Why Does Meghan Markle Still Look Pregnant?


By Emilia Chrostowska 

The world welcomed a new royal baby this week with the arrival of baby Archie, but in addition to the buzz about the cute as a button bundle of joy, the media enjoyed lots of discussion about why mom Meghan Markle still had a baby bump.

Turns out, Meghan is a normal mom just like the rest the world!

What is “normal” after all?

Well, pregnancy and delivery are momentous events for the female body and new mothers cannot miss all the changes that are occurring in their bodies. After delivery, most noticeably, women will realize that the stomach is not as small as it used to be, which is, indeed, completely normal. For the last 9 months, the body made adaptations to accommodate for a growing uterus and baby. After giving birth, the uterus is still enlarged, and the stomach muscles are stretched out and in a weakened state. Also, the body stores some extra fat to provide nourishment to mother and baby, which might also make the stomach look a bit larger than before pregnancy.

After giving birth, a fluctuation of hormones occurs that helps the uterus contract back to its usual size and also helps new moms burn off some extra fat. However, this change is not immediate and may take several months to occur.

What about changes you can’t see?

Not all changes of pregnancy and childbirth are noticeable to others, and urinary incontinence is also quite common after giving birth. Many women notice some urinary frequency or impaired ability to control bladder function beginning in pregnancy. However, it is not uncommon for this to persist 3-4 weeks postnatally. During pregnancy, the growing uterus causes additional pressure on the bladder and pelvic floor, causing the muscles to lengthen and weaken. This weakness is still present after delivery, many times resulting in some temporary incontinence.

Pain in the low back, pelvis, and hips is also a common unseen symptom during pregnancy and the postnatal period. Changes in hormone levels while carrying a baby contribute increased ligament laxity around the joints in preparation for childbirth. However, this additional mobility can contribute to poor posture and joint pain. Because the changes in hormones continue after delivery and while breastfeeding, it is not uncommon for this discomfort to persist for some time after delivery.

When to See a Professional:

Postnatal check-ups are important, especially for women who undergo a cesarean delivery or for those that had a tearing or episiotomy. However, we recommend that every woman see a physical therapist 6-8 weeks after delivery to ensure that the muscles of the abdomen and pelvic floor are resuming their normal function. While uncommon in the United States, working properly. This is standard practice in many other countries, so it is likely Meghan Markle will consult with an expert to confirm there are no lingering issues.

While standard postnatal check-ups may not be common in the United States, you should definitely should consult with a professional if you are experiencing discomfort or pain during intercourse, continued back or abdominal pain, vaginal bleeding, difficulty with bowel movements, straining with urination, urinary frequency, leaking urine with any activities (including sneezing, laughing, etc.), or difficulty getting back into your fitness routine 6-8 weeks after delivery.

However, do not wait to see your health care professional if you are experiencing numbness or tingling in the arms or legs, difficulty with postures for nursing or feeding, headaches, or other neck pains, no matter the timing after childbirth.

Emilia Chrostowska is a doctor of physical therapy student at Northwestern University, class of 2020.


#GetPT1st for Back Pain

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Photo by rawpixel.com on Pexels.com

Chances are that you or someone you know has had back pain. Each year 15% of the population has their first episode of back pain, and over the course of our lives, 80% of us will experience back pain. Even though back pain is common, the medical community traditionally has done a poor job managing it.

Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too common.  Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:

Low back pain is the #1 reason for opioid prescription in the US. However in 2016, the CDC recommended against the use of opioids for back pain in favor of “non-drug treatments like physical therapy.”

Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful.
Research has NEVER demonstrated a link between imaging and symptoms. As we age,
degenerative changes on imaging is common.
● 90% of people age 50 to 55 have disc degeneration when imaged, whether they have
symptoms or not
● In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6%
had a disc bulge
● Just getting an image increases the chances that you’ll have surgery by 34%

The United States has sky high rates for back surgeries — 40% higher than any other country and 5x higher than the United Kingdome. You would think that with all the back surgeries we do, we’d be pretty good at it but the outcomes are terrible!

A worker’s comp study looked at 725 people who had spinal fusions versus 725 people with back pain who did not.

The surgical group had:
● A 1 in 4 chance of a repeat surgery
● A 1 in 3 chance of a major complication
● A 1 in 3 chance of never returning to work again

Physical Therapy
● Current clinical practice guidelines support manual therapy and exercise
● Research proves that early physical therapy leads to better outcomes with lower costs, and decreases the risk of surgery, unnecessary imaging, and use of opioids
● A study of 122,723 people with low back pain who started physical therapy within 14 days of onset found that it decreased the cost to treat back pain by 60%
● Unfortunately only 2% of people with back pain start with physical therapy, and only 7% see a physical therapist within 90 days

Despite the data showing that physical therapy is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. Almost every state has direct access, meaning that you can go directly to a physical therapist without a doctor’s referral. If you see your doctor for back pain, and physical therapy isn’t one of the first treatment options, ask for it!

