Just given childbirth? Exercises for new moms!

A close friend had her first child recently, and took the opportunity to ask if I could advise her on exercises she could start with. The midwife had told her that she could start training lightly, but my friend felt a little unsure of what exercises that could fit in the beginning. So, I chose this topic for my next post ...

The information from midwives is that postpartum women should take it easy and let their body heal first few weeks when it comes to exercise, but start pelvic floor exercises as soon as possible after birth, and taking walks from the second week. To do abdominal exercises like sit-ups should be avoided for a few weeks, both because of diastase between the large abdominal muscle Rectus Abdominis two parts (separated abdominal muscles; Diastasis recti), and to avoid increased abdominal pressure in a situation where they are still struggling to get the strength of the pelvic floor back. With caesarean section it's even more important to avoid sit-ups as it takes 6-8 weeks for the tissue to heal properly.

If you are suffering from Diastasis recti, you should hold off on all the exercises for the trunk until you get the green light from a midwife or physiotherapist about the exercises you are allowed to do, in order to avoid aggravating the healing of connective tissue.

Whether your child is born vaginally or by cesarean section, the starting exercises I would give a new mother are the same. However, a woman who underwent cesarean should wait a few weeks longer with certain exercises, as it can stress the wound, but you have to be aware that various exercises could tug at the wound for up to 10-12 weeks in varying degrees. It will be my general advice that you can start with the first supine exercises 2-3 weeks after birth. Use the time before to focus on training the pelvic floor, as it is important to get good function, and you do not want to miss the recovery window in the beginning. Later you can take the opportunity to combine training the pelvic floor and core, as this provides a more efficient muscle training in these muscles.

The exercises I have chosen are effective for trunk stability and posture, without stressing the body with sit-ups. Midwives provide information that you can start with crunches (which is like a little mini sit-up) as soon as it feels good. It's really the only exercise I did not film, as I feel I want to be careful to prescribe that exercise in general to all.
Obviously, one can develop these exercises and program endlessly, but 8-12 weeks postpartum, you should normally gradually get back to your regular workout, if you feel restored.

(Incase the video doesn't work, click here.)

When you exercise, it is important that you listen to your body and stick to what feels good!

Good luck, and congratulations to the parenthood
Shirin Zarur, physiotherapist

Muscle pain and imbalance in the shoulder

I got inspired to write this post after seeing an old friend a couple of days ago. He has a shoulder problem and it started some time ago, got better but came back. (For us physiotherapists this is a very common scenario.) He noticed that trigger point treatment of some of the rotator cuff muscles (joint stabilizing muscles in the shoulder) helped. However, when the pain came back – it was worse, now with more muscles involved and he had trouble lifting his arm as a result. This could very well be the symptom of a lot of different diagnosis.

So, what to do?

As I've explained before in the previous post, this could be a typical history of pain due to imbalance around the shoulder joint, and the shoulder joint is very dependent on the shoulder blade and it's function, as well as eventual shortness and/or stiffness of the pectoral muscles.

Now, if I treat the symptom of trigger points in one or two muscles, I still haven’t addressed the underlying problem and the pain will keep coming back. The incorrect movement pattern is still there, ruining the balance. 

Altered pressure, joint force and muscle work around the shoulder can give many secondary symptoms; various inflammations and irritations in rotator cuff tendons, bursitis, impingements, small partial ruptures etc. 

If the pain is due to imbalance, then a massage, acupuncture, trigger point treatments etc. can ease the symptom of pain, but you also need to work on your body (in this example the shoulder joint) and get it in balance again to get to the root of the problem.

Imbalance and altered movement patterns

The subject of imbalance and altered movement programs that affect the muscular chain is a fairly complicated subject, it took me at least six years working as a physiotherapist to fully comprehend it. I might try to take it on and explain this concept in a deeper manner later in another post. But this post is really just an introduction for the next post about shoulder pain, and maybe other posts there after, who knows… :)

Normally, muscle pain is a symptom, not a diagnosis of a primary injury or problem if it isn’t for example an acute rupture. Why? 
We are born with certain movement patterns that develop during the childhood years. These movement patterns control the way we move and keep our body in good balance. Balance between flexors and extensors, between small stabilizing muscles and bigger power- or force muscles, and keeping our posture in balance.

BUT, our daily lives with monotonous movements, sitting, standing still and so on, ruins our physical balance… We overwork some parts, and become weak in other; our joints are used biomechanically wrong, putting strain on ligaments, cartilage, discs and so on. Our movement patterns are changed and the muscles keep working in the wrong way as they’ve now become programmed to do as a part of a new movement pattern.

Overuse muscle pain can be primary if for instants I clean 20 windows in one day, but the acute overuse pain will be in the shoulder muscles overall, and will subside entirely in a few days. If you haven’t triggered the pain in such a manner, then the pain is more due to the imbalances.

I hope you're a little bit wiser on the differences between the pain that sneaks up on you and over time due to imbalance, and acute overuse pain.

Regards,
Shirin

How do I know if an injury is serious or not?

It's very rare to have a doctor or other health professionals to ask when you are out exercising, running, working out in a group and so on. How are we to know whether one has become injured enough to step off and put compression on the injury? 

The moment you feel that something happened, trust your instinct! Often one feels that something in the body is not as it should; you know that something’s happened in your body; and you should trust that feeling. Because it is usually an injury you need to take care of ... Sometimes you can even feel that something snapped, or hear it inside your body. This is not a good sign and you should definitely take care of that body part as instructed earlier in Acute Injuries.

