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so you can make an informed recommendation for your patient.
show how you can include postpartum screenings in your practice.
Symptoms of Core Dysfunction:
Diastasis recti abdominis
Difficulty with bowel movements
Pelvic organ prolapse
The above complications from childbirth are so common that nearly every mother has had one of these symptoms at some point. Some symptoms improve within the recovery period on their own, but "it is likely that 50-80% of women have some type of pregnancy-related dysfunction that persists past 12 weeks and that number increases with each pregnancy" (Lee).
Statistics for two common complications support this statement.
Postpartum - 92% of those still incontinent at 12 weeks will still be incontinent at 5 years (Viktrup et al 2000)
5-7 years after delivery 44.6% of women have some degree of incontinence (Wilson et al 2002).
50% of parous women have some degree of symptomatic or asymptomatic POP (Hagen and Stark 2011). (all above from Lee)
These symptoms however are often not complained of directly in your office. Your patient may express concern over intermittent back pain, a bulging belly, popping in the hip or even shoulder pain. She may use phrases like "since my last pregnancy..." She may profess inconsistency in her exercise program due to lack of results or injury when attempting to progress her workouts. Many women believe that urinary incontinence and abdominal weakness simply go along with childbirth.
As a medical provider you can help your patients understand that these symptoms are related to core dysfunction. We know that exercise can improve and often cure these disorders. But your patient needs guidance on which exercises to use to safely strengthen her core. Running a marathon or jumping into cross-fit are not the best approach, nor do they address the central problem of core dysfunction.
A program like Mommy Ready focuses on core reactivation first then allows the patient to transistion into the exercise program of her choice.
Non-surgical approaches such as rehabilitative exercises are first-line treatment, however some women may need surgical correction to regain proper muscle function. Our purpose is to increase screening by medical providers for core dysfunction so that each woman can receive appropriate treatment for her specific symptoms whether treated with exercise alone or through surgical intervention.
We have created the first core screening protocol specifically to help medical providers identify and learn how to address symptoms of core dysfunction.
But we're not the first to use these techniques. Since groundbreaking reasearch first presented in 1996 by Paul Hodges and Carolyn Richardson started changing our understanding of how the core works (Hodges). Numerous researchers and clinicians have investigated and adopted core reactivation techniques into their practice around the world. Imaging technology, especially musculoskeletal ultrasound became used to assess function and provide important bio-feedback to help teach patients to perform their exercises more effectively (Whittaker).
The Quick Core Exam and the Core System Assessment are safe inexpensive methods medical providers can use to effectively assess core function via ultrasound and provide patients with a clear picture of how to properly perform the initial exercises that will help them regain core function and allow them to participate more fully in all the activities of motherhood.
Lee, Diane. New ISM Perspective for Treating Women with PGP, UI, POP and DRA found at https://learn.dianelee.ca/resources/.
Hodges, PW, Richardson, CA. Delayed Postural Contraction of Transversus Abdominis in Low Back Pain Associated with Movement of the Lower Limb. J of Spinal Disorders.1998;11:46-56.
Whittaker, JL, Teyhen, DS, Elliott, JM, Cook, K, Langevin, HM, Dahl, HH, Stokes, M. Rehabilitative Ultrasound Imaging: Understanding the Technology and Its Applications. J of Orthop. Sports Phys Ther. 2007;37:434-449.
additional references found here.
Mommy Ready is created by medical professionals who desire to improve access to quality postpartum care through an online exercise program. Based on techniques we use with our own patients and the latest research in rehabilitation and women's health we have designed this program to address core strengthening after childbirth starting as early as 3 days postpartum. This program not only benefits women who have recently given birth but you can recommend this injury-prevention program to any woman who exhibits signs of core dysfunction.
How can I tell if my patient has core dysfunction?
