Things will never be the same. People wished me well before the birth of my first child and told me to enjoy my last few months before he came. I have to say I am very glad for the experience of being a mother but I could do without the changes to my body pregnancies have brought me.
It was during my first pregnancy that I noticed a deep stretching, burning pain at my belly button area. I later came to find out that is my linea alba or white line, a band of connective tissue that connects the two rectus abdominus muscles. These are the "six pack" muscles that go down the center of the abdomen. This burning stretching pain should have been my first clue that I would have a rectus diastasis or a separation of the linea alba. But after he was born I didn’t notice pain there, in fact I didn’t have much pain at all. It wasn’t until I went back to work fulltime and my exercise regime was decreased to keep up with the responsibilities of work and taking care of baby that I started to have low back pain and a feeling of instability in my pelvis and at my pubic symphysis, this is the joint in the front of the pelvis where the two halves come together.
My sister is a different story, she has had three children and despite boxing, hot yoga and spinning and being in awesome shape she has a separation and instead of pain, she has bulging of the rectus diastasis. This is another presentation of the same problem, an intraabdominal pressure issue. It is not that she is weak, it is that her muscles are just confused about which ones should be working. So when she sits up from laying down, "pop" a little bulge occurs right down the middle of her belly. Other people do this same motion and instead of a bulge they get a deep pit between the two muscles.
Our bodies truly are amazing, they are able to go from a 28" waist, to having a basketball inside and back to a 28" waist all within a few months’ time. Why are we amazed then when the abdomen doesn’t go back to working the way it should? One reason is that it isn’t just the basketball that changes. There are many postural changes of pregnancy and postpartum baby care that help to perpetuate some of the changes that have occurred because of the basketball. In fact there are 85 joints in the torso that are attached or have influence on the stresses placed on the linea alba. Changes to the positions or functioning of any of these joints can cause muscle spasms in the surrounding muscles that actually fight against closure of the diastasis.
For example, the external oblique muscles are rotators of the trunk and they are attached to the six pack muscles. Therefore if I have a rib cage that is stuck open and out because my baby was pushing up into my ribs when I carried him, then my external oblique muscles are likely engaged in spasm or they turn on too soon when I go to move my body. This action works to continually pull the linea alba apart widening the gap and keeping us looking like we are still pregnant!
Though things will never be the same after baby there are a lot of plans and braces out now to finally help us get back to our pre-pregnancy function. Unfortunately the one size fits all plan doesn’t fit everyone. Working to improve posture, working on bringing the diaphragm back down to its original position (instead of staying up like the baby is still there under the ribs) and working to bring the muscle groups into better synergy to create the optimal tension on that linea alba are all things that need to be addressed to return to pain free and flatter post baby bellies! I’ll admit, I tried the braces, I tried the different plans, but it wasn’t until I delved deeper and took everything into consideration that I got better. You can get better too, it may not be the same as before but you can recover function, strength and stability.
So many of us dread the onset of winter because the icy temperatures seem to increase our pain. For that matter, many with surgeries on joints or past broken bones will complain of stiffness when the weather changes. Why does it hurt so much more in the cold?
To answer this question that many are facing these next few months, we should probably look to what causes us to feel pain in the first place. Pain is our body’s way of saying, “Hey, watch out, you are damaging me! Do something different!” But what if there is no danger or you’ve healed from the injury, but your body keeps acting like there is danger or an injury? What if there was never an injury, but you still have pain, and it’s worse when the temperatures drop?
Well there are some things you can do, and the first thing is to understand pain. It is not the same for every person. This is why it is so hard to describe and explain. What if I told you that just by understanding the way it is created in your body, or what causes you to have the sensation, it can actually help you to be less sensitive?
"Huh...You are telling me that just by understanding how pain is created in my body/mind I will feel less pain?"
That’s right, just by understanding it, your pain levels and sensitivity levels will decrease.
There’s another thing: If your visual system can see that you are doing something about your pain, to take the danger away, then your pain levels will decrease. Creating a management program will help address your symptoms, can decrease your sensitivity to pain, and can help you live a fuller life.
So how does this help with the cold? We can’t change the climate (unless you are like my parents and head down South for a month at a time), but we can change the state of your body right now. You see, pain is created in your body by neurotransmitters. If you have enough of them you get a message that feels like pain and starts a whole cycle of muscle guarding and discomfort. But the neurotransmitters are from all kinds of different inputs, like mechanical, temperature, and acidity. Regardless of where they come from, if you have enough of them they equal pain and start that same pain cycle.
