The hidden secret to your lady issues

Alright, I know that most ladies are not talking about their “lady issues” or what to do about them with other people other than their gynecologist.  But I’m going to talk about the things that you don’t want to because more and more women are coming into my office with these complaints and they have never been told that there could be a solution for them (other than taking some form of medication).  Some of the most common lady issues are incontinence, painful intercourse, and frequent urination.  The hidden secret to resolve these issues lies in your pelvic floor, literally.  Read on to learn more about these issues and how to resolve them.

Incontinence.  Urinary incontinence is defined as any amount of leakage of urine during any type of activity.  So no, it’s not okay that you just avoid jumping jacks at the gym or running up the stairs.  Your pelvic floor muscles are a really big factor here because when they are working optimally, you should not have any type of incontinence.  It’s not necessarily that the muscles are weak and require strengthening because there are instances where the muscles are in spasm and cannot work because they are already contracted too much.  The muscles should also be capable of several things, contracting strongly, maintaining a contraction for several seconds, making quick contractions and working reflexively to contract prior to coughing or sneezing.  If you are experiencing incontinence, you should think about working with a pelvic floor physical therapist that is specially trained in this area and can address your specific cause for the incontinence.  I would not recommend “just doing kegels” without having it evaluated first because if the muscles are in spasm, kegels will make things worse.

Painful intercourse.  If the pain feels more superficial, you could need more lubrication for sexual intercourse.  Vaginal dryness is a side effect of decreased estrogen so as women age, their estrogen levels decrease, and can result in dryness.  If you are experiencing deeper pain during intercourse, it’s likely that you could have trigger points within the pelvic floor muscles.  When something is putting pressure on those trigger points, it will elicit pain.  This is especially common after having a baby due to the trauma that the pelvic floor muscles underwent during pregnancy and birth.  The best way to resolve this issue is to work with a pelvic floor physical therapist that will be able to manually release these trigger points and eliminate the pain.

Frequent urination.  Do you find yourself running to the bathroom often even if you just went a few minutes before?  Or perhaps you feel like you aren’t fully voiding therefore you have to go again soon after?  Or maybe you get worried about needing to go so you have begun to just go to the bathroom before you leave a place “just in case.”  Sound like you at all?  These symptoms indicate urge incontinence where you get a very strong urge to urinate and may or may not have issues with leakage.  If this is a new issue that just popped up out of nowhere, you should see your primary doctor as it may be a bladder infection or urinary tract infection.  But if this issue has been going on for quite some time, it’s time to have it addressed.  What happens during urge incontinence is that the bladder begins to be trained to not fill fully so you begin to get signals from the bladder that you need to void even though it is not filled all the way.   This begins to form a habit and before you know it, you will be running to the bathroom all the time.  For women with this issue that come into the office, we typically have them start recording when they are going to the bathroom so we can begin to retrain the bladder and increase the time between bathroom trips little by little.  Find a pelvic floor physical therapist that can help you with this so you don’t have to be afraid to go on long car trips or on long shopping sprees! 

If you have been experiencing any of these issues, it’s time to get them addressed.  Women do not need to deal with these issues throughout life and you should be able to enjoy things such as sexual intercourse without having pain or jumping on the trampoline without wetting your pants.  The issues aren’t as simple as “doing kegels” like so many other articles you may have read so see a specialist that can address all the factors and get you living an active life again!  Check out our website or email me with your questions at


Everything you need to know about Cesarean section scars

Caesarean sections (C-section) have been around for a long time but have become more prevalent in recent years with 1 in 3 women undergoing a C-section according to the International Cesarean Awareness Network (ICAN).  Unfortunately, it is common for women to have persistent pain, numbness, and burning after their C-section, not to mention poor core strength and neuromuscular control, ie: the ability to correctly activate those muscles. 

