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core weakness after giving birth

Why Is My Core So Weak After Pregnancy?

Why Is My Core So Weak After Pregnancy? 1280 1019 ResilientRx

“Why is my core so weak after pregnancy?”

I get this question ALL of the time, even from people who have given birth many years ago. 

core weakness after giving birth

The answer to this question is: your abdominal muscles have been stretched for about 9 months, and if you have had a c-section, this is a major abdominal surgery that can weaken the abdominal muscles on top of being stretched.

And no, this does not mean you are doomed if you had a c-section, it just means that you may need to build up that strength at a slower pace than someone who did not.

Your abdominal muscles are like any other muscle in your body

I think it is important that we think of your abdominal muscles as any other muscle in your body. 

For example, if you could do 20# bicep curls then kept your bicep in a stretched position for 9 months, you wouldn’t start right up with 20# after the fact, you would gradually increase the weight.

You could start at 5lbs, then 10lbs weaning your way back up to your goal.

If you didn’t wean into building the strength a few things would happen:

  1. You could develop tendonitis (the load to the bicep is too much and causing too much tension to the bicep tendon–this is the part that connects the bicep muscle to the bone.)
  2. You will use momentum to help, you may swing your hips or back forward to help complete the curl.
  3. You would hike your shoulder blade and upper body to help make the elbow bend with the weight.

Either way, none of these are ideal. 

I think it’s interesting that we don’t think of the abdominals, and the pelvic floor muscles, this way. 

Let’s now apply this to the abdominals.

If the load to the abdominals is too much, you make feel:

  1. Your low back arching
  2. Unable to keep your belly from pushing upward
  3. You may see diastasis recti (bulging from the middle part of the abdominals)

It’s harder to quantify abdominal strengthening exercises because they aren’t as objective as weights.

Here are some general guidelines:

-You should feel the muscle burn in the abdominals you are targeting

-You should be able to maintain pelvic control (not arching the back or twisting the pelvis)

-It should not be painful to your hips or back

How to plank after giving birth

Next you can progress abdominal strengthening in different ways.

Here is an example:

Tina was a client of mine and she has been complaining of constant weakness of her abdominal muscles despite working out for years after her pregnancy. At this point she was about 5 years since her latest pregnancy

The major thing she was doing was pushing herself back into the old routines she was doing prior to pregnancy. Because of this other muscles compensated to help:

-Low back muscles were tight

-And the hip flexors continued to be bothersome.

The biggest change we made was modifying her abdominal exercises. 

Let’s go back to physics: when something is further away from our body, we know that it will be heavier than if it is closer. 

For example, If you hold a 5# weight at your chest, then you hold it away from your body with your elbows extended, it is going to be harder even though it is the same weight.

The same goes for abdominal strengthening, if your legs or arms are further away from the abdominals the harder it is going to be. Here is an example.

It is important to gradually load the abdominals after pregnancy

Here are some examples of how to modify:

Flutter kicks

  • Lay your upper body on the mat and bend your knees vs keeping them straight
  • Bring your legs higher up in the air (vs lower down toward the floor)
  • Try laying your upper body on the ground and complete marches vs legs straight

Planks (start from higher surface and gradually work your way to the ground)

  • Try a plank a wall
  • Then progress to a lower surfaces, like the back of a couch or counter
  • Then to a bench
  • Then to your knees
  • Then to a full plank

Here is an idea of the movements

Planking form that is too hard

Try these plank progressions

Each of these progressions can take weeks to move to the next one.

Gradual core strength after having a baby

Remember to be patient with your body. It has pushed out a human which is a beautiful thing.

Give your body the time it needs to ease into your activities. 

And yes, you may have had an easier time after your first baby, or in your 20s, but each birth and each pregnancy is different.  

And everyone else has their own journey, some people may return to exercise more easily but may have other issues that they are dealing with (postpartum mental health issues, social support, breastfeeding issues, etc).

Be kind to yourself!

-Dr. Mary

What to do if you already have back pain

What’s The Best Sleeping Position? The Answer Might Surprise You

What’s The Best Sleeping Position? The Answer Might Surprise You 2560 1709 ResilientRx

When it comes to sleeping and pain, I often have been asked questions like, “what’s the best pillow for neck pain?” Or “is sleeping on my stomach bad for my low back?” Unfortunately, there is no single answer, as each person’s circumstances will be vastly different, even with the exact same pain issue. There’s a lot of conflicting information out there, so I hope this blog can give some insight.

Should You Avoid Certain Positions?

We don’t want to underestimate the importance of sleep in our health. We know that poor sleep, especially chronically, can have significant health impacts on things like pain, injury risk, and performance. Such questions like the ones listed above are valid and need to be answered honestly by the healthcare community.

You may have heard advice like sleeping on your stomach is bad for your neck or back from friends, family, or even healthcare providers. While positions like this can be uncomfortable for many people, it is not an inherently bad position and is too much of a generalization to apply to all human beings. This is due to the simple fact that pain is such a multi-factorial, individualized experience. Not to mention that preferred sleeping positions are also influenced by things like age, health conditions, and body mass. 