So, the magic bullet for riding out winter in relative ease is to stick with your management program that addresses those things you do have control over, including dressing in layers to better control your environment. I know I own gloves and hats and warm boots but sometimes I feel like it is too much trouble to get all decked out. This is really not the right attitude to take on it though, because skimping on warm gear can mean I inch closer to that pain message. Even putting on the gloves, hat, and scarf can be something that your brain sees as addressing the danger and it may be the answer to keeping you in less pain this winter!
Want to learn more about pain? Check out the book Explain Pain by David Butler and Lorimer Moseley. Want to learn how you can create your own pain management program? A physical therapist, versed in pain neuroscience education, can help!
If you could do something to decrease stress, improve your body's ability to make vitamins, digest nutrients and decrease pain, would you? Our microbiome is ours to use or abuse, and it exists largely on the inside. Take a look at the shape of our digestive tract; the intestines are a twenty to twenty-five foot long tube lined with microvilli, the shag carpeting-like structure where digestion occurs. If you could flatten out the microvilli, the surface of our intestines would be the size of a tennis court. We need that much surface because there is so much activity in our intestines. Covering every inch are parts and pieces of the microbiome (bacteria, yeasts, fungi and viruses) packed in between the shags. The microbiome is a primary component of the immune system in the gut. Seventy percent of our entire immune system resides in the gut, and the microbiome comprises the majority of that system.
What is the microbiome?The microbiome is a community of bacteria, yeast and viruses that live in our guts, vaginal canals, nasal passages, mouths, throats, and on our skin. In the gut, it is critical for more than just digesting food; it is the control center for the whole body. The microbiome is linked to making vitamins, regulating metabolism and blood sugar and influences gene expression and brain chemistry. To exemplify this: for every message from the brain to the gut there are nine messages from the gut to the brain! Furthermore, your microbiome can weigh up to 5 pounds, nearly twice as much as our brains! There are 100 to 150 times more genes in our microbiome than the 23,000 genes in human DNA. There are 10X more cells of bacteria in our gut than all the cells in the rest of the body put together. Because of this, many experts have come to think of the microbiome as less like an additional organ in the body and more like a completely different organism, with a life of its own. For more information on the microbiome check out Dr. Tom O'Bryan's book The Autoimmune Fix at theDr.com.
What does this have to do with my pelvis?If a web search is done with just the search words microbiome and pelvis, 6 pages of results pop up! Scientists are trying to get to the bottom of the cause of pelvic pain and have drawn correlations between people with IC, overactive bladder, male and female pelvic pain, depression and anxiety and how their microbiomes are different from healthy controls. The reason this could be so impactful is that changes in the microbiome can have impact on sensitivity of the nerve endings that cause pain.
We are just hitting the tip of the iceberg with research in this area. Even in the infancy of research, one thing has been established; there is a statistically different microbiome in patients with just about any type of pelvic disorder compared with controls. This imbalance means there are higher levels of some bacteria and viruses and lower numbers of others, this is a term called dysbiosis. For the most part, I tell my patients that altered gut flora has been found to be detrimental to all kinds of pelvic issues.
So how do I improve my microbiome?Dr. DJ Klumpp suggests we should look toward therapy through mechanistic probiotics. Other researchers at this point are saying there is some evidence to supplement with lactobacillus probiotics. They see a particular decrease in the bacteria lactobacillus, which is why they are recommending probiotics with lactobacillus. That seems like a good idea on the surface, but a better plan is to improve your habitat for this amazing organism. It seems daunting because there are many factors at play, but decreasing stress is one way to make the microbiota thrive, oftentimes creating a positive feedback loop. Altered microbiota creates anxiety and increased stress, balanced microbiota creates decreased stress levels.
OK, so what can I do to improve my microbiota habitat?So, what are we to do when we are sick, stressed out and in pain? Make our insides hospitable to the microbiome by changing what we put into our mouths. In Dr. Mark Hyman's book, Food – What the Heck should I Eat? he describes the why's, and what to eat to clean up our diet so we can thrive. Here are a couple of hints regarding cleaning up our body to be more hospitable to the good bacteria, fungi and viruses that inhabit or no longer inhabit our guts.
Erin Raible-Wilson, PT, MSPT is a physical therapist in Louisville, KY