While the specific surgical technique can vary for C-sections, the most common method involves a horizontal incision slightly above the pubic bone, then the separation of the muscles in order to get to the uterus.  Surgical techniques and protocols are not my area of expertise so I can only give you a general overview but it is important to understand the trauma that the body goes through during a C-section.  In some techniques, the muscles are cut, but the most common technique pulls the muscle layers apart which places a great deal of stretch on the muscles, connective tissue, and nerves.

Underneath the skin lies a layer of connective tissue, called fascia, which also surrounds all of the nerves and blood vessels.  Deep to that lay your muscles with a layer of fascia surrounding each muscle so they can glide over one another when overlapping.  With a C-section, the muscles and fascia get pulled apart far enough to pull your baby out.  As part of healing, those muscles have to try to go back to their original place (in addition to being stretched from being pregnant) and the fascia has to realign itself.  The skin also must heal up from the incision and it is a natural part of the healing process for your body to produce scar tissue.  Scar tissue is highly variable but can create adhesions between the tissues underneath the skin. 


These adhesions limit how the tissues glide over one another so they essentially get “stuck” on each other.  This can create problems because the limitations don’t allow the tissues to work how they are supposed to.  The fascial layer also gets stretched and disrupted, which pulls on all of the nerves that are within that layer.  As things heal up, the fascia often does not go back to how it was prior to C-section.  Together, the bound up fascial layer and adhesions/scar tissue create a lot of the common complaints after C-section such as numbness, burning, pain, or electric shock sensations.


While most things you may have read talk about nerve damage during C-sections, a lot of these symptoms actually are symptoms of scar tissue and disruption of the fascial layer.  When the fascia gets damaged, it often gives burning sensations or like a hot knife is going through that area.  Scar tissue can create pain and/or numbness in an area.  The nerves can be overstretched along with the fascia and contribute to some of the sensations but they typically respond well to desensitization techniques.  There are instances where the nerves can be severed but it is highly likely that all of your symptoms do not stem solely from nerve damage. 

In addition to all of the weird sensations and pain that can occur after a C-section, the core muscles are also greatly affected.  For starters, they get pulled apart and stretched to their max after being stretched out for 9 months prior to that.  This makes them not work very efficiently.  Every muscle has an optimal length to produce a contraction.  When the four layers of core muscles are stretched to a longer length, they aren’t able to contract as strongly.  The stretching also disrupts the nerve innervation to these muscles so your muscles aren’t getting the correct signals from the brain when you are trying to contract them.  And with the fascial layer being bound up and not aligned properly, it makes it more difficult for the muscles to contract properly.  All of these issues are common for anyone after pregnancy but there is more damage after a C-section.  Without core muscles that work properly, your trunk will not have the stability and support that it truly needs.  This is a main contributor to low back pain especially since you will now be lifting and holding a baby which puts a higher demand for the need for stability and support. 

Most women are not aware of the traumas that occur during pregnancy and particularly with C-sections.  Due to this, most of these issues never get addressed and women end up living with pain for many years because they never knew what to do for it.  All of these issues can be resolved with proper physical therapy treatment that utilizes hands-on techniques to break up the scar tissue, realign the fascia, normalize sensation, and retrain the muscles.  If you are in the Milwaukee area and have had a C-section, give me a call at (414) 331-2323 or email me at  I also want to mention that these issues can last for years and years.  I have seen women with these issues from a C-section that occurred 15 years ago.  So the takeaway is that it’s never too late to seek out treatment and that these issues don’t tend to spontaneously resolve.  Check out our website for more information and feel free to reach out to me with any questions.

Are your shoulders bothering you after raking leaves?

Have you been spending all of your free time raking leaves?  I can totally relate…our new house is surrounded by woods and lots of trees, which I LOVE, but it also means lots of raking.  Fall is a time filled with lots of yardwork whether it is raking or gardening.  And we see quite a few people in our office with pain after a long weekend of yardwork.  Most commonly, shoulder pain with raking and gardening.