What is Dry Needling and How Can it Help Me?

Dry_NeedlingBy Mandie Martuzzo, PT

Dry needling is a skilled form of therapy in which fine needles are inserted into myofascial trigger points (painful knots in muscles), tendons, ligaments or near nerves in order to stimulate a healing response. The needle allows the therapist to target tissues that are not manually palpable. Dry needling is a modern, science-based technique that can be used to treat painful musculoskeletal conditions such as neck or low back pain, headaches, shoulder impingement, tennis elbow, or plantar fasciitis, to name a few. Dry needling can also be helpful in treating nerve-related issues by improving circulation and disrupting fibrosis in chronic pain syndromes. Dry needling may relieve tension or improve flexibility in muscles. The technique utilizes a thin sterile needle;  nothing is injected or extracted. In many cases there patients experience an immediate increase in flexibility and movement and decreased pain within 24-48 hours.

Is Dry Needling Safe?

Dry needling is very safe, though it is possible that you may become drowsy, tired, or dizzy after treatment. However, this happens in only a small number of patients (1-3%). Mild bruising or bleeding may occur after dry needling (15-20% of the time) and is considered normal.   Temporary pain or soreness can happen during or after a treatment session, but soreness usually fades within 1-2 days, and in some cases even sooner. Only single use, disposable needles are used. This treatment is performed by physical therapists trained and certified in dry needling procedures.

Dry Needling vs Acupuncture

Dry needling and acupuncture both involve puncturing the skin with thin needles, but while the goal of both treatments is to alleviate pain, the practices are very different.

Dry needling involves needling into anatomical structures, such as muscles, to relieve tension and trigger points. Acupuncture utilizes needles with the intent of altering energy flow along traditional Chinese meridians for the treatment of diseases.

What are the benefits of dry needling?

Dry needling is typically part of larger treatment plan by your therapist. It can result in decreased muscle pain and stiffness, increased flexibility, increased circulation and healing response for a variety of musculoskeletal conditions, which can be helpful in optimizing sports performance, recovering more quickly from injuries, and preventing conditions from becoming chronic. Dry needling can be used in addition to regular physical therapy practices or as a standalone self-pay treatment for maintenance of the results of previous plan of care.

Learn more about dry needling on our website or call to schedule a consultation.


Medical News Today; Jenna Fletcher 5/13/18

Dry needling institute of American Academy

Kicking A Sedentary Lifestyle With Martial Arts


By Katrina Sholeen, PT, DPT

Starting a new fitness routine can be challenging for many people. Time and money both certainly factor into this equation, but finding activities you enjoy is equally important when it comes to making exercise part of your life. Quite simply, it will be much harder to add something to your busy schedule if it is not fun or meaningful to you! While signing up for a gym membership or starting a Couch to 5k program works wonders for some people, initiating a practice like martial arts, yoga or dancing can be another fun way to learn a new skill and continuously set and reach goals for yourself — all while you get your body moving!

While different styles of martial arts have different areas of emphasis, most offer a wide array of physical benefits by working on endurance, strength, speed, coordination, flexibility and balance. Additionally, martial arts also offer the perk of being a full body activity — meaning you’ll never have to worry about skipping “leg day”! Currently, adults are recommended to participate in at least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous aerobic exercise per week. Strengthening should also be part of the routine at least twice per week to keep your muscles and bones in their best condition. Many of these fitness goals can be met through participation in a striking-based martial art, such as karate or tae kwon do or grappling-based arts like judo or jiu jitsu.

However, other varieties of martial arts provide the benefits of dynamic exercise without physical contact.  The health benefits of Tai Chi, in particular, has been extensively studied. Research has shown that it is an effective method for preventing falls in older adults, and there have even been studies demonstrating the benefits of Tai Chi in more specific health demographics, such as individuals with chronic pain, Multiple Sclerosis, or Parkinson’s Disease. Non-contact boxing has also been studied as a method for promoting improved physical function in individuals with Parkinson’s.

As spring enters full swing, finding a fun and meaningful new activity might just be what you need to start working towards your health and fitness goals. Whether you are energized by kicking, dancing, running, lifting or any other way you can think of to be active, remember to check in with your health care provider before starting a new exercise program to make sure it is right for you!

