​Previously, we talked about safe exercise during your pregnancy. But how do you know when and
where to start after having your baby? As always, consult your doctor before beginning an exercise
program. Complications during labor or other factors, such as diastasis recti, can change your return-to-exercise timeline.

Before I list a few suggestions for exercise, it’s important to review the guidelines:

 Protect your joints- effects of the hormone relaxin can last up to six months postpartum. Your
ligaments will have more laxity and range of motion will be increased. It is important that you
control your movement throughout the entire range and avoid loading your joints at the end
range. An example that I use a lot is crashing into the bottom of a squat—avoid that! Mobility
exercises, specifically distraction, with bands should not be used directly after pregnancy and added conservatively after a few months.

 Ease into exercise- you may find that beginning with low impact exercise is more comfortable,
such as swimming, biking, light weight training. Just as during your pregnancy, listen to your
body and avoid going to exhaustion right out of the gates.

 Stay hydrated- especially if breast feeding, it is important to remain hydrated. The
cardiovascular changes that took place during pregnancy will begin to level off. So drinking
plenty of water and maintaining electrolyte levels is important for the health of you and your
child!

 Mind your belly- diastasis recti is the separation of your abdominal muscles during pregnancy.
Depending on the amount of separation, different exercises should be avoided. Not all women
experience diastasis recti but it important that you communicate with your care provider to
determine if it affects you. If so, abdominal crunches, planks and sit-up variations should be
avoided until it is healing and closed to a certain degree.

 Pelvic floor health- many factors during the pregnancy will make your pelvic floor vulnerable to
dysfunction: pressure from the baby, altered posture during the pregnancy, episiotomy or
spontaneous laceration, vaginal delivery. It is important to check in with your pelvic floor and
decide if it needs some attention before returning to exercise. Pelvic floor dysfunction can lead
to a slew of issues; three very common issues are urinary stress incontinence (peeing when you
sneeze, jump, etc), low back/hip pain and painful intercourse. If any of these issues persist, see
a pelvic floor physical therapist and they can get you back on track. These are all common but
not normal.

​Keeping the guidelines in mind, work through these exercises and find your weaknesses.
​
Hollow Rock Regression- this exercise is great to begin to regain midline control. Do not do this if you have diastasis recti.

​Air Squat- slow and steady, controlling your speed on the descent. If you are having hard time with
control, squat to a box!

​Monster Walks- the deep rotators of the hip have fascial connections with the pelvic floor so they
directly impact its function.

​Diaphragm Reset- it is important to practice breathing with proper posture- ribs over hips. In the later stages of pregnancy, the exaggerated lumbar lordosis (sway back) puts your diaphragm at a
disadvantage.

Starting with these foundational exercises will make your transition back to higher level exercise as seamless as possible. Keep those precautions in mind and communicate with your healthcare provider if you have any questions. If pelvic floor dysfunction seems to be sticking around, seek out a pelvic floor therapist. This is something that can be treated and resolved!

Thanks for reading,

Dr. Jackie


Photos:

http://www.nydailynews.com/news/national/crossfit-mom- back-gym- baby-great- article-1.1745386

http://www.someecards.com/usercards/viewcard/a2679791515bfaa20529fedf7844268414

http://wodathome.com/wod-at- home-mom/high- intensity-work- outs-and- pregnancy/a-second-
trimester-review/

http://redefiningstrength.com/best-glute- exercises/

                                      This used to be me, minus the 16 year old Asian kid part.

Like most kids in the United States, sports were a huge part of my life growing up. If you would have asked the 10-year-old me what I wanted to be when I grew up, it wasn't a physical therapist, it was a professional baseball player (that obviously didn't happen). 

When I do look back on my athletic career (I guess you could call it that), it's riddled with injuries. Here's a list of the major injuries I have sustained playing sports to include, football, baseball, basketball, soccer and dabbling in military combatives.

-Broken right ankle at the growth plate age 15.
-Non-contact related right meniscal tear requiring surgery age 16.
-SLAP labral tear right shoulder age 18.
-Torn disc lower back L4-5 causing nerve root compression for 6 months age 24. (High volume deficit dead lifts with poor technique, my own damn fault)
-Torn disc neck C5-6 causing nerve compression for 3 months age 26.(Army combatives, accidents happen)

Looking back all the injuries that I have sustained it's a fairly long list. Some people would say that I'm injury prone, others may blame it on my genetics. I blame it on my horrific lack of mobility!

