Ultrasound to Help Postpartum Return to Fitness

Any pelvic floor rehabilitation provider knows that pregnancy can lead to changes in the pelvic floor and the abdominal wall. In the postpartum period, many individuals would like to strengthen their pelvic floor and abdominal muscles in an attempt to return to fitness and previous exercise routines. Is there a difference in how someone approaches training these muscles in the postpartum period? Will activating the muscles cause harm for our patients? This can be controversial amongst pelvic rehabilitation providers. I have heard some clinicians say that once a patient has had a pregnancy and vaginal birth, then they should never do sit-ups again, instead they should work the abdominal muscles in different ways. Others argue it depends on the individual patient.

A recent study examined the effects of different types of abdominal contractions on the positioning of the pelvic organs in nulliparous and postpartum women. Six different pelvic floor and abdominal contractions were tested, and the bladder positioning was examined using ultrasound imaging. There was significantly more lift of the bladder base when a submaximal contraction of the pelvic floor and transverse abdominis were performed with an elongation of the back. With a curl-up contraction, there was a significant amount of descent of the bladder base (Martinez-Bustelo, 2021). This increased descent of the bladder demonstrates that the choice of abdominal activation does make a difference and influences the pelvic organs. However, the overall individuality of the patient makes a difference as well. The overall management of the internal pressure system for the individual can influence the descent of the pelvic organs positively or negatively. Additionally, patients who have a diastasis recti abdominis may have additional precautions when wanting to exercise their abdomen and core.

How can clinicians observe the supportive component of the pelvic floor?
Ultrasound imaging can be performed quickly and easily, allowing the practitioner to view the pelvic organs and their response to different types of contractions. This can allow us to customize a program for post-partum individuals that are wanting to return to fitness and exercise activities and make sure that the patient is not exerting pressure into their pelvic area in a way that is not ideal. Ultrasound imaging also allows clinicians to treat postpartum patients sooner. We can treat them immediately in the postpartum period. We do not need to wait until the patient is cleared for internal work or deal with lochia for an external assessment. We are able to immediately help our post-partum patients through abdominal imaging.

You can learn to use ultrasound imaging through Herman & Wallace’s Rehabilitative Ultrasound Course. This course guides you through the process of learning to use ultrasound imaging transabdominally and transperineally to assist your post-partum patients in regaining core and pelvic organ strength. This tool is also useful for other diagnoses including anyone with lumbopelvic pain, pelvic floor weakness, and pelvic organ prolapse. Join us this April to learn more about ultrasound imaging!

Upcoming course details:

• Rehabilitative Ultrasound Imaging - Pelvic Health and Orthopedic Topics is a 3-day course that presents both ideal and abnormal responses of real-time imaging of the transverse abdominals, rectus abdominis, deep multifidus, levator ani, bladder, bladder neck, urethra, and vagina during contraction and Valsalva. Imaging methods used during labs will consist of transabdominal viewing as well as transperineal/translabial viewing methods. Prior experience with perineal and vaginal assessments is required to take the course.
  • Scheduled for April 11-13
• Rehabilitative Ultrasound Imaging - Orthopedic Topics is a 2-day course that presents both ideal and abnormal responses of real-time imaging of the transverse abdominals, rectus abdominis, deep multifidus, levator ani, bladder, and bladder neck.
  • Scheduled for April 12-13
• You can also meet Allison and get a hands-on demonstration of rehabilitative ultrasound at HWConnect.

Reference:

• Martínez-Bustelo, S., Ferri-Morales, A., Corral-Gómez, L. et al. Transabdominal ultrasound to assess the displacement of the bladder base during abdominal and pelvic floor contractions in continent parous versus nulliparous women. Int Urogynecol J 33, 2257–2266 (2022). https://doi.org/10.1007/s00192-021-04756-4

AUTHOR BIO
Allison Ariail, PT, DPT, CLT-LANA, BCB-PMD, PRPC

Allison Ariail has been a physical therapist since 1999. She graduated with a BS in physical therapy from the University of Florida and earned a Doctor of Physical Therapy from Boston University in 2007. Also in 2007, Dr. Ariail qualified as a Certified Lymphatic Therapist. She became board-certified by the Lymphology Association of North America in 2011 and board-certified in Biofeedback Pelvic Muscle Dysfunction by the Biofeedback Certification International Alliance in 2012. In 2014, Allison earned her board certification as a Pelvic Rehabilitation Practitioner. Allison specializes in the treatment of the pelvic ring and back using manual therapy and ultrasound imaging for instruction in a stabilization program. She also specializes in women’s and men’s health including conditions of chronic pelvic pain, bowel and bladder disorders, and coccyx pain. Lastly, Allison has a passion for helping oncology patients, particularly gynecological, urological, and head and neck cancer patients.

In 2009, Allison collaborated with the Primal Pictures team for the release of the Pelvic Floor Disorders program. Allison's publications include: “The Use of Transabdominal Ultrasound Imaging in Retraining the Pelvic-Floor Muscles of a Woman Postpartum.” Physical Therapy. Vol. 88, No. 10, October 2008, pp 1208-1217. (PMID: 18772276), “Beyond the Abstract” for Urotoday.com in October 2008, “Posters to Go” from APTA combined section meeting poster presentation in February 2009 and 2013. In 2016, Allison co-authored a chapter in “Healing in Urology: Clinical Guidebook to Herbal and Alternative Therapies.”

Allison works in the Denver metro area in her practice, Inspire Physical Therapy and Wellness, where she works in a more holistic setting than traditional therapy clinics. In addition to instructing Herman and Wallace on pelvic floor-related topics, Allison lectures nationally on lymphedema, cancer-related changes to the pelvic floor, and the sacroiliac joint. Allison serves as a consultant to medical companies, and physicians.