Lotus Physical Therapy for Women @ the Open Space
150 S. Broadway
Nyack, New York 10960



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Exercise and Pregnancy​  

​Frequently, I am asked by pregnant clients, "What exercise is okay for me to do?"

​Excellent question!!!

​Very often during pregnancy, women want to begin exercise programs to ensure the health of their developing babies as well as themselves.  On first consideration, this sounds like and often is a good idea and recommended. 

​So, how to answer this question?

Before answering, there are some important considerations that need to be kept in mind.

My first response is, "What kinds of pre-pregnancy exercise have you been engaging in up until the present?"  This clues me in to how active they have been and currently are.  It also tells me what types of exercise they enjoy and are more likely to continue if deemed safe.

In accordance with the ACOG's (American Congress of Obstetricians and Gynecologists) guidelines:

- 30 minutes/day on most days is recommended.

- Recreational and competitive athletes with uncomplicated pregnancies can remain active during pregnancy and should modify their usual exercise routines as medically indicated.  The information on strenuous exercise is scarce; however, women who engage in such activities require close medical supervision. 

-  Previously inactive women and those with medical or obstetric complications should be evaluated before recommendations for physical activity during pregnancy are made. 

-  A physically active woman with a history of or risk for preterm labor or fetal growth restriction should be advised to reduce her activity in the second and third trimesters.

Keeping these guidelines in mind, a customized exercise program can be formulated to meet the health and recreational requirements of the client.  Some women are professionally athletic, some are recreationally athletic at a very high and competitive level, some exercise 2-3 times per week at a gym and others take dance and or yoga classes one to several times per week.  Others still, are sedentary.  The range of how and how often women move their bodies is highly variable.

In general, if a woman is regularly active prior to pregnancy, she may continue at the same level unless:

-  It is extremely strenuous with or without twisting.

-  Involves high impact like jumping and or bouncing.

-  High altitude sports.

-  Heavy weight lifting.

-  Board and platform diving.

-  Competitive events.

-  Contact sports.

-  Scuba diving.

-  Exercise in hot, humid conditions.

There are also other activities that may become unsafe like horseback riding, Alpine skiing, exercises performed on your back, ice skating and volley ball.

Due to modern cultural pressures, often women feel they must exercise excessively during pregnancy in order to maintain their "figures."

It is important to reinforce the benefits of exercise during pregnancy for purposes of health including:

-  Increase or maintenance of aerobic exercise.

-  Increase cardiac reserve.

-  Improve muscle tone.

-  Promote good sleep.

-  Prevent low back pain.

-  Reduce gestational diabetes.

-  Improve psychological aspects.

-  Easier labor and delivery.

-  Faster recovery from labor.

Education on the maintenance of health and the acceptance of the NORMAL changes that occur to a mother's body during pregnancy should be reinforced. 

Pregnancy can be a time of nescience.  There can be insecurity based on fear of the unknown.  An educational and supportive birth community can help ease insecurity and provide mom with the confidence she needs to fully experience and enjoy her pregnancy.

I am always delighted when client asks the question about exercise during pregnancy.  I am pleased to demystify any misconceptions about entering into or continuing on with exercise and movement.  I recommend that any pregnant woman who is unsure of what type of exercise to engage in consult with an appropriate professional healthcare practitioner who is an expert in Women's Health and pregnancy for guidance.   Keep moving for health!!!

June 7, 2017

A Topic Few Wish to Discuss​ 

So often, I hear women complaining to me about experiencing the symptoms of vaginal itching.  They are stumped and frustrated by this symptom, asking what causes it and how can they eliminate it.  

Vaginal "itching" can have many causative factors.  Itching can result from dryness of the skin.  This can happen as a consequence to hormonal change during menopause or even pregnancy.  It can be a sign of nerve irritation.  The pudendal nerve is one of the major nerves that course through the pelvis.  This nerve provides sensation to the vulvar and anal regions.  If the nerve is inflamed, it can cause the sensation of pain or itching or both to those areas.  Vaginal infections, such as yeast and or bacterial can also create an itching sensation. 

What can you do?   See your healthcare provider to help determine the cause.  For dry skin, provided you are not allergic to any of these,  a natural emollient,  such as coconut, almond, olive oil or aloe vera can be applied topically to the area to moisturize and sooth the skin. Just as the skin on your face, arms, legs and other body parts can become dry and irritated, your vulvovaginal tissues can as well.    If your MD or other appropriate healthcare provider agree, topical hormonal creams, can also be applied as directed to help with hormone balance to the effected tissues. With nerve irritation and any associated pelvic muscle tension or spasm, physical therapy can be helpful to provide relief from inflammation via various modalities, manual techniques and gentle exercises.  Medications can also be prescribed by your healthcare provider to diminish the nerve pain.  If there is an active infection, it needs to be diagnosed and treated with the appropriate medication and possibly diet modification. 

If you are experiencing this type of symptom, don't hesitate to discuss it with your healthcare provider as there are many ways to address and treat the problem.  Why suffer in silence? 


