Post-Natal Care

Prenatal care for expectant mothers is provided automatically.  However, after the baby is born there is seldom any assistance to help mom return to her pre-baby state.  In Physical Therapy world, we think every new mom deserves post-natal care!  This was understood centuries ago, when postpartum care was given to mothers and newborns in India in the form of massage.

It is still a good idea today.  If you are expecting a baby, here are reasons to continue with professional care after you have your baby:
1.  Get your body back faster — Carrying a baby distorts the actions of your core muscles from the abdominal wall, back, respiratory diaphragm and pelvic floor muscles.  For instance, a separation of the abdominal wall, known as diastasis recti, can lead to back problems.  This can be helped with proper rehabilitation.  A physical therapist specializing in pelvic health can help you on the road to recovering your body sooner and preventing future problems.
2.  Prevent organ prolapse.  The effects of carrying the baby, delivering the baby and the ensuing lifting and carrying baby after delivery can contribute to dropping of the pelvic organs (bladder, uterus, and rectum).  This is correctable with the proper exercise and guidance.  As much as one third of surgical repairs of bladder prolapse fail, and this may have to do with the need for behavioral and muscular retraining.  A physical therapist specializing in pelvic rehabilitation may help prevent the need for surgery in the future,  in this early post-partum stage.
3.  Restore normal bowel and bladder function.  It is not uncommon after having a baby to have some problems with urinary or fecal leakage.  Physical therapists can help you correct this through behavior and muscle retraining.
4.  Return to sex with less pain.  We get very little guidance on how to return to sexual intercourse after having a baby.  A physical therapist can give you some tips to avoid pain with intimacy.
5.  Address pain before it becomes a constant.  Postpartum can mean continued back, hip, pubic and sacroiliac joint pain.   A busy mom may put her own pain aside to meet the demands of new motherhood and all its responsibilities.  It is important to address pain right away.  There is no need to suffer.  If a c-section was necessary, addressing the scar tissue can help prevent future problems as well.
If you don’t learn how to correct some of these issues, they can follow you for decades!  Consider including post-natal Physical Therapy care as part of your health care in the pregnancy, birth and post-partum experience.


By Sara Nelson, PT, DPT

As a physical therapist, I see a lot of people with physical problems that appear insurmountable.  Through the years I began to believe that some people just couldn’t move because of their pain or limitation.  I looked for ways to help them survive within those limitations.  This view is common in the medical world.   My son taught me this is an erroneous view.  My son is an Ironman.  If you don’t know, that is a competition in which participants swim 2.4 miles, Bike 112 miles and finish off by running a marathon (26.2 miles).  I was so concerned he would hurt himself when he did his first Ironman, he hadn’t even run a marathon.  He showed me that with proper pacing, fueling and self care, you can do almost anything.   He finished that Ironman and has gone on to do four of these races.  His wife was able to use his guidance and her own consistent effort to participate in and finish an Ironman herself, with 11 months of training.  She accomplished that with no joint injuries, and having not been a swimmer.

There were lessons for me as the observer of these accomplishments that I have put to use in my own life and passed on to my patients.  As a result, I am seeing people over come significant problems.  These lessons include (1) be careful what you believe about your body, you may be putting unnecessarily limits on yourself, (2) Pushing through injury and forcing limitations will NOT help you achieve physical goals.  Learn to work within your capacity and with your body to expand your abilities, (3) Modify workouts or take a break when you are hurting, until you can find the path forward where your will and body can work in harmony to achieve a goal. (4) Proper ‘fueling’ is absolutely necessary to go the distance.  In other words, practice healthy eating which includes adequate hydration and nutritious food eaten at regular intervals. (5) If you hurt, do something to feel better.  Self care is a powerful healer, and it includes massage, Epsom salts baths, learning about your body and how it works and how to help it heal, and more.

When I ask my son what he learned from the experience, he says he has learned that you can’t let your thinking intimidate you.  No matter how far you have to go, you only have to take one step at a time.

