The entire body is affected by pregnancy, delivery and breastfeeding.
- During pregnancy, the pelvic width increases by 10-15%:
- Changes in hip muscles
- Increased strain on knees
- Decreased connection between deep abdominal and the pelvic floor muscles
- Increased low back pain
- During delivery, there is a tremendous stretch on muscles, tendons, ligaments and connective tissue of the pelvic organs. This is especially true with episiotomy, tearing, incisions, cesarean section. Scar tissue may permanently impair muscle connections without skillful rehabilitation. Cesarean section is a major abdominal surgery.
- Increased intra-abdominal pressures during delivery can increase the risk of prolapsed bladder, uterus, rectum
- Reduced muscle integrity increases risk of incontinence.
- Abdominal muscle injury affects posture and core strength
- Increased risk of musculoskeletal pain which can include pain with intercourse
- Hormonal changes persist up to 6 months postpartum
- Pregnancy requires increased progesterone
- Increased progesterone and thyroid changes may slow digestion and are associated with constipation
- Pregnancy requires increased Relaxin/Elastin hormones
- Required during pregnancy and at high levels up to 6 months postpartum
- Increases flexibility of ligaments, which increases risk for sprains, strains and even dislocations as well as increased shoe size
- Breastfeeding requires reduced estrogen
- Low estrogen is associated with pelvic and perineal pain and increased bladder sensitivity
PREVENTION and Treatment of Pregnancy and Pospartum-related
musculoskeletal injury and pelvic floor dysfunction is possible!
- Following just one single pregnancy women are 3x more likely to develop urinary incontinence1 and 2x as likely to develop prolapse2.
- Women that participate in pelvic floor PT during pregnancy can reduce their risk of incontinence by 62%3 and waiting until after delivery, but still participating in pelvic floor retraining can decrease the risk of incontinence by 40%4. Current research is still lacking in specifically tracking prevention percentages for prolapse in women that proactively participating in pelvic floor therapy. However, medical consensus agrees that maintaining proper strength in the pelvic floor, in addition to avoiding weight gain, not smoking, avoiding constipation, and strain with heavy lifting all assist with the prevention of prolapse5.
What is the “Fourth Trimester”?
- Postpartum weeks and months of significant hormonal, musculoskeletal and emotional change as the uterus shrinks, internal organs return to their pre-pregnancy position, emotional and physiologic bonding with baby continues and breastmilk is produced.
- These body changes continue for a minimum of 12 weeks following delivery with several important hormonal factors persisting until 6 months postpartum
- To “bounce back” is a cultural myth and a physical impossibility.
- Recovering your strength and vitality takes time, but it is a crucially important process in order to care for your baby and your family.
Common, but not inevitable, post-partum physical complaints include:
- Bladder or Bowel Incontinence
- Prolapse or “Falling Out Feeling”
- Musculoskeletal Pain
- Back, Neck or Joint pain
- Tendonitis, especially of wrist or thumb
- Scar or incisional pain
- Painful penetration including intercourse, pelvic exams or tampons
- Diastasis Recti
- Persistent abdominal separation reduces core strength and may increase back pain or incontinence
How can your specialist Pelvic Health Physical Therapist help?
- Re-train core muscle coordination of abdominals, hips, spinal muscles and the pelvic floor.
- Safely and progressively strengthen abdominals, hips, spinal muscles and the pelvic floor.
- Teach ergonomic posture and body mechanics for squatting, lifting and even breastfeeding.
- Reduce pain through gentle stretching, progressive strengthening, teaching body mechanics as well as manual therapy, massage and scar tissue reduction.
- Prevent further and future injury to abdominals, the pelvic floor and pelvic organs.
You deserve to feel confident about your body again.
You deserve support and encouragement in your
postpartum recovery journey.
References:
- Hansen, BB, Svare, J, Viktrup, L, Jørgensen, T, Lose, G. Urinary incontinence during pregnancy and 1 year after delivery in primiparous women compared with a control group of nulliparous women. Neurourol. Urodyn. 31(4), 475-480 (2012).
