Physical therapy; orthopedics; Moore – Orthopedic Spine & Sports Physical Therapy (OSSPT)

By Jenna Jarvis

Over the last decade, the term “Kegels” has become the standard recommendation and almost promoted as a “cure all” for women dealing with pelvic pain or dysfunction; the assumption being that the pelvic muscles are weak and need to be strengthened. We know that miracle cures rarely exist and as a Women’s Health Specialist, I often cringe when I hear patients tell me they were told to do Kegel exercises by a friend, website, or even a medical provider, without first undergoing an individualized examination to determine whether pelvic floor weakness is the true underlying problem. To be clear, Kegels can be helpful for pelvic floor dysfunctions related to weakness; however, Kegels are not a one-size-fits-all exercise for all women with pelvic floor dysfunction.

Similar to any other muscle in the body, the pelvic floor can and often has too much tone and recommending generic Kegel exercises for someone who already has too much tone will be like adding fuel to a fire, the symptoms will often worsen! You ready for the tricky part?

Even for women with too much tone, they often STILL have weak pelvic floors, which can lead to signs such as urinary or fecal incontinence, often confusing the patient as to what is the cause. To reiterate, patients can have too much tone in a muscle that is still weak. All muscles have an ideal length-tension relationship. To produce optimal strength and function, they need to maintain a proper length-tension relationship.

So if Kegel exercises are not always the right solution, what is?

Pelvic floor physical therapists have the understanding and training to interpret symptoms, and then examine the pelvic floor, lumbar spine, pelvis, and hips to determine what treatment is appropriate for the patient. If the pelvic floor has too much tone, we must first address this issue via combination of deep breathing exercises, down-training of the pelvic floor, manual therapy of the pelvic floor, biofeedback exercises, etc. If pelvic floor weakness is also an issue, we will prescribe specific pelvic floor exercises based on the patient’s weakness and symptoms. Ultimately, a thorough assessment of the pelvic floor is necessary to target the underlying cause of the patients and create a detailed, individualized treatment plan.

Congratulations! For all those who completed the full marathon, you have accomplished a feat that less than half of 1% of people in the United States accomplishes in his/her lifetime (1). For those who completed the half marathon, less than 1% of people complete this feat yearly. Immediately after the race, the sense of accomplishment and pride quickly morph into some notable soreness (at least for us).

To help combat your post-run aches and pains, we have several tips:

Re-hydrate: during the race, we sweat out fluid to keep our body temperature regulated and we must replenish those fluids after the race to reduce cramping, dehydration, and potential heat exhaustion. The average adult should consume approx. 3 liters of water daily (2); however, less than 25% of adults drink enough water on a daily basis. For the next few days after the race, re-hydrating is vital and we encourage people to at least intake the normal recommendations of 3 liters.
Perform Light Exercise: exercising may seem counter-intuitive after a long run to reduce soreness, but the literature strongly recommends performing light low load exercise to reduce muscle soreness after a strenuous run. This can be as simple as a 15-20 minute walk, riding a bike, or a light swim. All of these activities will promote increased blood flow which can help expedite the inflammatory process and promote lymphatic drainage, which are all contributing factors to the muscle soreness/stiffness.
Soft Tissue Work: After a marathon, blood flow and other fluids become stagnant in the muscles and other surrounding tissues. Through a variety of techniques, such as foam rolling, we can help “squeeze” out those stagnant fluids, which the body will then replace with new fluids/nutrients reducing soreness and aid in overall recovery of the soft tissues. Too often, patients believe foam rolling should be a “no pain, no gain” situation; however, we should avoid excruciating pain. We instruct patients to stay in an “it hurts so good” zone where you are experiencing only a little discomfort while foam rolling and no worse afterwards. Another excellent recovery strategy is receiving a soft tissue massage from a licensed and skilled massage therapist. This should be a lighter intensity massage, focusing more on “flushing” strategies. The muscles are already traumatized from the run. We do not want to add additional trauma to the tissues or this can slow recovery.
Take Time Off Running: For all of our high level runners, do not freak out. We are only asking you to take a short break. For half marathoners, we recommend taking a week off. For our full marathoners, at least two weeks off of running is our recommended time off. Some people may choose to perform light runs as a recovery strategy, but we encourage utilizing cross training strategies mentioned above.

We know there are a lot of snake oil salesmen pushing all kinds of expensive recovery products on the market. Many of these are unnecessary and have not shown any evidence of being beneficial. Following these simple strategies, you should be back to pounding the pavement in no time.

For those runners who experienced specific pain during or after the race, such as hip pinching, knee grinding, low back pain, foot pain, etc, this may be a WARNING of an underlying issue that warrants more specific and skilled treatment from a physical therapist. Up to 68% of runners experience an annual injury (2). Many of these injuries go untreated and lead to a snowball of issues down the road, often resulting in runners shortening distances or eliminating running all together. In a previous blog post, The Straw That Broke the Camel’s Back, which details how repetitive, overuse injuries occur and are often due to underlying movement impairment syndromes. Running is no different. Running, in itself, is not a bad or harmful activity; however, running without the prerequisite movement patterns, flexibility, mobility, stability/motor control, etc. will lead to injury over time.

Do not stress, soreness is normal and expected after any high level workout, much less a 26.2 mile run; however, if you notice that one particular area is not recovering like the rest of the body, then we can help. No referral is needed. Call us at 405-735-8777.

References

Tag: Physical therapy; orthopedics; Moore

Are Kegels Making Your Symptoms Worse?

Is My Post-Marathon Pain Normal & What Now?