While the ideal way to rake would put more emphasis on your legs instead of your arms, there’s no way to not use your arms for raking.  It really is a whole body workout (and burns quite a few calories I might add).  If you end up with sore shoulders after a weekend of raking, chances are you’ve had some shoulder pain in the past even if it was pretty minor.  Granted, there are instances when someone pulls a muscle acutely, but most of the time, that pain indicates an overuse injury.

Ever heard of rotator cuff syndrome?  It’s common as adults age because the tendons get worn out similar to a clothes line that hangs outside for years and years and becomes brittle.  This also combines with some muscle imbalances with the upper back, poor posture and lifting habits, and results in pain.  What happens is the tendons get pinched in the shoulder joint and also aren’t strong enough to provide the stability at the shoulder.  So then when you are doing a strenuous task such as raking, the arm and shoulder can get very sore.

The best thing you can do is rest it and ice it for 15 minutes at a time.  This will help clear up any inflammation that is in the shoulder joint and help decrease the pain. It’s also important that you address the true issue as well since rest and ice are temporary treatments.  Most people think, it’s not that bad, it’ll just go away on its own.  Well, you will likely continue to irritate it and the longer you go without addressing some of the other contributing issues such as posture, mobility, and strength, the longer it will take to get better down the road.  See a physical therapist to get started on treatment and get your shoulders working in top condition before it goes on for too long.  If you’re near Hales Corners, Muskego or Franklin area, feel free to reach out to me and I’d be happy to take a look at it for you.  Shoot me an email at or call me at (414) 331-2323.


4 ways to avoid pain at the gym

It’s hard to believe that we are coming into fall now!  But seeing the seasons change is always exciting and there’s always great things to do in fall (like hiking in the Kettle Moraine).  If you’re like me, you want to stay active even as it gets cooler outside and don’t want your fitness goals derailed.  This article is for all those active people (gym or no gym) to help you stay active and keep you working out without pain.  Follow these tips to stay injury free and get a jumpstart on your fitness before all the Christmas cookies…

Avoid overhead movements.  We see a lot of people that begin to have shoulder pain and it is likely due to the rotator cuff “wearing out”.  These people get pain with overhead movements because it impinges the shoulder joint (simply put, the shoulder joint gets jammed together and sends a pain signal).  If you notice that you are starting to get some shoulder pain with your everyday activities, avoid overhead movements such as shoulder presses.  This will only exacerbate the issue and make the pain worse.

Watch that knee alignment.  This fault is VERY common with moves such as squats and lunges where the knee is moving too far forward and moving over the toes.  It’s important that the knee stays behind the toes.  This also keeps the weight centered more on the heels and works the quads more effectively.  If the knee is coming too far forward, it puts a lot of additional strain on the knee joint and can lead to quite a bit of pain at the knees.  If you notice that your knees feel achy after a workout, chances are your form wasn’t ideal and next time, assess your alignment to make sure you are doing them correctly.


Keep your back flat with planks.  Ever see the person doing a plank and their low back is sagging in?  Well, that’s not a good thing and can lead to low back pain or exacerbate the issue if you have a history of low back pain.  The ideal form is having a flat or neutral back so there is no sagging but also no butt up in the air.  Practice in front of a mirror so you can see how your form is.  And remember to draw the belly button in towards the spine like you are zipping up tight pants.  This will help you keep a good posture during the exercise.  If you are holding a plank and after alittle bit of time you notice that it’s very hard for you to not sag at the low back, then stop there because that means your core muscles are tired and not giving you the support you need for the proper form.


Work within your comfort level.  Everyone has a different fitness level and what works for one person doesn’t work for everyone.  It’s important that you recognize your body’s limits and try to work within them.  When people try to do something that is much more difficult than they can tolerate, that’s when injuries occur.  It’s not a competition because everyone is at different stages and that’s okay.  Do what works for you and you will be on the right path to avoiding injuries and pain.

