Physical Therapy in Kansas City

Women of all ages, from adolescence, through the childbearing years, and during menopause and beyond, experience a range of uniquely female health challenges. In some cases, an individualized exercise therapy program is an effective strategy for preventing and treating the pain and discomfort that often accompanies a variety of women's health conditions.

Women's Rehabilitative Services offers a comprehensive approach to helping women feel and look their best at every stage of life. Therapists provide specialized treatment and private consultation for adolescent females, pregnant moms, women who have undergone hysterectomies or breast surgeries, those who experience incontinence, pelvic pain and women with osteoporosis. Women who are diagnosed with pelvic floor dysfunctions and those who are experiencing obstetrical musculoskeletal problems can depend on our team of experts for effective intervention. Our focus is on providing personalized care that enables women to lead active, vital lives.

In addition, the SportsCare staff at AdventHealth Shawnee Mission coaches active females who are involved in a range of athletic pursuits. They provide helpful strategies designed to prevent injuries from occurring. Women who have sustained an injury can come to SportsCare for advice and therapy that will minimize recovery time.

Busy Mom Exercises

The following article is a continuation from a feature in MyHealthKC magazine.

When life gets hectic for busy moms, and there’s no time to catch that power aerobics or relaxing yoga class at the gym, there are still simple yet effective things to do at home to get fit and feel fabulous. Whether your kids are infants or teens, all moms need to learn some extra care for their muscles and joints so they can keep going with less aches and pains. This is especially true in postpartum and breastfeeding moms whose joints and ligaments are still loose and healing. Middle-aged and perimenopausal moms who may be experiencing early arthritic changes, bone density or muscle tone losses also need to learn special care and exercise for their particular bodies.

If moms of any age can learn to pay attention to three basic principles of body alignment and movement in all they do – whether at the gym or in the home, they can protect themselves from injury and move forward towards fitness. Physical therapists see many women in the clinic who hurt themselves doing too high level a core or yoga class for their body’s condition. They have poor awareness of the postures and movements that allow their bodies to sit, stand or move with ease.

Physical therapists stress these three basic principles when prescribing general fitness exercises:

1. Find your body’s own “neutral spine” position
2. Maintain these spinal postures by properly activating your deep core, pelvic and shoulder girdle muscles
3. Build strength and endurance in the major power muscles of your legs—your gluteals, quadriceps, hamstrings, calves and feet.

These three things are more easily said than done because they require body awareness, focus and practice.

Neutral Spine Versus Natural Spine

The natural curves of your spine may not be the same as the more proper neutral spine position. Depending on how we’ve learned to use our bodies over time, or how tired we are, we may be getting though our busy days by just hanging on our joints, ligaments and rope-like muscles. Over time, this can cause pain and strain. The curves that our low back and neck naturally fall into, due to habits or weakness, may be too extreme for ease of movement.

Neutral spine by contrast, is that position where the joints are not too closed or open, and there is equal tension in the surrounding soft tissues, like muscles and ligaments. When you finally learn how to find this neutral position, it’s like magic. You feel taller and lighter because you’re standing up straighter with the weight of gravity more equally distributed in your joints, instead of pulling you down. Then the challenge comes in maintaining that neutral posture throughout your movements, and this requires proper core strength.

Deep Core Muscles

The deep core muscles include the pelvic floor (muscles of bowel and bladder control), the corset-like abdominal muscle that pulls the belly button inward, the respiratory diaphragm, and the deepest back muscles that hold the spine upright and vertical. The phrase, “pull in your core,” has become such a buzz phrase in fitness classes that physical therapists always wonder when we hear that, how many women are actually doing it correctly, especially if movements are fast with legs and arms flying!

When core muscles are weak, it usually requires slow, mindful movements at first to keep them holding the spine still while the limbs are moving. Small ranges of motion in the arms and legs should come first during core exercises, then larger, faster limb movements, then resisted movements (like with weights or bands), then finally, adding in twists or changes in body direction – all keeping the spinal joints in neutral. If you can’t hold your spine still during one of those levels, moving on to the next level leaves you vulnerable to injury.

The following exercises help promote all three basic fitness principles for busy moms, but if you have trouble understanding or performing them, it is recommended you seek help, especially a new mom whose abdominal and pelvic floor muscles have been stretched from pregnancy and birth. Extra attention and a one-on-one session with a women’s health therapist can help.

Wall Angel Spinal Stretch

This exercise will help you find and maintain a neutral spinal posture, while stretching tight muscles that can pull you out of good alignment and cause back strain.

1. Stand with your back against a wall and feet hip-width apart.
2. Find, feel and activate your deepest core muscles, first with a gentle pelvic floor or Kegel contraction (as if holding back gas or urine), then continue to layer on the deep stomach muscle by pulling the belly button inwards towards the spine and upwards as if to tuck under the rib cage. (Don’t just hold your breath here!)
3. Keeping this core engaged, start to slowly slide down the wall, making sure your hips, kneecaps and second toes are in an imaginary line. Go down just enough to feel the power muscles of your legs – the quads, calves and gluteals – kick in. Don’t descend so deeply you can’t get up, feel pinching in your knees or see the knees slide beyond your toes. You should feel you that are working hard with your core and legs, and that your spine is lengthening and getting closer to the wall.
4. Now focus on your upper trunk and “angel wings” by gently pulling your shoulder blades back and down towards your spine and the wall. Let your shoulders and arms follow this blade motion. Keeping the shoulder blades contracted, raise arms toward the wall to form your “wings”. Your elbows, wrists and hands may or may not be touching the wall here, depending on how tight your shoulder girdle muscles are. Tuck your chin gently to bring your ear back over your shoulder. You should feel like this is giving you a double chin but don’t worry, it’s just stabilizing your head on your body!
5. After aligning yourself in this manner from head-to-toe, start to slowly slide your arms or “wings” upwards and overhead parallel to the wall, without losing any of your good postures. Stop if you feel your back is beginning to arch or shoulder blades are pulling away from the wall. Hold here for both stretch and strengthening, starting with short 10-15 second holds, then increasing up to 30-45 seconds.