If you need help knowing what steps to take, talk to a physical therapist!

Help Stop This Epidemic!!!

We have a health epidemic on our hands.  It’s contributing to a plethora of physical injury as well as chronic disease (heart disease, asthma, stroke, cancer and more), and mental health problems (PTSD, anxiety, depression) and it’s contagious.  And you can stop it.   I am talking about the known effects of violence. In the United States, violence claims an enormous $450 billion toll and nearly 60,000 lives annually. (

Using physical force to cause harm or damage to someone or something has become a mainstay of how we express our opinions and even how we entertain ourselves.  Watching violent images has led to a numbing effect that has built up our tolerance of some pretty awful actions.  In addition, using social media to air our darker more violent tendency has the same effect.  We are seeing this behind the scenes practice of meanness and hatred on social networks spill out into the world of actions.  And yes, these not only causes physical injury to those involved, it causes harm to all of us in the form of poorer health. It makes it easier for all of us to be violent and thus it spreads.

The antidote is quite easy and no cost and has equally strong positive health benefits.  That is the practice of kindness.  Descriptors of kindness include gentleness, caring, compassionate action, and going out of your way for others.  These can simply be a smile, or opening a door for someone.

Scientific research has shown that kindness has measurable health benefits and is also contagious.  Performing or watching an act of kindness causes the body to release a hormone called oxytocin which lowers the blood pressure and can protect your heart.  Oxytocin also reduces inflammation levels and can therefore slow the aging process. Acts of kindness also increases the release of dopamine, your body’s natural opioid.  With more dopamine, you will feel happier and even reduce pain.

Here are some actions you can take today to improve your health and the health of those around you.

  1. Perform a random act of kindness regularly.
  2. Print out this pdf about the health effects of kindness and share it with people you know.
  3. Be kind to yourself. Rest, eat nourishing food, spend time in nature, laugh, and move!
  4. If you find yourself overcome with anger, rage or bitterness; if the view point of another different than yours enrages you; consider working with a counselor.
  5. Envision and practice the hypothesis of compassion. Think the best of others, rather than the worst.  Put yourself in their shoes, imagine what life is like for the other person.
  6. Learn about how you can help prevent violence. For more information check out this website:
  7. Don’t support violent entertainment, seek out entertainment that supports positive human qualities.
  8. Practice kindness in your language on social media. If you disagree, find a way to express that with respect and seeking to understand.


Kind words are ever more mighty than swords.

– Peter Burn


Women and Heart Health

Carrie Fisher’s death in 2016, highlighted a problem facing women: 90% of women have one or more risk factors for heart disease or stroke, but many do not even know they have a problem prior to a fatal heart attack. In fact, symptoms of heart disease are often different for women compared to men and are often misinterpreted as acid reflux, the flu, or normal aging. In addition, women have a higher lifetime risk of stroke than men. According to the American Heart Association, 1 in 31 American women die from breast cancer every year, but one in three dies of heart disease (stroke and heart attack), making heart disease the No.1 killer of women in the U.S. Younger women are not excluded from silent heart attacks either. Learning the risks of heart disease and making lifestyle changes as preventative measures can not only save you from a heart attack, but also can be less expensive and more pleasant.


What is cardiovascular disease?

Cardiovascular disease is a broad term that includes a variety of heart and blood vessel conditions. It can be referred to as coronary artery disease, peripheral arterial disease, heart attack, stroke, high blood pressure, heart valve disease, and congenital heart disease, to name a few. The most common cause of cardiovascular disease is atherosclerosis which is a build-up of cholesterol and plaque on the inner walls of the arteries, thus restricting blood flow to the heart. Chronic low-grade inflammation is prevalent in all stages of atherosclerosis. Without adequate blood, the heart becomes starved of oxygen and vital nutrients it needs to work properly, causing chest pain called angina. When one or more of the coronary arteries becomes blocked, a heart attack can occur.