Lotus Physical Therapy for Women, PLLC shared a link

I have written a chapter in this book and it is FREE for download for the next three days, starting today 2/8/13. Please share if you know a new mom who would like to improve her health. This book is also appropriate for anyone who would like to begin exercising again. Have a look......

17 Minute Workouts for New Moms
17 Minute Workouts for New Moms (Fit Expert Series - Book 15)


Under Wire  Bras

Every so often I either read or hear about the controversy as to whether under wire bras play a role in breast cancer. Some claim that under wire bras are the cause of breast cancer. They claim that the pressure beneath the breasts imparted by the wires and restrictive elastic create a blockage to lymphatic flow and drainage, making it difficult for toxins to be removed from breast tissue. In my opinion it is doubtful that bras are the sole cause in creating breast cancer. Things like environmental toxins, diet, stress, inflammation and genetics probably play more of a role. There are also those that claim bras have no relationship whatsoever with breast cancer because they do not apply enough pressure to be problematic. They claim that more intense pressure would need be applied to the body in order to create any restriction. Having said that, I differ with the later opinion. Having studied lymphatic drainage in the breast area, I have learned that lymphatic channels respond via mechanoreceptors. They are sensory endings in the tissue that interpret input from pressure. It apparently does not require much pressure for these sensors to respond. In fact, lymphatic drainage techniques used on patients post mastectomy only require very light touch. If you think about it, most under wire bras are worn for many hours with localized pressure probably greater that light touch in a localized area. In theory, this could lead to a decrease in lymphatic flow. Others argue that lymphatic fluid does not drain toward the base of the breast where the under wire is situated but rather up and out of the axilla or armpit. As far as I know, there is only one study that has looked at this. The outcome states that women who wore under wire bras for extended hours regularly demonstrated an increased level of breast cancer. Others, site this study to be flawed. As is often the case in science and medicine, there is conflict and controversy. No doubt that someone with larger breasts may have discomfort in the neck and upper back and that a supportive bra may help. Not always. Many women believe if they wear an under wire it will prevent their breasts from sagging. Not necessary true. Breasts rely on ligaments that are attached to the muscular wall of the chest for suspension. With time and aging, gravity will effect these structures regardless leading to a sagged orientation. Nevertheless, under wire bras are uncomfortable. Usually, when removed leave a mark on the skin for a period of time. This has to in some way effect your circulation. Certainly more research and investigation needs to be done in this area. While under wire bras may not cause breast cancer in and of themselves, they may be a contributing factor well worth a further in-depth look.



I came across an ad for these sunglasses. They are designed specifically for migraine headache sufferers. Light is a common trigger for migraines. These sound great.




You most certainly have heard the term or perhaps have even experienced "Sciatica". It is a broad term referring to pain or sensory changes in the distribution of the sciatic nerve which exits from the lower lumbar spine and courses down its respective leg. The sciatic nerve can be compressed or inflamed for a number of reasons resulting in the aforementioned discomfort.
There is another condi tion which is similar that you probably have not heard of, it is called "Pudendal Neuralgia". The pudendal nerve also exits from the lower spine however, typically, in the region of the sacral area (the region just above the tail-bone or coccyx) and sends branches into the perineum or genital area. It too can become inflamed and irritated for a variety of reasons resulting in pain and the sensation of burning in the perineum. It can also result in decreased sensation in the area and possibly even bladder, bowel and sexual dysfunction.
Avid bicyclists, pianists and others having professions that require sitting a lot, as well as child birth and various viral infections can trigger pudendal neuralgia. It is commonly seen in females but can also occur in males.
While it can be quite painful and life-altering, effective treatment is available.
Certain dietary changes and medications can help. Appropriate pressure relief to the perineum when sitting can help. Working with a physical therapist who is well trained and experienced in treating the condition can be extremely beneficial in relieving compression and inflammation to the nerve and surrounding structures.


Use Antibiotics Judiciously

More reasons to use antibiotics judiciously.......
New Antibiotics in the Pipeline But Situation Still Dire

Despite some progress in the clinical development of new antimicrobial agents against resistant Gram-negative bacteria (GNB), none has been identified that is active against panresistant GNB.


Urinary Frequency

People who suffer from urinary frequency tend to avoid drinking water in order to decrease their sensation to void. In doing so however, their urine becomes concentrated and can actually irritate the lining of the bladder leading to further frequency. It is important to have adequate water intake in order to keep urine dilute and keep irritation down. The recommended daily intake should be roughly 1/2 of your body's weight in fluid ounces per day. Keep in mind that certain fruits and vegetables contain water which can contribute to your daily intake. Happy drinking!!



How many of you do "crunches" to strengthen your abdominal muscles? Perhaps you work with a trainer at a gym, crunch away while watching an exercise video or just do them on your own. Think about this.. Do you actively coordinate your breathing while you crunch? I hear time and again from clients that they are doing crunches to improve their abdominal strength and tone but no one has taught them how to properly breathe when they perform the exercise.
The proper way to perform a crunch is when you lift your head and shoulders, an exhalation should occur, while drawing in the lower belly and even engaging your pelvic floor muscles. An inhalation is performed on the release back down.
Why is this important? If it is done in reverse where you are breathing in with the lift or holding your breath, you are increasing intra-abdominal pressure and pushing down on your internal organs, blood vessels and spine. This can aggravate things like abdominal and inguinal hernias in both men and women. It can strain your back. It can also exacerbate what is known as a diastatis recti in post natal women who have a separation in their abdominal muscles secondary to childbirth. It can also lead to or worsen incontinence and more.
Most people tend to think that crunches are the only way to strengthen their abdominals. There are many other ways, but that is a topic for another discussion.
If you are intending to crunch, be sure to coordinate your breathing while you sculpt your abs.