If you have questions about your physical fitness or how to start exercising safely, call PhysioPartners to schedule an Annual PT Exam or consider the benefits of starting under the supervision of a personal trainer in a private or small group session.


U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018.

Huang Z, Feng Y, Li Y, et al. Systematic review and meta-analysis: Tai Chi for preventing falls in older adults. BMJ Open 2017;7:e013661. doi: 10.1136/bmjopen-2016-013661


Li F, Harmer P, Fitzgerald K, Eckstrom E, Stock R, Galver J, et al. Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med. (2012) 366:511–9. doi: 10.1056/NEJMoa1107911

Combs-Miller S, Dyer Diehl M, et al. Boxing Training for Patients With Parkinson Disease: A Case Series. Phys Ther. 2010. 91. 132-42. 10.2522/ptj.20100142.

Life is a Movement Journey — Your PT Can Help

CAD84269-5056-A04E-37A13372AB511E40.jpgNow that spring has arrived, temperatures are starting to rise in many parts of the country. And that means the transition from heating our homes to cooling our homes is right around the corner. No matter what method you use to cool your home during the warm spring and summer months (central air conditioning, window units, or fans and dehumidifiers), each spring you cross your fingers that your approach still works. If not, you might be calling an expert for a tune-up, or in extreme circumstances, you might need a complete overhaul.
Just like an AC system that may have been dormant for many months of the year, a body that hasn’t been physically engaged on a regular basis may have trouble getting started again. And yet, this time of year, the warm temps draw many people to city and suburban streets, tracks and trails, ready to take that first run of the season. A good percentage of these spring runners haven’t kept up their strides throughout the winter. It should come as no surprise that a 4-mile run for a previously inactive person is going to stir up a few aches and pains.

Especially as we age, our ability to move undergoes changes. Whether we’re talking about a college student or a retiree, returning to an activity without proper planning is a recipe for disaster. That’s where physical therapy comes in. Physical therapists are trained to treat injuries and ease pain, but they can also help their patients prevent injuries and safely prepare to participate in new activities.

Think of physical therapists as “movement consultants” who can ensure that your body is physically ready to tackle a new challenge—or resume a favorite leisure activity. Here’s another example to illustrate what we’re talking about: Let’s say that you play in an adult soccer league and you’re preparing to play in your first game of the season in a few weeks. You probably hung up your cleats when the last season ended months ago, but expect to pick up just where you left off. It’s simply too much to ask for your 2019 debut on the field to be on the same level as the last game of the previous season, when you likely had reached peak performance.

This is a good time for your PT to step in and help you shake off the rust.  Your physical therapist can customize an exercise plan to help you slowly return to sport and avoid an injury that could sideline you for the whole season. Or like cleaning the filters before firing up your air conditioner for the first time this year, your physical therapist can help ensure that your body is prepared to return to its former activity level following a hiatus.

April is Occupational Therapy Month!

By Caitlin Smith, OTD

Did you know April was occupational therapy month? Probably not. If you are like many people you might be confused about what exactly occupational therapy (OT) does.

Maybe you had a co-worker see an OT when she had carpal tunnel or your friend’s kid went to see an OT for sensory regulation issues. Your great uncle may have had an OT teach him how to dress after his hip replacement. It can be confusing to define OT because the same field would address all of the above and more. OT helps people across the lifespan to do the things they want and need to do through the therapeutic use of daily activities (or as we call them–occupations). For a child these may be simple, such as playing, learning, and self care. As we get older, we take on more complex activities, which may include typing at work, cooking meals, and managing finances.We often take for granted the importance of these tasks until something gets in the way of completing them. OT is founded on the simple belief that being able to complete all the activities you want and need to do leads to increase quality of life, social engagement and overall well being (and research backs this up!).

OT is a science-driven, evidence-based profession that enables people of all ages to live life to its fullest by helping them promote health and prevent – or live better with – illness, injury or disability. Deceptively simple, right? Occupational therapists take an indepth look at your personal abilities, as well as the tasks and environments and help find a way for you to get back to what matters. As someone far more eloquent once stated, “Occupational therapy is where science, creativity and compassion collide” (Kensky, 2016). Treatment plans may address physical impairments, emotional barriers, or modify the task or environment to get you back to your valued activities

PhysioPartner’s occupational therapist treats a wide range of impairments. With specialty in the upper body and lymphedema/oncology care, our OT can help you get back to your valued activities after:

  • Elbow,wrist or hand fracture, strain, or sprain

  • Repetitive strain injuries (Carpal Tunnel Syndrome, De Quervains, trigger finger, TFCC injury)

  • Help you cope with chronic conditions such as rheumatoid arthritis, osteoarthritis, chronic pain/RSD, or neurological disorders

  • Provide ergonomic evaluations to prevent work related pain/strain

  • Provide manual lymph drainage and educate on prevention of upper extremity lymphedema

  • Treat fatigue, cognitive changes, neuropathy or general deconditioning during or post cancer treatment

  • Address sensory processing issues, fine motor and visual motor impairments in pediatric population

Ask us if occupational therapy can help you!

