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Addressing Postpartum Leaking: Why It’s Common but Not “Normal”

by Margarita Miras, PT, MS

Experiencing urinary incontinence after pregnancy is incredibly common, but just because it’s widespread doesn’t mean it should be accepted as normal. Many new mothers are told to brush off leaking, but it’s actually a sign that your body needs attention. Postpartum leaking is typically caused by a combination of factors, including poor breathing patterns, overactive muscles, weakened core muscles, and increased pelvic floor pressure, all of which can be addressed with the right approach.

What Causes Postpartum Leaking?

Several factors contribute to urinary incontinence after pregnancy:

• Poor breathing patterns:

If you’re not breathing efficiently, it can create downward pressure on the pelvic floor, increasing the likelihood of leaking.

• Limited rib cage mobility:

Without proper movement through the rib cage, your body can’t expand and contract fully, leading to imbalances.

• Weak core and glute muscles:

The core and glutes are essential for stabilizing the body, and when they’re weak, they don’t support the pelvic floor properly.

• Poor movement patterns:

Over time, habits like poor posture or improper lifting can increase pressure on your pelvic floor, worsening the issue.

During pregnancy, the lower abdominals stretch to make room for the growing baby. In some cases, these muscles become so overstretched that they “turn off,” leading to core imbalances. This can result in a weaker and distended lower belly—often referred to as the “disconnected tummy”—which may linger for months or even years after childbirth.

How to Address the “Disconnected Tummy” and Improve Core Function

To improve core strength and reduce symptoms like leaking or lower back pain, it’s important to take a holistic, total-body approach. This means focusing on:

• Proper body alignment:

Ensuring that your body is well-aligned helps reduce unnecessary strain on your muscles.

• Breathing:

Learning how to breathe in a way that supports your core and pelvic floor is essential.

• Progressive exercises: Targeted exercises that gradually build core stability and strength will help restore balance and function.

Exercises Your Pelvic Floor Will Love

Here are some simple exercises to start strengthening your pelvic floor and core:

1. 360 Breathing: This breathing technique helps improve rib cage mobility and create balanced pressure through your core.

2. Inner Thigh Exercises: Engaging your inner thighs can help activate the pelvic floor muscles.

3. Glute Exercises: Strong glutes are essential for stabilizing the pelvis and reducing pressure on the pelvic floor.

4. Thoracic Mobility: Improving mobility through your upper spine (thoracic area) can help with better breathing, movement, and posture.

5. Hip Hinges: Learning how to properly hinge at the hips will help protect your back and strengthen your core and glutes.

Takeaways: Postpartum leaking is a common issue, but it doesn’t have to be your new normal. By improving breathing patterns, core strength, and body alignment, you can alleviate symptoms of urinary incontinence and promote long-term pelvic floor health. Incorporating these exercises into your routine can help you restore balance to your body and regain confidence.

www.synergyphysios.com

info@synergyphysios.com

781-205-9046

The Power of Breathing: Unlocking Core and Pelvic Floor Stability

by Margarita Miras, PT, MS

Did you know that the way you breathe could be the key to a stronger core and a healthier pelvic floor? It all comes down to something called “intra-abdominal pressure”(IAP). This might sound technical, but it's simply the balance of pressure inside your abdomen, and it plays a major role in stabilizing your core, preventing pain, and protecting your pelvic floor.

What is Intra-Abdominal Pressure?

Imagine your core like a soda can. The top is your diaphragm (your main breathing muscle), the bottom is your pelvic floor, and the sides are wrapped with your abdominal muscles. When we breathe in, our diaphragm pulls air into our lungs, but it also works with the rest of our core to stabilize the spine and keep us upright. Without balanced IAP, your body can struggle to find stability, leading to issues like back pain, pelvic floor dysfunction, and even incontinence.

Why Does Balanced Breathing Matter?

Balanced breathing is key to managing IAP. If pressure is unevenly distributed in the abdomen—such as when you hold your breath or overly grip your abs—your core muscles can't activate properly. This can lead to poor posture, muscle pain, or even pelvic organ prolapse (when pelvic organs shift out of place).

Think of it like this: every time you cough or lift something heavy, pressure builds up inside your abdomen. If that pressure isn't distributed evenly, it pushes down on your pelvic floor, causing stress and potential damage over time.

How to Optimize Intra-Abdominal Pressure with Breathing

The good news? You can “train” yourself to breathe in a way that supports your core and pelvic floor. By focusing on balanced, deep breathing, you can strengthen the deep muscles that stabilize your core without overloading any part of your body. Over time, this can reduce pain, improve your posture, and even ease symptoms like urinary incontinence.

In short, the right breathing techniques can transform your health from the inside out. With consistent practice, you'll build a strong, balanced core and a healthy pelvic floor—without straining your body.