- Kudish, BI, Iglesia, CB, Gutman, RE, Sokol, AI, Rodgers, AK, Gass, M. Risk factors for prolapse development in white, black, and Hispanic women. Female Pelvic Med. Reconstr. Surg. 17(2), 80-90 (2011).
- Woodley, Stephanie J, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews: 06 May 2020 in Issue 5, 2020.
- Boyle R, Hay-Smith EJ, Cody JD, Morkved S. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. The Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.:CD007471. DOI: 10.1002/14651858.CD007471.pub2.
- www.MayoClinic.org
Amanda Cranston , OTR-L, CLT
Areas of Special Interest
- Lymphedema
- Pelvic Health
- Post-Oncological
- Vestibular
Amanda graduated from D'Youville College located in Buffalo NY with a Masters in Occupational Therapy and minor in Psychology. She had a Clinical in WNC and fell in love with the mountains, moving to Asheville after graduation in 2012.
She started working in a Skilled Nursing Facility after graduation, where she worked for 7 years, developing a passion in treating Lymphedema and Oncology Rehabilitation. She obtained her Certification in Lymphatic Treatment from The Academy of Lymphatic Studies in 2019. She has a passion for treating a wide variety of oncology diagnosis, providing evidence based cancer rehabilitation to survivors with focus on improving function and quality of life throughout the continuum of care. She has expanded her knowledge base with ongoing education in Oncology rehabilitation, receiving oncology rehabilitation specialist certification through the Pori Cancer institute.
Amanda also has received specialty training in Pelvic rehabilitation for both male and female pelvic floor conditions, with a goal in helping each of her clients through their own pelvic health journey.
When not at work, Amanda enjoys exploring the beautiful Asheville area with her husband and 2 pups.
Bekah Campbell, PT, DPT, PHC
- Clinical Director
Rebekah (Bekah) was born in Pennsylvania, close to Allentown, and she received her Bachelor's degree from Temple University in Philadelphia and later her Doctorate in Physical Therapy from Chatham University in Pittsburgh. Upon graduation, her adventurous spirit brought her and her fiancé, Brian, out west for 6 years. This eventually landed them in Washington State, near Seattle, where she found her passion for treating pelvic health. Bekah's goal is to bring awareness of pelvic health to the public eye and improve the lives of millions by changing the way preventative pelvic health is addressed in the healthcare system. Bekah has gone through extensive continuing education on how to treat the pelvic health population and in October 2020 completed a yearlong Pelvic Health Certification (PHC) through Evidence In Motion. When Bekah isn't in the clinic, you will find her teaching or practicing yoga, exploring the new city of Asheville with her other half, hiking outdoors to embrace nature, working out in the gym or sitting and reading a good book.
Kristen Murphy, PT, DPT
- she/her
Areas of Special Interest
- Pelvic Health
- Gender Affirming Care
Hi there, my name is Kristen! Here's a little about me...
I received my DPT from East Tennessee State University in December of 2014 and have been practicing Pelvic Health Physical Therapy since February of 2015 here in WNC and am loving it! I completed my Sexuality Counselor and Education certificates through the University of Michigan earlier this year and am in supervision for my AASECT certification. It is a passion of mine to work with people of all genders to treat any and all Pelvic Health or Sexual Health concerns in order to help them feel comfortable and confident in their bodies. I treat my patients from a trauma informed perspective that encompasses the biopsychosocial aspects of patient health and wellbeing.
On a personal note, I love to spend time with my partner and my dog, reading a good book, or getting outside and enjoying a nice walk in the park.
I look forward to working with you!
Rebecca Duncan, PT, COTA
Areas of Special Interest
- Pelvic Health
Although born in the Northern Appalachians, Rebecca has lived in 7 states from the Great Lakes to the Lone Star state while finally settling in the Asheville area some 20 years ago. After graduating from the Physical Therapy program at Russell Sage College in NY she headed South and gained 7 years of experience in treating clients with orthopedic, sports and work-related injuries. During a hiatus to homeschool her children, she obtained her Certification as an Occupational Therapy Assistant and acquired clinical experience in lymphedema management, and in the specialty of seating-mobility for clients in need of wheelchairs and other medical equipment.