Exercise and Rheumatoid Arthritis: Facts & Fallacies


By Erin Buenger, PT, DPT

What is Rheumatoid Arthritis?

Rheumatoid Arthritis (RA) is a chronic, autoimmune disorder in which your body attacks its own soft tissue structures, primarily the synovium or tissue lining of the joints.  About 40% of those affected with RA experience symptoms beyond the joints including skin, eyes, lungs, heart, kidneys, salivary glands, nerve tissue, blood vessels and bone marrow.  This inflammatory condition causes a painful swelling at the affected sites.  Over time, chronic inflammation can cause eventual bone breakdown and visible deformities.

Osteoarthritis (OA), on the other hand, causes a breakdown of cartilage located at the joint interfaces only.  It does not affect the organs of the body directly.

Isn’t it best to stop exercising when in pain?

RA symptoms are highly variable with periods of flare-up and remission.  When it comes to RA, one of the worst things you can do is to become sedentary.  There is a common misconception particularly that during a flare up, cessation of all physical activity is the appropriate prescription.

Exercises for RA should be aimed at decreasing the development of deformities and in hope of preventing joint fusion or joint replacement down the line.  Physical activity must be consistent in order to achieve and maintain gains/adaptations.  Varying the intensity, time, and type of exercise according to symptoms is the key — not discontinuing physical activity for an extended period.  Appropriate exercise levels vary from person to person.  Asking for guidance and listening to your body are important.  If an exercise causes direct pain, it will have to be modified.

You may want to start first with a physical or occupational therapist consultation prior to a more regular exercise routine, particularly if you are sedentary or have been sedentary for a length of time.  He or she can give you modifications for painful activities of daily living, stretches to help keep the joints mobile and start to progress you into regular exercise, as well as offer modalities and manual interventions to help manage the pain.

What are the current recommendations?

According to American College of Sports Medicine, exercise guidelines for RA include:

Regular exercise to improve strength and flexibility.  Strengthening the muscles surrounding the joints can help reduce the disability of RA.  It can additionally help combat fatigue and depression often associated with RA.  Walking, bicycling, swimming are great exercises to start with and easier on your body during a flare period.  Classes to consider include Pilates, yoga, tai chi, and gentle strength training.

Does research support physical activity in RA?

According to Mayo Clinic, those affected by RA are more prone to developing heart disease, diabetes and osteopenia/osteoporosis due to decreased physical activity, as well as some medication side effects.  According to the British Society for Rheumatology, “sedentary behavior may exacerbate already heightened inflammation in RA and hold relevance for disease related outcomes.”

A review article in 2011 of the “Benefits of Exercise in Rheumatoid Arthritis” found that:

Exercise in general seems to improve overall function in RA without any proven detrimental effects to disease activity.  Thus, all RA patients should be encouraged to include some form of aerobic and resistance exercise training as part of their routine care.  More research is still required on the optimal dose and types of exercise, especially when combining types, as well as how best to incorporate exercise into the lives of RA patients across the variable course of the disease. (Fenton, et al.)

Always get the green light from your doctor and keep them apprised of any lifestyle changes or change in symptom status.  Work with you doctor to determine the best plan for managing your RA over time and get back in the driver’s seat to improve your physical activity status!

Feeling like you can’t implement an exercise program safely, have other injury considerations, or just can’t find the motivation to make a change?  Consider a physical therapy evaluation, one of our group fitness classes or one-on-one personal training and/or Pilates at PhysioPartners!

Dr. Erin Buenger is a physical therapist at PhysioPartners.  Visit our website to schedule an appointment with Erin.



Benefits of Exercise in Rheumatoid Arthritis – Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Summary-of-general-exercise-guidelines-for-RA-This-information-is-derived-from-ACSM_tbl1_50395976 [accessed 9 Mar, 2019]




https://academic.oup.com/rheumatology/article/57/2/213/3192222.  (Fenton, et. al)


Picture reference:  https://www.painfreelivinglife.com/food-exercise/exercise/exercise-and-rheumatoid-arthritis/