Key Takeaway: Don't underestimate the power of breath! Balanced intra-abdominal pressure is the foundation for core stability, preventing pelvic floor issues, and keeping musculoskeletal pain at bay. With the right techniques, you can train your body to distribute pressure evenly and move with strength and stability every day.

www.synergyphysios.com

info@synergyphysios.com

781-205-9046

The Infamous "Kegel" - What You Need to Know About Pelvic Floor Exercises Postpartum

By Divya Natesan, DPT

If you've recently had a baby, you've likely heard about Kegel exercises. Kegels, also known as pelvic floor muscle contractions, involve tightening the pelvic floor muscles, holding the contraction, and then releasing it. These exercises are commonly recommended for women after childbirth to help reduce urinary incontinence and improve sexual function. However, while Kegels can be beneficial in certain situations, they aren't always the right solution for everyone.

Why Kegels Aren’t Always the Answer?

Many women are told to “do Kegels” to strengthen their pelvic floor postpartum. But what’s often left out is the fact that doing Kegels when they aren’t appropriate—or doing them incorrectly—can actually make things worse. For example, Kegels can exacerbate pelvic floor pain, increase urinary urgency, make painful intercourse worse, and contribute to further dysfunction.

In fact, “85% of women report pain with their first attempt at intercourse after having a baby”, often due to increased tension in the pelvic floor or scar tissue. Even after 18 months postpartum, “25% of women still experience pain during intercourse”.

The issue can be even more pronounced for women who have had a C-section. Studies show that despite avoiding vaginal delivery, women who undergo C-sections experience the same incidence of pelvic girdle pain, and often rate the intensity of that pain higher. This pain is commonly due to overactivation of the pelvic floor muscles, and in these cases, doing Kegels could worsen the situation.

When to Seek Professional Help

This is where a physical therapist can provide critical support. A physical therapist specializing in postpartum care can thoroughly evaluate both the internal and external pelvic floor muscles to determine the best course of treatment. Often, the treatment plan might not involve Kegels at all! But if Kegels are appropriate for you, a physical therapist will ensure that you're doing them correctly, with proper form and control, to avoid any complications.

At Synergy Physiotherapy & Wellness, we offer individualized care for women navigating postpartum recovery. If you're experiencing pelvic floor pain, incontinence, or pain during intercourse, our team is here to help. We’ll create a personalized treatment plan based on your needs, whether that involves Kegels or alternative exercises to improve your pelvic floor function.

Kegels can be an effective tool for pelvic floor recovery, but only when done at the right time and in the right way. Let us guide you through the process safely and effectively.

www.synergyphysios.com

info@synergyphysios.com

781-205-9046

How to Stay Injury-Free While Running: Tips for Runners of All Levels

By Margarita Miras, PT, MS

Running is a fantastic way to stay active, maintain heart health, and boost your overall well-being. However, as with any form of exercise, it's essential to take steps to prevent injuries, so you can enjoy running and walking without unnecessary pain or setbacks. The key is understanding common running injuries and how to reduce your risk with proper training and technique.

Common Running Injuries to Watch Out For

If you've been running for a while, you might already be familiar with some of these common injuries. The good news? Most can be prevented with the right approach to training. Here's a list of the most frequent running-related injuries:

- Patellofemoral dysfunction (runner’s knee)

- Patellar tendonitis (jumper’s knee)

- Achilles tendonitis

- Hamstring strains

- Iliotibial (IT) band syndrome

- Plantar fasciitis

- Ankle sprains

- Low back pain

These injuries often result from factors like poor posture, lack of flexibility, muscle imbalances, or previous injuries. When one part of your body isn’t working correctly, it can throw off the entire system, leading to pain or injury elsewhere.

Why Previous Injuries Increase Future Risk

The strongest predictor of future injury is a past injury. Why? When a muscle or joint heals after an injury, it often regains less flexibility or coordination than before. This imbalance can lead to inefficient movement patterns, which makes you more susceptible to reinjury if not addressed properly.

How to Reduce Your Risk of Injury While Running

Now that you're familiar with the common injuries, let's dive into how to protect yourself from them. Incorporating the following strategies into your running routine can significantly reduce your risk:

1. Restore Alignment and Symmetry

When your body is out of alignment, whether from poor posture, weak muscles, or tightness, it can’t generate force evenly across your body. This imbalance increases your risk of injury. By working to restore proper alignment and ensuring you generate symmetrical force, you’ll improve your shock absorption and reduce the strain on your muscles and joints.

2. Strengthen Your Core, Hips, and Ankles

Weakness in your core, hips, and ankles is one of the most common reasons for running-related injuries. If these areas aren’t strong enough to stabilize your body and absorb the impact of each footfall, other structures (like your knees or lower back) take the hit. Focus on building eccentric strength, which helps with deceleration and shock absorption when your feet strike the ground.

3. Correct Training Errors

One of the most preventable causes of injury is improper training. For instance, running more than 40 miles a week is a proven predictor of injury for many runners. Overtraining can lead to exhaustion and a higher risk of injuries like tendonitis or sprains. A proper training plan should incorporate rest days and cross-training to give your body time to recover.