During her own journey through pelvic pain, she became aware of the overwhelming need for Pelvic Health Physical Therapists in our area. She has received specialty training in Pelvic Health via the Herman & Wallace Institute with a goal of successfully helping each of her clients through their own pelvic health journey.
Over the past 15 years, she has enjoyed being a Girl Scout and 4H leader in Henderson County and has been actively involved in the Boy Scouts of America up until 2020. When not in the clinic, she enjoys spending time with her family, friends and pets. She is always looking forward to her next adventure hiking or camping especially along sections of the AT where she was given the trail name of Chewbecca despite not looking like any Wookiee she's ever seen.
Stephanie McElhaney OTD, OTR-L, CLT
Areas of Special Interest
- Lymphedema
- Pelvic Health
I received my bachelor's degree in exercise science in 2019 from Ball State University in Muncie, Indiana. During my time at Ball State, I developed a passion for the rehabilitation process and made it my goal to help others return to living life to their full potential. I then attended the University of Indianapolis and received my doctorate degree in occupational therapy in 2022. I completed my capstone project working with individuals with substance use disorder and worked towards restoring participation in meaningful occupations. Since graduating, I have developed a passion for pelvic health and oncology services. I am currently working towards receiving my Pregnancy and Postpartum Corrective Exercise Specialist certification and will be completing my lymphedema certification in August.
In my free time, I enjoy running, bouldering, and doing anything outdoors. I am an avid reader and love anything non fiction or historical fiction. I am engaged to be married in May 2025 and have two cats that are my life!
Ferris Fakhoury MS, PT
Ferris was born in a small town in southern Georgia near the Florida border. She received her BS in Physical Therapy from the Medical College of Georgia. After practicing for 12 years, she returned to academia and completed an advanced Masters in Human Movement Science from UNC Chapel Hill. Upon graduation, she accepted an appointment as Assistant Professor at the Medical University of South Carolina. While she enjoyed teaching, Ferris opted to return to the clinic to pursue a position in research and data collection at the Shriner's Hospital for Children in Greenville, South Carolina. In this position, Ferris developed educational programs for parents and clinicians as well as work as lead PT in the Motion Analysis Lab for 10 years.
Desiring a change in her career, Ferris left the Shriner's Hospital and opened a yoga studio in Asheville. During the next five years, Ferris, in addition to teaching yoga, made a transition from working with children to pursuing her interest in aging adults and began her journey toward working in pelvic health physical therapy and adult orthopedics. Today, Ferris is happy to work in a split position at Cornerstone and spends her week working in both orthopedics and pelvic health. Her goal as a therapist is to provide individualized care to all people and to use evidence-based care grounded in research.
When Ferris is not in clinic, you may find her in a hot yoga class, hiking, painting, or relaxing with a good book… and yes, Netflix.
Allie Steinhoff, PT, DPT
- she/her
Areas of Special Interest
- Orthopedics
- Pelvic Health
- Gender Affirming Care
Allie has lived in WNC for most of her life. She earned her Bachelor of Exercise Science from Brevard College and her Doctor of Physical Therapy from Western Carolina University. As a health at every size (HEAS) provider, Allie is passionate about inclusive and empowering care with the core belief that all bodies are good bodies. She prioritizes a holistic full body approach for treating pelvic health and orthopedic conditions for people of all genders. Allie is certified in the LSVT BIG protocol for individuals with Parkinson disease and is also a guest lecturer for Western Carolina University's Physical Therapy program in gender affirming, inclusive, & trauma informed care.
She enjoys weightlifting, reading, crocheting, all things nails, hair, and makeup as well as spending time with her husband, Jamar, and dog, Fiona Apple.