If you’re currently having pain during your workout, don’t try to wait it out.  Have it looked at by a skilled physical therapist to determine what the issue is and get it resolved quickly so you can get back to the gym without pain.  If you’re in the Milwaukee area or Hales Corners, feel free to send me an email at and I’d be happy to sit down with you and talk about your issues.


3 beginner yoga poses to try today

Are you like me and find yourself running a million miles a minute during the day, constantly on the go and your mind always turned on?  Or maybe you are sitting during the day for your job and feel stiff and tight frequently?  If this rings a bell, perhaps you should think about trying yoga?  Granted, it is best to do a full yoga sequence regularly but even doing a few poses will get you on the path to less stress and more mobility.

I am so excited because we recently added yoga to our class offerings at Revitalize Physical Therapy (check out our schedule here), and Kristin, our awesome Rehab Technician, will be teaching them. If you are near Hales Corners, Franklin, or Muskego and want to join us for a yoga class, we would be more than happy to have you!  If you can’t make it, try these three beginner poses and see what you think.

  • Tree Pose: Begin in mountain pose (feet close together, good posture, arms at your side) then reach down and grab your right foot.  Pull it up and place the bottom of your foot onto your left inner thigh above the knee.  If this is too challenging, place the foot below the knee.  Try to keep your hips facing forward without twisting or bending.  You may place your hands in prayer position in front of you or above your head.  Hold for 5 breaths then repeat on the other side.


  • High Lunge: Begin in a forward bend pose (like you are touching your toes).  Take a step backwards with your left foot far enough so your right knee will bend approximately 90 degrees.  Try to keep your right thigh parallel to the floor and bend forward so your chest is resting close to your right thigh and reach towards the floor.  Think of relaxing your left hip and hold for 5 breaths.  Repeat with the other leg.


  • Downward facing Dog: Begin on your hands and knees with hands directly under your shoulders and knees directly under your hips.  Exhale and lift your pelvis up towards the ceiling and gently straighten your knees.  Your body should form an “A” as you press through your arms into the floor and continue to lift your pelvis and lengthen the spine.  Keep your head tucked in between your arms and hold for 5 breaths.


Let us know if you have any questions or concerns about doing any of these yoga poses.  And don’t forget that you can come try out a class with us.  Email me at if you’re interested in learning more. Namaste!

How to have a healthy pelvic floor during pregnancy

I know some of you are probably thinking “ya right, there’s no hope for my pelvic floor.”  Well, I’m here to tell you that there is and there are things you can do during your pregnancy to help your pelvic floor and even set you up for better success after delivery.  The pelvic floor is so important in giving you stability and with all of the changes that occur during pregnancy, the pelvic floor undergoes a lot of stress.  Here are my top 4 tips on how you can keep your pelvic floor happy! 🙂

Exercise it.  Your pelvic floor is working so hard because your body has gained roughly 30 pounds of weight very quickly over the course of your pregnancy.  And all of that weight rests on the pelvic floor.  So you can imagine why it seems to be common during (and after) pregnancy to experience incontinence.  If you had to hold 30 pounds all day long you would probably be tired too.  To help with this, it’s important to do specific pelvic floor exercises, ie: kegels.  Now, I’m going to put a disclaimer in here and tell you that this is not for everyone because sometimes women have an overactive pelvic floor and kegels will make this worse.  And I’m also going to tell you that the advice you read on the internet that tells you to do like 50 kegels is absolutely ridiculous since most women struggle to do 10.  It’s best to work with a pelvic floor physical therapist to do what is right for you but if you can’t find one close to you, it’s important to only do an appropriate amount of kegels.  Try doing several in a row and count how many you can do before you feel as if you are not getting a full contraction.  This might only be 4-5 reps (or less).  But this will be your starting point for reps during the day.  Squats are also a great exercise for the pelvic floor.