Heart attack symptoms in women (American Heart Association)

  • Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. However, women can experience a heart attack without chest pressure.
  • Pain or discomfort in one or both arms, the back, neck, jaw or stomach
  • Shortness of breath with or without chest discomfort
  • Breaking out in a cold sweat, nausea or lightheadedness
  • Chest pain is the most common heart attack symptoms in men and women. However, women are somewhat more likely than men to experience shortness of breath, nausea/vomiting and back or jaw pain


So what can you do to prevent heart disease? Get going on these 8 ways to get on track!

  1. Quit smoking. Your risk for heart attack and stroke decreases by 50% after just one year of quitting
  2. Improve cholesterol levels by lowering your LDL levels, the “bad cholesterol”
  3. Control high blood pressure. Regularly check your blood pressure
  4. Get active! Start an exercise program involving walking 30 minutes/day
  5. Follow a heart-healthy diet. Choose healthier fats such as leaner cuts of meat, fish, nuts and olive oil
  6. Get to a healthy weight
  7. Control diabetes. The World Health Organization suggests 6 tsps (25g) of sugar/day
  8. Manage stress and anger. Practice relaxation techniques such as deep breathing, yoga, enjoyable hobbies




Thyroid Dysfunction: a hidden cause of joint pain.

By Sara A Nelson, DPT

Over years of providing physical therapy in the outpatient setting, patterns become more apparent.  One pattern I became aware of was women with joint pain and underactive thyroid glands.  When I went searching, I found the connection.

The thyroid gland is a small butterfly shaped organ at the front of the throat.  Although small, it has far reaching effects in the body.  Thyroid hormone regulates metabolism and growth.  It has an effect on many functions including breathing, heart rate, body weight, muscle strength, menstrual cycles, body temperature, cholesterol levels and more!

When the thyroid produces too much hormone, symptoms include anxiety, nervousness, trembling, and hair loss.  When there aren’t enough thyroid hormones, symptoms include fatigue, dry skin and hair, depression, sensitivity to cold, and joint and muscle pain!

There are several possible causes for thyroid dysfunction.  If you suspect you have problems you need a thorough evaluation by a medical doctor.  Genetic predisposition can play a role.

Autoimmune thyroiditis, also called Hashimoto’s disease, is seven times more common in females compared to males. Did you now that 4-10% of women will develop postpartum thyroid inflammation during the first year after giving birth?  About 20% of these women develop Hashimoto’s disease in later years.

Treating the inflammation can assist with reducing joint pain and help you have a healthier thyroid gland.  Good thyroid function is supported with a healthy diet, exercise, rest and stress management.  Yes, one more reason to develop your health habits!  Learning how to exercise when inflammation is present may take the help of a professional (like a physical therapist!)  to find how to move without aggravating joints and worsening inflammation.  There are some special diet recommendations that come from natural medicine.  You can consult a naturopath for more information on that approach for healthy thyroid.

Don’t wait for problems to develop.  It is much more cost effective to prevent than cure!

The Economics of Fitness (Do healthful practices save you money?)

By Sara Nelson, PT, DPT

There are four modifiable lifestyle factors that are known to increase risk of illness.  These are inactivity, obesity, excessive alcohol/drug use and smoking.   It only takes a calculator to see that stopping a $10 a day smoking or junk food habit would save nearly $3650 per year.  But what about the cost of the vegetables you should be eating? According to the US Department of Agriculture, the cost of 9 servings of fruit and vegetables per day is $2.60.  Maybe you need some help learning how to prepare those vegetables to appeal to your palate.  So, it may be worth the cost of using a nutrition coach.

Pain management is another example of cost vs. benefit of medical intervention compared to health habits.  In recent years it has been popular to manage pain with injections, procedures and medications.   An injection can cost as much as $600 (plus the office visit).  A year’s supply of pain medication can be as much as $6000.  In the end, the person has not learned how to change their pain.  Pain may return and they are as helpless as they were on the first encounter with pain.  Compare that to the cost of rehabilitation. At $150 average physical therapy visit, that same $6000 would pay for 40 visits, and at the end of that the patient would have better fitness and skills to change their pain the next time.