Low Rise Jeans

Low-rise jeans may look great, but did you know they have been linked to a condition called, Meraglia Paresthetica. That's right. A small branch of the femoral nerve, the lateral femoral cutaneous nerve, that runs through the groin area a
nd can become compressed from low-rise, skinny-type jeans. This can trigger the sensation of pain and or tingling and numbness in the upper and outer portion of the thigh. Wearing high heels in combination with tight, low-rise jeans tilts the pelvis forward exacerbating the problem. Word of advise, loosen up those jeans!


Breast Cancer & Chronic Inflammation

There are multiple factors related to acquiring breast cancer. One more recently being observed in the scientific world is the relationship of breast (and other types of) cancer to chronic inflammation in the body. It is important to address any chronic inflammatory conditions such as GERD (gastroesophageal relflux disorder), for example. These types of conditions may lead to cancer down the road if left untreated.



Human beings are not designed to withstand prolonged stress. When we are subject to on-going psychological tension, the part of our nervous system that responds to stress becomes heightened in sensitivity. Thus, the threshold for the stress response gets set at a lower level. Even things that are joyful can sometimes trigger a negative response. Have you ever met someone like Felix Unger, from
the Odd Couple? A person who seems to be sensitive to everything. He or she has allergies, aches and pains, an on-going plethora of complaints. That person's nervous system has been sensitized. He or she often is experiencing the results of a prolonged stress response.
It is no secret, we have all read or heard about or even experienced the physiological responses to stress like acid reflux, ulcers, migraine or tension headaches, back and neck aches, pelvic pain, altered immune response. The list goes on. What also happens is that our respiratory and heart rates become elevated. We breathe in a more shallow fashion. Our bodies and minds engage in the fight or flight response.
One of the first steps in beginning to minimize the adverse effects of stress is to become aware of your symptoms and behavioral patterns. Only then can you begin to make changes. Another simple thing you can do to begin feeling better is to slow down your respiratory rate and breathe deeply. Put your hands on your lower belly, take a slow, deep breath in so that your belly puffs up like a balloon. Then at an even slower rate, exhale. You could try breathing in to the count of 4 seconds and out to the count of 6 seconds. Repeat that 10 times every hour and you are on your way. As you become more comfortable with this you can increase the timing and repetitions. You will be sending a signal to your brain that all is well. It is one method that does not cost anything and makes you feel better.
So, breathe, just breathe!!!


Urinary Frequency

People who suffer from urinary frequency tend to avoid drinking water in order to decrease their sensation to void.  In doing so however, their urine become concentrated and can actually irritate the lining of the bladder leading to further frequency.  It is important to have adequate water intake in order to keep urine dilute and keep irritation down.  The recommended daily intake should be roughly 1/2 of your body's weight in fluid ounces per day.  Keep in mind that certain fruits and vegetables contain water which can contribute to your daily intake.  Happy drinking!!

The Childbearing Year

The childbearing year is a wondrous period in any woman’s life.  During this time there are many changes including physical ones.   For instance, one of the most obvious is hormonal change which assists in preparing the body for birth.  Ligaments can become lax to allow the pelvis to expand for the baby’s trip down the birth canal.  This may also bring on back and pelvic pain.  Changes in hormones may also induce headaches and a decrease in the digestive process.    Breasts enlarge adding additional weight to the front of the chest which may trigger neck and upper back pain.  As the baby grows, mother’s ribcage elevates and broadens which can lead to excessive pressure on nerves, difficulty with deeper breathing and discomfort in the neck and upper back.  Edema or swelling in the legs and feet can make gait or movement more challenging.  Varicosities may occur in the legs and vulvar region causing discomfort.  As the baby grows, additional weight is gained by mother, placing additional strain on back, legs and feet.  With the growing fetus, the abdomen enlarges drawing this area forward causing the low back muscles and ligaments to tighten which may lead to low back, buttock and leg soreness.   During the time of delivery, with vaginal birth, there may be injury to the muscles that line the pelvic cavity (also known as the pelvic floor) which may contribute to vaginal and tailbone pain.  It is also common to experience incontinence post-delivery.  Pelvic organ prolapse or dropping may also be a consequence of childbirth.  With Cesarean section delivery often abdominal muscle weakness and painful scar occurs.

This may all sound daunting but the good news is things like keeping fit, eating a well- balanced diet, getting proper rest and keeping stress levels low are helpful in maintaining a healthier pregnancy.  Physical Therapists who are specially trained in working with women in the childbearing phase can also be very helpful in resolving and supporting many of the aforementioned conditions and helping to make mother’s pregnancy a more joyous event.


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Physical Therapy for Women, PLLC