When I was in elementary school, I can remember taking the President's Physical Fitness Test. It was a big deal to me back then, mainly because I was sure I would be a professional athlete one day. I did great on all of the events and went into the last event with my confidence at an all time high. The last event was the sit and reach and I failed it! I could not for the life of me reach forward and just touch my damn toes. I was an emotional train wreck, my whole life revolved around sports and I couldn't even pass a national standard. That's a tough pill for a 10-year-old to swallow.

I think back to that test and I think of something different that could have come out of that. An educator, my parents or a coach could have seen that as a red flag or a warning sign. Sadly, the reality is that mobility is often overlooked and brushed aside as just being "tight". If you are making all-star teams and progressing in your athletic skill sets, who cares if you are a little on the tight side, right? Wrong, that's a big mistake and it needs to change. 

We as coaches, parents and physical therapists have to prioritize movement first. That comes down to two components, motor control and mobility. Motor control is the ability to perform a movement correctly aka technique. Mobility is having enough available range in your joints and tissues to perform that movement optimally and safely. You need both to have proper movement, one without the other is worthless.

For me, mobility was my greatest obstacle to achieve better movement. Working on mobility sucks! I know, both as an instructor and from personal experience. Shit, two years ago I couldn't even touch my toes and now I teach Movement and Mobility courses across the country. It's very humbling for me to teach these courses for CrossFit and it's because I know first hand how much it can change people's ability to perform at a high level and stay injury free. Since adding MWOD concepts into my training I have not been injured once. I did get hit in the face with a surfboard that broke my nose a couple years ago but no amount of mobility/technique would have changed that. Some injuries are unavoidable but they are very rare.

Here's my advice for all my CrossFit athletes in Atlanta. If you suck at something, you need to focus on trying to improve that weakness everyday. This is not what most people want to hear. If you're flexible, you will enjoy yoga. If you're strong, you will enjoy powerlifting. The reality is, that super flexiblity yoga practitioner would benefit a hell of a lot more from doing some heavy squats than working on her pigeon position. 

Find your flaws, chase them down, go for the throat and don't let go until your weakness becomes an asset!


-Danny

​During internal rotation, the ball of the joint (humeral head and femoral head) will glide posteriorly and roll anteriorly. This movement can be restricted with a tight posterior capsule or muscles around the joint.  Unfortunately, many people will have issues here due to increasingly sedentary lifestyles and desk jobs.  As you sit all day, the hip rarely reaches full extension, allowing the posterior capsule to become tight.  This in turn decreases the posterior glide and thus decreased internal rotation.  The same deal happens at the shoulder when you sit all day at the computer with terrible posture.

Interestingly, hip internal rotation deficits have been correlated with low back and sacroiliac pain.  It is better to start improving internal rotation now rather than trying to manage back pain!

How to check internal rotation

It is easiest to accurately check internal rotation of the shoulder with a buddy.  Lay on your back, arm straight out to the side and elbow bent (as in the picture below).  Your buddy should provide solid but comfortable pressure to the front of your shoulder to avoid it from raising off of the ground. Now move your palm down towards the ground.  Ideally, you would be able to get at least a fists-width from the floor! Be sure to check both sides because noting an asymmetry is important.  Also, be sure to do this same test after practicing the mobilizations below! ​

​
​To check hip IR, lay on your stomach and allow your feet to drop out to the side.  Again, we are looking for asymmetries and major deficits.  Ideally, your leg will move about 40 degrees or roughly halfway down toward the floor.

​Mobilizations to Improve Internal Rotation
​
Below are a few mobilizations for the shoulder and hip to improve internal rotation.  They are by no means an exhaustive list but merely a starting point.

Bully stretch- used to mobilize the humerus into the back of the shoulder capsule, which increases internal rotation. ​

​
​Internal Rotation Stretch- start with your foot flat on the ground and the other leg crossed over.  Slowly walk your foot out to the side until you feel a strong but comfortable stretch in the hip.  You should feel this in the bottom leg.