Massage has also been shown, scientifically, to help pain.  You could get as many as 80 visits with that $6000!  Research is also mounting as to other health benefits provided by getting regular massage.  For instance, massage has shown to reduce blood pressure, thus helping heart health.

Let’s look further at the medical costs incurred with heart disease.  Stent placement (a mesh tube inserted into an artery in the heart) costs $30,000-$50,000.  Medications to control ischemic heart disease can be $25 to over $400/month, depending on the medications prescribed.  This doesn’t take into account the side effects of those medications.  Compare that to the cost of a gym membership or home stationary bike.  Research has shown thirty minutes of stationary biking three days per week is nearly as effective as a stent placement.  The side effect may be weight loss, improved mood, improved energy and greater mobility.

But say you have been inactive and you jump on that bike and hurt your knee.  Now, it has cost you more.  Well, there is the value of using someone to guide you in exercise who can help you to ease back into it without injury.   Other forms of guided exercise have good scientific evidence supporting their use for all kinds of health issues.  These include yoga, Qi Gong, and good old weight training.

Maybe your doctor has recommended compression stockings but you don’t want to pay the extra cost of these medical grade garments.  A procedure to correct varicose veins costs as much as $3000, and you still have to wear compression stockings afterward.

Being fit and healthy helps if you do become ill.  Those who are fit and healthy withstand the rigors of illness and treatment better than those that are unfit.  It is in your financial interest to be fit, in healthy or ill states.  The old adage is true: an ounce of prevention is worth a pound of cure.  Spend some money now to save money (and suffering!) later!!


Breast Pain and What to Do About It.

One common breast symptom that is often NOT cancer related is pain (only 7-10% of breast cancers have breast pain as a presenting symptom).  But breast pain is a problem for many women.  In a study published in 2014, over 50% of the 1659 subjects had breast pain and some for over half their life.

The causes of breast pain include hormone fluctuations due to menstruation, some birth control pills and infertility treatments, some medications, low thyroid function, poor fitting bra, breast cysts, large breasts, lack of fitness, inactivity and excessive stress.  Breast swelling and pain can be seen with some shoulder and neck problems.  This has to do with muscle tension that compresses vessels and subtly limits fluid return leading to the secondary problem of breast pain and swelling.  It is important to have a doctor help you sort out the cause of the symptoms.
How to address breast pain

Once you have had your symptoms medically evaluated and you have been cleared of pathological conditions like cancer, then ask for a referral to a women’s health physical therapist (PT).   You may find surprising, is that a PT can help you to ease breast pain, but many of the causes of breast pain are best addressed by physical therapy.  Physical therapy that helps breast pain includes the following:

Myofascial release (MFR) – This is a generic term for a form of manual therapy.  The type of MFR I am referring to here works with your body by providing a gentle stretch to the connective tissue that surrounds and supports all the structures in your body including the breasts, neck rib cage and shoulders.  By providing a low load, long duration stretch the tissues gain better mobility and can relieve pain.

Manual lymphatic drainage (MLD)—This method is another form of manual therapy.  MLD is a light technique that takes many hours to learn.  If a therapist is well trained they can be very effective in reducing swelling that contributes to pain.

Instruction in self care – A PT can help you learn how to change your symptom using self treatment methods, behavior modifications and education on the role of posture, bra fitting, diet, inflammation and stress management.  They will teach you how to modify these components to reduce pain.

Exercise – Many women who are experiencing breast pain are also unfit and/or generally inactive.  There are usually reasons why lack of fitness develops and a physical therapist can help you work through the barriers to find a consistent and enjoyable program that can help relieve pain.

So don’t put up with breast pain.  Check with your doctor and then come see a women’s health physical therapist!  Physical therapy will help you sort through the various contributing factors and come up with a plan of action to put you on a path of feeling better!