility impairments that reached consensus were abdominal wall laxity, and tightness in hip flexors, lumbar extensors, iliotibial band and hamstrings. The risk factors for pain in postpartum runners were muscular imbalance, poor lumbopelvic control, too much too soon, life stressors, pain during pregnancy and pelvic floor trauma.
Conclusion
This study presents a framework for clinicians to understand pain in postpartum runners and that can be investigated in future cohort studies.
Level of evidence
5
... 2 Moreover, case reports on antenatal and postpartum running consistently demonstrate no severe maternal or fetal effects. 8,27 Despite a likely increase in the number of pregnant and postpartum women participating in vigorous-intensity activity, few studies have described this population. Pregnancy and childbirth present unique anatomical and physiologic changes and are associated with adverse postpartum conditions such as musculoskeletal pain, stress urinary incontinence (SUI), and diastasis recti. ...
Background
With a recent increase in running popularity, more women choose to run during and after pregnancy. Little research has examined exercise behaviors and postpartum health conditions of runners.
Hypothesis
Antenatal and postpartum exercise is beneficial in reducing certain postpartum health conditions.
Study Design
Cross-sectional study.
Level of Evidence
Level 5.
Methods
A self-administered, online survey was developed that consisted of questions regarding antenatal and postpartum exercise behaviors, maternal history, and postpartum health conditions. The survey was completed by 507 postpartum women who were running a minimum of once per week.
Results
Seventy-two percent of participants ran regularly during pregnancy, with 38% reporting running in the third trimester. Women with musculoskeletal pain during pregnancy were more likely to experience pain on return to running postpartum (odds ratio [OR], 3.08; 95% confidence interval [CI], 1.64-5.88). A birth spacing of <2 years or a vaginal-assisted delivery increased the odds of postpartum stress urinary incontinence (OR, 1.71; 95% CI, 1.00-2.91 and OR, 2.08; 95% CI, 1.24-3.47, respectively), while Caesarean section delivery decreased the odds (OR, 0.58; 95% CI, 0.35-0.96). Multiparous women and those who reported a Caesarean section delivery were more likely to report abdominal separation (OR, 2.11; 95% CI, 1.08-4.26 and OR, 2.20; 95% CI, 1.05-4.70, respectively). Antenatal weight training decreased the odds of postpartum pain (OR, 0.52; 95% CI, 0.28-0.94), stress urinary incontinence (OR, 0.46; 95% CI, 0.21-0.98), and abdominal separation (OR, 0.51; 95% CI, 0.26-0.96).
Conclusion
Musculoskeletal pain, stress urinary incontinence, and abdominal separation are prevalent conditions among postpartum runners and are more likely to occur with specific maternal history characteristics. Antenatal weight training may reduce the odds of each of these conditions.
Clinical Relevance
Strengthening exercises during pregnancy may prevent weakening and dysfunction of the abdominal and pelvic floor muscles, decreasing the odds of pain, stress urinary incontinence, and abdominal separation after pregnancy.
... 4,24 Exercise can target the muscles and joints of the low back to rehabilitate the injured athlete. 1,2,13,14 Therapeutic exercises, specifically core stabilization exercises, decrease pain, reduce disability, improve quality of life, increase muscular endurance and strength, improve segmental stability, and reduce risk of injury. 10,13,21 Part 1 of this article presented 2 clinically popular core stabilization rehabilitation strategies for individuals with LBP: a motor control exercise (MCE) approach and a general exercise (GE) approach. ...
Therapeutic exercises are frequently prescribed to patients with low back pain. Numerous exercise programs for patients with low back pain have been described. Many of these treatment programs are based on 1 of 2 popular rehabilitation strategies: a motor control exercise approach or a general exercise approach.
PubMed clinical queries from 1966 to March 2013 for keyword combinations including motor control exercise, core stability exercise, therapeutic exercise, general exercise, global exercise, local exercise, transversus abdominis, segmental stabilization, and low back pain.
Randomized controlled trials that assessed the effects of a motor control exercise approach, a general exercise approach, or both for patients with low back pain that were published in scientific peer-reviewed journals.
Included studies underwent appraisal for exercise intervention and outcomes.
Fifteen studies were identified (8, motor control exercise approach without general exercise comparison; 7, general exercise approach with or without motor control exercise approach comparison). Current evidence suggests that exercise interventions may be effective at reducing pain or disability in patients with low back pain.
