Episode 1751 - HEP for the new mom

Dr. Heather Salzer // #ICEPelvic // www.ptonice.com

In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Heather Salzer discusses tips for designing home exercise programs for newly postpartum moms, including removing barriers to movement, being smart with the structure of the HEP, and encouraging habit stacking.

Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog.

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EPISODE TRANSCRIPTION

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HEATHER SALZER Good morning, PT on ICE Daily Show. I'm Dr. Heather Salzer and I'm here with the pelvic team at ICE. And today we are going to be talking all things home exercise plan for the new mom. I think this is an area where we can do better as clinicians. Oftentimes I hear, man, my postpartum population just really doesn't do a good job doing the exercises I give them. This is a group where they have a lot going on, right? So oftentimes we just assume, okay, well, they don't have time to add in these extra things. And that's where we're wrong. I think if we meet them where they're at and set them up for success, not only will they have small wins of being able to accomplish, that part of their rehab plan, but also we're going to see better results with our care plan from there. This is a topic that's very near and dear to my heart. In clinic, I treat about 70% pregnant and postpartum individuals, so I've had a lot of time to help these people figure out how can we best increase compliance and set them up for success with their exercises. Additionally, I am about four months postpartum with an adorable little daughter at home, but she certainly takes up a lot of my time. And so in the last few months, I've had some experience using some of these same tips and tricks that I use with my clients for myself to be able to get in some of my rehab as well. So this is a topic that's fresh on the mind for me. We're gonna divide this up into about four different sections of tips today. So we'll be talking about workout structure, removing barriers, habit stacking, and managing expectations and how you can use these areas to help set your clients up for success. Let's dive in.

WORKOUT STRUCTURE So first of all, workout structure. I am a huge fan of using time-based workouts or home exercise plans for this group. And the reason is then they know, man, I only have five minutes, but I can sneak that in right now. And so within that, I like to keep it 10 minutes or less. And if it's somebody who's wanting more, you can give them several segments of five minute or 10 minute things, but that way you at least know like, okay, let's at least try to get these five minutes in. So what does that look like? I will use a lot of remands, so rehab every minute on the minute, and set them up with maybe three exercises, and we'll do that two times through, or three times through, and so that gives them either a six minute or nine minute workout. Another thing in this postpartum population that I'm a big fan of is the Tabata, so 20 seconds on, 10 seconds off. One specific example of something I give people a lot is some variation of that hollow hold and Superman hold. I'll set this up, what this looks like is eight rounds, so four rounds of hollow hold, four rounds of Superman hold, and we'll do that for 20 seconds on, 10 seconds off, and you can scale it up or down. So maybe that hollow hold in the beginning is just lifting one leg and focusing on kind of finding that core tension. Maybe we're progressing it all the way to a hollow rock. Similarly with the Superman, we can lift just the arms, lift just the legs, and then talk them through what are the progressions across this. And then four rounds of each, flip-flop back and forth or do all four hollow, all four Superman, and in less than four minutes, like three minutes and 50 seconds, right, they'll get a really effective both core workout and some blood flow to that posterior chain, which can be both important areas with this group. If you're like, man, I don't know, Heather, I don't know if that's really enough of a workout, I challenge you to try it today and choose a level that feels difficult for you, wherever that may be along that spectrum, I bet by the end of four minutes, you're gonna be like, oh, yeah, okay, I can see how that could work. So using those time-based intervals can be huge in this group to help set them up for success when we're thinking about workout structure.

REMOVE BARRIERS TO MOVEMENT Second, we're gonna be worrying about removing any barriers to set them up for success for getting their workout done. A big piece of this can be equipment or space. So if all of their equipment is in their garage and they have a garage gym set up, but it's hard for them to hear their baby from the garage, they may be avoiding going in and using that space. So can they bring their dumbbells in, maybe just one set of them, program everything with one weight to start, and put them by the couch? Make that more accessible. Maybe we're using baby for weight instead. Little one doesn't want me to put her down. So instead, let's hold her. Let's see what we can do with that baby, using the baby for our weight instead. Another thing, if you're a new parent or have been around new parents at all, I'm sure you've heard the words tummy time. So I love utilizing this time that mom is going to be on the ground with her new baby as a way to get in some of our exercises as well. So we're kind of removing that barrier of like, all right, you're already going to be there. Let's set this up. So what this could look like is maybe we're working on some C-section scar tightness. So while baby's on the ground, working on baby's tummy time, mom can do the same. She can be down there doing some gentle Cobra stretching. Maybe we're taking that opportunity to slow down, take some deep breaths, get into happy baby, child's pose, do some side planks, get creative with it. What does your patient need? But tack it onto that time. And yeah, tummy time is a great opportunity to sneak that in. So really think about what's their setup at home? How can, like ask them, where do you envision yourself getting these things done? what will make space or what will make sense with your space and then work with them with that.

HABIT STACKING Number three is going to be habit stacking. So this ties a little bit into what we were just talking about tummy time, doing their exercises while they're already doing something that they're doing that day. I first kind of heard the term habit stack from James Clear's book, Atomic Habits. And I love this concept where we take something that we are already doing across the day, and then we add our new thing that we want to do on top of that, and it's gonna help increase our ability to get that new thing done because we already have established that other habit. So in the postpartum population, there is a lot of things that happen routinely across the day, and so let's take advantage of that, right? Tummy time was one example. Another example of something that I give a lot in clinic is when we're dealing with like shoulder tension, maybe we're spending a lot of time breast bottle feeding, holding baby, coming forwards, and I want just more blood flow to kind of open things up and get them moving across the day just to get them out of that position. We always say your next posture is your best posture, right? So Can we figure out where they're spending the most of their time nursing or bottle feeding or whatever that