Often we are so pumped up with endorphins when we’re working out, that we don’t feel the pain, and therefore you can’t trust that symptom. Many have unfortunately the tendency to pause a moment and try the injured area out and find that it's not so bad, it barely hurts, and decide to keep training ... But this is the worst thing you can do for the healing process of the injury; as the bleeding increases, and unfortunately the healing and recovery time will increase because of this. 

In other words ... Trust your instincts! 

I would appreciate any comments on the texts I've posted so far, good or bad, and suggestions for improvement, etc. And why not questions or ideas for new topics. What would you like to read about?

Good Luck!
Shirin Zarur

When it comes to muscle injuries, what is the difference between “pulling a muscle” and a small “stretch injury”?

Actually both of these variants of injuries are ruptures in the soft tissue, for example in muscles, and in medical terminology we only use the word rupture, but the injuries are divided into partial and total ruptures.

The word rupture actually involves damage to basically all soft tissues, including injuries to meniscus, muscles, ligaments and tendons. But what we usually mean by the above terms, “pull a muscle” or smaller “stretch injury”, is a larger partial rupture or a smaller partial rupture, but in both cases muscle fibers are torn. The only question is how much is the damage, how many fibers are involved? 

This is also crucial for knowing how rapid the rehabilitation and healing process can be. This process however can be very different between people, depending on age, fitness, and individual differences. The rehabilitation is therefor always individual and the load of the exercises is increased after how the patient is responding. 

After the acute phase you should generally begin by activating the muscle statically (ie, just contract the muscle), but without load to be able to control the tension in the muscle. This type of activation is gentle on the tissue and will help the muscle fibers in their guiding into a neat order, running parallel with the other fibers. The danger of pushing too quickly is that the fiber scheme will be disturbed and the inflammation becomes more prolonged. 

My advice is to take care of the injury as good as possible during the acute phase, and then consult with medical personnel as soon as possible. But if you fail to get an appointment until after a week, which is not uncommon in Sweden by any case, you can begin with static exercises to start the process or rehabilitation. 

Stay well! 

Shirin Zarur

Take care of your acute muscle injuries!

Recently, a friend of mine suffered a muscle injury when training for a race involving running, climbing, getting through mud etc (you know, one of those popular crazy fun races). I gave her some instructions on how to take care of the injury the fist couple of days, and encouraged her to make an appointment with a physiotherapist, as it is important with rehabilitation to get full function back. Shortly thereafter, she told me that some acquaintances mentioned that they probably pulled a muscle or got a small rupture in various muscles, and she was asked; shall I put heat on? This is actually the most common mistake...

For this reason, I chose the topic of acute muscle injuries for this post. 

Clarification of acute injury; an injury that occurs at a specific time with tissue damage as a result, such as damage to the menisci, ligaments, muscles, and bone fractures. While tendon inflammation/irritation, stress fractures and so on are termed overload damage. 

In all acute injuries, there is tissue injury with bleeding as a result, although there are some very few exceptions - but I’ll put no focus on it now. The primary goal is always to stop the bleeding as quickly as possible, as the accumulated blood will prolong healing time. The reason for this is that the body will have to put a lot of time and energy to take care of the blood that leaked into the tissue, and has to be absorbed or decomposed, instead of focusing on renuilding the injured tissue. The days after the injury, the compression bandage is used to prevent the secondary swelling, which consists of fluid/edema that collects in the area because of the inflammatory process that initiates, and it's an advantage to keep down that swelling as well. 

There's an ongoing inflammation in the acute phase, which lasts three days. During this time you should: 

• Take care of tissue and unload, that is, try not to work so much with the injured area, let the muscle or joint rest, and only do circulatory movements without any load

• Keep compression bandage on 

• Use ice on the area for pain relief 

What you should NOT do during the acute phase: 

• Take anti-inflammatory tablets. In recent studies researcher have found that initially healing is faster and the patient can get started earlier with exercise and get back to training faster. BUT, a few weeks later, those who took anti-inflammatory medication have weaker tissue in the injured area than those who had not taken the medication. Although, we do not know how long this weakness of the tissues continues. How ever, my opinion is; better to be safe than sorry. Do you need pain relief, use paracetamol 

• Adding heat to the injured area - this increases circulation and increases the inflammatory process, which is not good for healing, as the symptoms from the inflammation will increasy

• Massage and different massage equipment – gives the same negative effects as heat 

See you! 

Shirin Zarur

About me; Who is Shirin Zarur? And how did I get into my profession?

As a child, my parents believed that young girls needed to learn self-defense, and therefore enrolled me in judo and later karate.
That didn't fit my character, so during mid-teens I decided to switch my focus onto basketball as a sport instead. Practicing basketball on a professional level, I happened to get both overload and traumatic injuries. While recovering, I came in contact with physiotherapists for the very first time, and found my calling.

Since I finished the physiotherapist program in 2004, my main work has been joint and muscle related injuries / disorders, and focused on sports medicine. Besides work, it has been a struggle to complete a Master's program, but when finished, it was definitely worth it!
The past 6-7 years, I've been involved in the Swedish Basketball Federation both as regional Physio working and teaching the youngest groups, and Physio with junior national teams. The work also included the development of injury prevention- and physical training, lecturing at basketball courses aimed on injury prevention, including risk factors, and development of physical training.
During 2015 I've been working abroad, in Qatar, which has shown me new aspects of life and the world, to add to my personal live experience. I try to make time to do what I love; share my knowledge and experience to those interested. That is when I have anything worth telling about... 

The ideas for the different posts are namely from the questions I get from friends, patients or what I observe around me, and of course problems most commonly seen in our patients. I hope it will be of some help for you.

Nice to meet you... :)