Stabilization exercises for patients with low back pain may help to decrease pain and disability. It may not be necessary to prescribe exercises purported to restore motor control of specific muscles.
... The inclusion of core exercises in a healthy client's training program may aid performance and reduce injury risk. Core exercises were included in a successful return to running training program for a postpartum client (Brumitt, 2009). After an 8-week course of training, the client had returned to running and realized improvements in core strength (Brumitt, 2009). ...
... Core exercises were included in a successful return to running training program for a postpartum client (Brumitt, 2009). After an 8-week course of training, the client had returned to running and realized improvements in core strength (Brumitt, 2009). ...
This case report details the musculoskeletal evaluation and the successful rehabilitation of a 24-year-old female recreational distance runner who self-referred to physical therapy with an acute bout of low back pain (LBP). Her LBP was provoked during each distance run. The patient's musculoskeletal evaluation revealed core weakness, especially on the left. A recently reported functional test, the Bunkie test, was administered as part of the physical evaluation. The scores from the Bunkie test correlated with other quantitative and qualitative findings. A therapeutic exercise program emphasizing core stabilization was prescribed. The patient was able to shortly return to running pain-free.
The postpartum period in a woman's life is filled with numerous changes, including physical changes, changes in sleep habits, and learning how to best care for a newborn. A common goal among postpartum women is to either begin or resume an active lifestyle, which often includes physical activity such as running, biking and swimming. The postpartum athlete may discover barriers that prevent her from returning to or beginning an exercise routine. These obstacles include muscle weakness, fatigue, depression and physical changes that require exercise modification. The physical therapist is well-suited to properly assess, treat and manage the care of the postpartum athlete. Postpartum athletes wishing to begin or resume training for triathlons require special consideration, as the triathlete must balance training to compete in three different sports.
The purpose of the paper is to identify the unique physical and physiological changes that occur to the female during the postpartum period. In addition, injuries that are more commonly seen during the postpartum period will be discussed. Recommendations for beginning or resuming an exercise program will be reviewed. Lastly, sport-specific training for the postpartum triathlete, including challenges presented with each triathlon component, will be discussed.
We made a systematic review on physical therapy as a method to prevent pelvic floor dysfunction in the postpartum period and to determine the most common therapeutic methods used.The search was carried out from September 2011 to January 2012 using the following databases: ENFISPO, Pedro, CINAHL, CSIC, Spanish Library Cochrane Plus, Cochrane Library, Medline, Pubmed, Wos, Scopus and Sport Discus with full text.Following the inclusion and exclusion criteria, in 14 studies we found that the most frequently used methods during postnatal period are Kegel exercises, hypopressives exercises and depressive exercises with the baby.Little bibliography was found on methods to prevent pelvic floor dysfunction in the postpartum period. The methods used do not involve an overload level on the care level for the physical therapist.
Case report.
Postpartum low back and hip dysfunction may be caused by an incomplete recovery of abdominal musculature and impaired neuromuscular control. The purpose of this report is to describe the management of a postpartum runner with hip and low back pain through exercise training via ultrasound imaging (USI) biofeedback combined with running-form modification.
A postpartum runner with hip and low back pain underwent dynamic lumbar stabilization training with USI biofeedback and running-form modification to reduce mechanical loading. Muscle thickness of transversus abdominis and internal oblique was measured with USI preintervention and 7 weeks after completion of the intervention. Additionally, 3-dimensional lower extremity joint motions, moments, and powers were calculated during treadmill running.
The patient's pain with running decreased from a constant 9/10 (0, no pain; 10, worst pain) to an occasional 3/10 posttreatment. Transversus abdominis muscle thickness increased 6.3% during the abdominal drawing-in maneuver and 27.0% during the abdominal drawing-in maneuver with straight leg raise. Changes were also noted in the internal oblique. These findings corresponded to improved lumbopelvic control: pelvic list and axial rotation during running decreased 38% and 36%, respectively. The patient's running volume returned to preinjury levels (8.1-9.7 km, 3 days per week) with no hip pain and minimal low back pain, and she successfully completed her goal of running a half-marathon.
The successful outcomes of this case support the consideration of dynamic lumbar stabilization exercises, USI biofeedback, and running-form modification in postpartum runners with lumbopelvic dysfunction.
Therapy, level 4.