As you advance in this exercise, you will see you can take your arms up further without losing your wall position, and that all of your body parts more closely touch the wall. This exercise can be made harder and promote postural strength by placing a resistive exercise band around your wrists and thighs to push out against when your reach your maximal overhead reach.

Wall Squat with Advancing Challenges Away from Wall

This exercise builds power and endurance in both your core and leg muscles, especially as you advance to adding longer holds, movements and challenges away from the wall.

1. Start against a wall just like in the Wall Angel Stretch, but this time, with only your buttocks touching. Your trunk should be bent slightly forward from the hips, and again, hips, kneecaps and second toes in an imaginary line.
2. Activate and maintain that same deep core throughout as you slowly slide down just enough to feel leg muscles working, but not past your toes. Hold there to tolerance for strength and endurance building.
3. Start with as little as 5-10 seconds, but work up to 15-20-30 seconds. With time, you can even challenge yourself to minutes of holding, but don’t be surprised if your legs get shaky and sore in all the right places if your body’s not ready for this! Each time you come out of your wall squat, be mindful to keep your core muscles contracted and visualize pushing up with the strong leg muscles you are creating, not just popping up to lock your knees or hips.

There are many ways to take this wall squat to a higher level. For example, you can add an element of balance challenge by placing a large exercise ball behind your back while sliding up and down. Or, you can add in arm or leg movements once down in your squat, like alternately lifting your heels as if marching, or arm lifts forward, out to the side or overhead. When stronger, try holding a medicine ball or weight first close to, then farther from your body while sliding or holding, all the time keeping proper core and leg alignment.

If staying against the wall becomes too easy, even with these challenges, you are probably ready to try using these same muscles away from the wall. Walking forwards, backwards and side-to-side while this same squat is called “duck walking” or “monster walking”, and physical therapists use this as a high-level, full-body strength and endurance move. You can advance your duck or monster walk to the use of resistive bands around thighs or ankles, or again holding weighted objects first close to, then further away from your body, all the while paying attention to muscle activation and alignment. Make sure you both swing and stand on each leg in that same proper hip, kneecap and second toe alignment. If you need to focus on upper body strength and posture, try holding a broom stick lined up along your spine from your tailbone to the back of your head, while duck walking. Only when these straight directional challenges feel easy, should you add in a change of body direction while in your squat – like lunging different directions or twisting, while holding your core tight.

Bridging Bottom Buster

Here’s another exercise that stresses proper core and leg strength, especially the gluteals, but in a reclining position. If you find yourself down on the floor with the kids but still want some me-time to tone and strengthen your legs, try this.

1. Lay on your back with hips and knees bent, feet flat on the floor and at a comfortable distance from your buttocks. Make sure hips and knees are in a line and pointing straight throughout this exercise. Don’t let femurs bones or knees roll in or out during the movement of this exercise or you will be activating different muscles and pulling on your joints at abnormal angles.
2. Again, start by finding and activating the deep core, but this time, add in a gentle gluteal squeeze (just enough to feel the muscles tense, without arching the low back or rolling the hips in or out). With these three muscles turned on, you have just activated your “pelvic girdle,” whose job it is to keep your low back and pelvis stable while moving.
3. Now, visualize that from your belly button to your groin creases, you are box full of your family’s fine china with no packing inside. On an exhale and with your pelvic girdle muscles holding, lift your hips to gently lift your box of china so as not to shift or break any piece. If feeling too weak to do this, you can assist your lift with a gentle push through your feet, keeping thighs and knees in line, and/or through your palms flat down at your side. Your goal is to be able to lift your china box with minimal assist from hands and feet and high enough to form a straight line from the side that goes through your shoulders, spine, hips and kneecaps, forming as near a 45 degree angle with the floor. If you have a low back condition and/or are weak, be careful not to arch your back. You should not feel any pinching in your back.
4. You can hold at the top a few seconds for endurance, but a greater core challenge will come when you try to lower your china box without shifting the plates, one vertebra at a time, tailbone last, before letting the pelvic girdle release. Start with low repetitions and frequent breaks on this one. If you can do 2-3 sets in good form and without fatigue, you may challenge yourself by placing resistance, like a weight, across the top of your pelvis to lift, or shift your weight into one leg when your box is lifted and try to extend the other leg out without tipping, dropping your hips or shifting the plates in your box.

Linda Mufich is a Physical Therapist who specializes in the care and fitness of women in all stages of their lives – teen and women athletes, pregnant and postpartum moms, menopausal and geriatric clients. For more information or to make an appointment for a women’s specialty evaluation, call Therapy Specialties at Call913-676-2444.

As with any exercise program, it is advisable to consult with your health care provider about your readiness to exercise. Don’t push into any pain, numbness or tingling sensations, and remember to listen to your body.