Mothers are busy. And commonly mothers are guilty of putting off their own needs as she attends to the needs of her children and others. A woman may de-emphasize the severity and sometimes ignore the impact these symptoms of core dysfunction are having on her everyday life. Many women seek out treatment but wish to find a non-invasive cure or are reluctant to spend the money and time required to attend physical therapy.
The ideal situation would be for each woman to recieve one-on-one care with an experienced professional to direct her rehabilitation. However time, money, arranging babysitters and schedules can be, sometimes HUGE, barriers. Also with lack of access to proffessionals trained to provide this type of care - the ideal situation, at least for now, is not realistic.
Mommy Ready Postpartum Program was designed to overcome these major obstacles and provide women a program that is inexpensive and accessible, (ie online, in their own home, no babysitters) created by a reliable source, a medical provider like you.
We expect that many women will be able to successfully restore their core function through our 7 phase program alone. We know that women experiencing more complex core dysfunction will need assistance from a medical provider or rehabilitation specialist. Our program has 7 self-assessments at the end of each phase with specific quesitons and self-tests to help the patient recognize any issues they should address with their medical provider. In addition to the self-assessments we recommend each participant obtain a Core System Assessment with a certified medical provider who can help direct her program and individualize it to her specific needs.
For some complex patients simply starting the Mommy Ready program acts as a screening tool to educate patients about core dysfunction and help them recognize the importance of spending time and money to see their medical provider for additional individualized treatment.
The basics on the Mommy Ready Postpartum Program
When to start:
Women can sign up for the program in their 3rd Trimester.
The exercises can be started as early as 3 days postpartum for women with normal vaginal deliveries or minor perineal tears grade 1-3. Women who delivered by c-section, or have more severe pelvic floor damage may prefer to wait until 2 weeks to begin. It is helpful to schedule a Quick Core Screen at 2 weeks to assure your patient is doing her exercises effectively. Unless contraindicated, don't wait until her 6 week appointment to recommend starting. Help your patient take advantage of beneficial hormones and recovery that happens in the first 8 weeks postpartum.
You should instruct your patient to start the exercises when she feels ready based on the above guidelines.
Women 6 weeks and over can start the program at any time with approval from her medical provider.
When to get the Core System Assessment:
For women starting the program prior to 6 weeks postpartum we recommend they schedule a Core System Assessment between 4 and 6 weeks.
Women starting the program after 6 weeks will benefit most from having the Core System Assessment done prior to starting the program.
How long is this program?
The length of the Mommy Ready program is adjusted by each woman as she works through the course and checks her progress with self-assessments. Two weeks is typically spent on the first two phases. Some women may pass a phase in as little as one week, while others may take 2 to 4 weeks on earlier phases and less time on later phases. The self-assessments help guide each participant on when to move to the next phase.
What does the program include?
For a one time fee your patient gets one year online access to the Mommy Ready program that includes videos, pdf printouts and exercies logs of each of the core exercises. Unlimited email support and a one time video chat to answer program related questions. Education through articles, diagrams and videos about core dysfunction, injury prevention and many topics related to postpartum and women's health. Support through monitored private social media forums to help her connect with and encourage mother's just like her.
What can the Mommy Ready program do for my patients?
We Train Medical Providers to Identify and Treat Core Dysfunction
The Quick Core Exam
Screen patients for core dysfunction and help them begin effective core exercises through the Quick Core Exam. Incorporate this 10 minute musculoskeletal ultrasound exam into your practice to help you identify those patients that would benefit from the full Core System Assessment. Complete the FREE online training course to become an US Core Provider.
The Core System Assessment
Expand your skills in musculoskeletal ultrasound and patient evaluation to assess the full core system with our training course to become a certified Core System Specialist. Learning this 45 minute in office evaluation will allow you to identify core dysfunction, help you determine best treatment for rectus diastasis and pelvic floor dysfunction and enable your patient to see how to effectively perform core exercises. Become a certified Core System Specialist and offer modern, evidence-based, quality care for your patients.