How a Physical Therapist Can Help

A skilled physical therapist can be your best ally in preventing and treating running injuries. They can evaluate your posture and running mechanics to identify where things are going wrong—whether it’s an alignment issue, poor mechanics, or a lack of control.

www.synergyphysios.com

info@synergyphysios.com

781-205-9046

Importance of Intra-Abdominal Pressure to Core and Pelvic Floor Stability

By Margarita Miras, PT, MS and Divya Natesan, DPT

Balanced intra-abdominal pressure is critical to optimal core stability and pelvic floor function. Poor core stability is a major factor in the development of musculoskeletal pain and pelvic floor dysfunction. To achieve optimal core and pelvic floor stability, we need to learn to create balanced intra-abdominal pressure while breathing.

Think of the core muscles as a cylinder or canister. The top of the “cylinder” is the diaphragm, the bottom is the pelvic floor muscles, and the abdominal muscles wrap around this cylindrical space.

How does intra-abdominal pressure create postural stability?

The diaphragm, a major muscle of respiration, functions to draw air into the lungs and oxygenate the blood. Another equally important function of the diaphragm is to aid in postural stability. The diaphragm has a close relationship with the deep abdominal muscles which function to stabilize your core and prepare us for movement. The deep muscles function differently from the superficial abdominal muscles in that they should function reflexively and are not movement or direction dependent.

Why is balanced breathing important to postural stability?

Balanced breathing creates balanced pressure in the intra-abdominal cavity and, in turn, balanced stabilization of the spine. If the pressure created inside the abdominal cavity is not evenly distributed or able to reach the lower lumbar region, the deep abdominal muscles and stabilizing muscles of the spine will not activate appropriately. Poor or delayed activationof these muscles can worsen any existing musculoskeletal pain or pelvic floor condition.

Excessive gripping of one of the superficial abdominal muscles and a lack of counter pressure balance between our lower abdominals and the pelvic floor muscles often create an impairment in core stability.

For example, we generate a downward force when we cough, and if we are unable to distribute the pressure evenly through the thorax and abdomen, we experience excessive

pressure onto the pelvic floor muscles and the bladder muscles, causing musculoskeletal pain, leaking, pelvic organ prolapse, and more! Balanced breathing allows us to distribute that pressure evenly.

Can we train how we breathe to optimize intra-abdominal pressure?

Yes! We can train ourselves to breathe optimally and create balanced pressure within the intra-abdominal region. When we breathe optimally, we facilitate appropriate activation of core and pelvic floor muscles. By restoring balanced intra-abdominal pressure and activation of the deep core muscles, symptoms of musculoskeletal pain, urinary incontinence, and pelvic organ prolapse can significantly improve!

www.synergyphysios.com

info@synergyphysios.com

781-205-9046

Core Training and Core Strengthening: What You Need to Know.

Margarita Miras, PT, MS

Core training and core strengthening are often confused, but they refer to distinct approaches with different goals when it comes to improving the function of your core muscles. Here’s how they differ:

What Is the Core?

The core refers to the area between the diaphragm (a muscle crucial for breathing that separates the chest from the abdomen) and the pelvic floor. This region includes the lumbar spine, the thorax below the shoulders, and pelvis. Key muscles supporting this area include the pelvic floor, the transversus abdominis, the internal obliques, the external obliques, rectus abdominis, multifidus, paraspinals, and the diaphragm.

Core Training vs. Core Strengthening: Why They’re Different

Your deep core muscles (like the transversus abdominis and multifidus) work differently from the larger, more superficial muscles (like the rectus abdominis and external obliques). These deep muscles activate in preparation for movement and don’t depend on direction or specific actions. They provide essential control over the spine and pelvis by engaging in response to the body’s needs, regardless of movement.

Core Training: This is focused on retraining these deep muscles to activate in the right sequence and at the right time. When you’ve experienced back or pelvic pain, this activation can become disrupted. Through core training, you’re essentially reprogramming these muscles so that they respond appropriately. It’s about using techniques and tools like imagery and biofeedback to ensure the muscles are firing before you move.

Core Strengthening: Once your core muscles are properly trained and functioning with good timing and coordination, you can start to add weight or resistance. Strengthening exercises are designed to increase the endurance and strength of these muscles, ensuring they can support your body effectively during more demanding activities, without compromising mobility.

The Importance of Timing and Muscle Synergy

Studies have demonstrated that pain—whether from the back, pelvis, or even visceral organs like the bladder or uterus—can disrupt the communication between your brain and core muscles. This disruption leads to delayed muscle activation and poor coordination. Even when the pain subsides, the improper muscle patterning can persist, often leading to chronic or recurring pain. Core training is designed to address this issue by focusing on restoring the timing and coordination of muscle activation. After this has been achieved, strengthening exercises can be safely introduced to build a stable, well-functioning core. Jumping straight to strengthening without proper training can reinforce dysfunctional patterns and potentially lead to further pain or injury.

Conclusion

Core training and core strengthening are distinct but complementary phases of improving core function. Training focuses on re-establishing proper muscle activation and timing, which sets the foundation for more effective strengthening. Strengthening, in turn, builds strength, endurance and power on top of that foundation, ensuring stability and mobility.

For anyone experiencing back pain or aiming to enhance their core stability, it’s essential to begin with core training before progressing to strengthening. This holistic approach will help prevent the recurrence of pain and improve overall physical function. Working with a trained professional is key to developing an individualized program that addresses your specific needs.