Take it easy with all the jumping.  Since your pelvic floor is working really hard to give you support, jumping makes it work even harder!  Simply put, high intensity exercises such as running and jumping puts a lot more stress on the pelvic floor and can make it fatigue quicker.  It can also create the issue where the pelvic floor is overactive, ie = spasm, because the muscles are really tense trying to work really hard.  This will make your delivery much more difficult and long since the muscles have difficulty relaxing.  If you enjoy doing these types of exercises, work with a pelvic floor physical therapist to make sure your pelvic floor is functioning properly so you can have a quicker and easier delivery.

Stay hydrated.  Consuming an adequate amount of water is important to stay hydrated and minimize the risk for incontinence.  It may seem counter-intuitive to drink more water to stop leaking urine but the rationale behind this is because when you are dehydrated, your urine becomes very concentrated.  This irritates the bladder and makes incontinence more likely because the bladder will be trying to expel the irritating contents within it.  Hydrated muscle tissue also allows it to work properly so if you’re well hydrated, your pelvic floor muscles will be able to get everything it needs to function.

Practice good breathing techniques.  Have you heard of diaphragmatic breathing?  You’ve most likely read something about it at some point or another.  Well, it’s important for SOOO many reasons.  When you breathe correctly, meaning the belly expands out rather than the chest and shoulders rising upward, this helps the pelvic floor to relax properly.  If you are breathing with your upper chest more, like so many of us do, it causes the pelvic floor muscles to tense up more and become overactive (like we talked about above).  The diaphragm also completes the cylinder along with the pelvic floor, ab muscles and back muscles.  All four need to be strong and work properly in order to give you the support you need.  When one (or more) is not, there are issues such as pain, incontinence, or instability.  And as you move along in your pregnancy, there will be less room for your diaphragm to expand so practicing these breathing techniques will help keep everything healthy.

If you ever have questions about anything we talked (or didn’t talk about), please feel free to reach out to me at and I would be more than happy to talk with you.  Did you also know that we offer the Revitalize Bump Package and Revitalize Body After Baby Package that addresses some of the things we talked about today?  Check them out on our website and please pass it along to any friends that you have that are pregnant.


How to know if you have a diastasis recti

Pregnancy is such an exciting time in a woman’s life, especially if it is the first baby!  And what’s even better is being able to carry that baby and then later run around after them at the park.  Unfortunately, I see way too many women in my office that can’t do those things and the big culprit is diastasis recti.  That’s just the fancy (medical) term for a separation between your abdominal muscles.  As your belly expands with a growing baby, the abdominal muscles begin to pull apart from each other down the center of your stomach.

What’s the big deal with it?  Well for starters, it is very common in women to get one while pregnant.  However, you ideally want those muscles to go back to where they were and often times they don’t.  When the muscles separate too much, you can begin to have a bulge in the middle of your stomach and that is essentially your intestines pushing through similar to a hernia.  It also means that the abdominal muscles can’t work very efficiently when they are stretched apart so much.  This can lead to other issues such as low back pain and pelvic floor dysfunction because you no longer have a stable core.

In order to determine if you have a diastasis, lie on your back with your knees bent.  Place your fingertips over your belly button and lift your head and neck slightly.  If you fill a gap where your fingers are, that is a separation of the muscles.  Repeat this slightly above and below the belly button.  It’s considered a diastasis recti if the gap is 2-3 fingers wide or larger.


If you have a diastasis, it is best to have a specialized set of exercises from a physical therapist for this.  Everyone starts at a different stage in regards to core strength and stabilization so reading exercises on the internet may not be the best thing for you specifically.  We offer a post-partum package here that has core as one of it’s focuses so if you’re close by to Milwaukee, check us out.  If you’re pregnant (regardless of a diastasis or not) or recently had a baby, do not even both doing crunches.  For starters, it doesn’t do much for your core strength.  It doesn’t work the stabilizing muscles that you need.  And most importantly, it increases the pressure inside your abdomen which can put you at risk for forming a diastasis or make it much worse.  So just stop with the crunches…

Feel free to comment or email me at if you have any questions about diastasis recti.  And you can always check out our website for our therapy packages that focus on pregnancy and postpartum.