In my nearly 11+ years of clinical experience, I have observed such variety of positions that both help or exacerbate people’s pain. For example, one person reports that switching from their side to back-sleeping helped their pain, while the next person found the exact opposite to be true. Again, we simply can and should not paint with such broad strokes and say X is bad and Y is good. There’s even research that suggests that there is no association between things like shoulder or spine-related pain and sleeping position (Cary, et al, 2016 & Holdaway, et al, 2018).

Should you sleep in Neutral Spine

Sleeping With a Neutral Spine Is Good, Right?

Have you tried sleeping with a pillow between your knees to maintain a “neutral spine,” but almost NEVER seem to wake up with it in the same spot? That’s because we naturally change positions frequently throughout the night. Studies have reported that we can change positions upwards of 19 to 32 times per night! (De Konick, et al, 1992, and Kubota, et al, 2003).

Additionally, we know that neutral spine is not one position, but a range. If sleeping with a neutral spine helps you sleep better or perhaps with less pain, that’s great! But there will inevitably be others that will sleep better or have decreased pain when not in spinal neutral. And that is okay too!

What to do if you already have back pain

What to Do if You Already Have Pain

Aside from all of the things you could be doing during your waking hours to help with pain (we’ll save that for another blog), there may be certain positions that you may want to temporarily avoid. For example, if you have shoulder pain, you may want to sleep on the opposite side and hug a pillow close to support your injured shoulder. If you have a lower back or neck problem, sleeping on your stomach may be irritating because you are laying in pain-provoking positions for longer periods of time than your tissue will tolerate.

Making positional adjustments like laying on your back or using pillows may help you get more restful sleep. This does not mean you should not or could not go back to sleeping in those other positions.

Waking up refreshed


  • There’s currently not enough evidence to conclude that certain sleep positions are better or worse for musculoskeletal problems such as neck, shoulder, or back pain.
  • Some research supports that there is no causal link between sleeping positions and risk for developing pain.
  • If you feel like you’ve “slept wrong” and now have pain, it’s more like a matter of what you’ve been doing (or not doing) during your waking hours the preceding days/weeks/months. In other words, you are doing too much or too little of movements or activities which contributes more to your pain experience than simply how you are positioned in bed.
  • Quality and quantity of sleep matter more than specific positions. If you’ve been told that certain position(s) are harmful, but they still feel comfortable to you, IT’S OKAY TO SLEEP IN THOSE POSITIONS.
  • I’m NOT saying position NEVER matters. Certain postures can influence pain, but we should not create fear-based narratives around how people sleep (i.e. you will have pain or be misaligned if you sleep on your stomach)
  • Temporarily changing positions or utilizing certain postures (i.e. propping with pillows) can be helpful during an episode of pain
  • You may have to experiment and find the right combination of pillow or mattress type right for you. Unfortunately, there is not one solution that will be best for everyone. That’s where guidance from your physical therapist can help!


De Koninck, J., Lorrain, D., & Gagnon, P. (1992). Sleep positions and position shifts in five age groups: an ontogenetic picture. Sleep, 15(2), 143-149.

Kubota, T., Ohshima, N., Kunisawa, N., Murayama, R., Okano, S., & MORI‐OKAMOTO, J. (2003). Characteristic features of the nocturnal sleeping posture of healthy men. Sleep and Biological Rhythms, 1(2), 183-185.

Cary, D., Collinson, R., Sterling, M., & Briffa, K. (2016). Examining the relationship between sleep posture and morning spinal symptoms in the habitual environment using infrared cameras. Journal of Sleep Disorders: Treatment & Care.

Holdaway, L. A., Hegmann, K. T., Thiese, M. S., & Kapellusch, J. (2018). Is sleep position associated with glenohumeral shoulder pain and rotator cuff tendinopathy: a cross-sectional study. BMC Musculoskeletal Disorders, 19(1), 1-8.

Urinary Incontinence (Accidental Leakage): Myths & Reality

Urinary Incontinence (Accidental Leakage): Myths & Reality 2046 1364 ResilientRx

According to recent statistics from the National Association for Continence, over 25 million adult Americans experience temporary or chronic urinary incontinence. This is a common, widespread, but oftentimes very overlooked and misunderstood issue. What most people don’t know is that there are different therapeutic solutions to help reduce daily leakage, or even eliminate it altogether. 

If this sounds like you, wouldn’t you want to know how to overcome urinary incontinence? 

What is urinary incontinence?

Urinary incontinence is the accidental leakage or increased urgency to urinate often. It can be felt by anyone of all ages.  It can range drastically from person to person – and can be managed or treated by exercise, lifestyle changes, or dietary changes. 

What causes urinary incontinence?

There is a lot of misinformation surrounding the causes of urinary incontinence, or UI. In a broad sense, the types of UI can be put into two different categories: urge and stress urinary incontinence.

Urge urinary incontinence

Urge urinary incontinence can be caused by certain drinks, foods, and even medications and stimulants. Included in this list are things such as: 

  • Alcohol, caffeine, carbonated beverages
  • Artificial sweeteners, chocolate, overly spicy and sweet foods, citrus fruits 
  • Heart and blood pressure medications

Here are common examples of urge incontinence

  • Feeling the urge to pee as soon as you put your key in the door to your house
  • Worried about prolonged walking because you won’t find a bathroom
  • Feeling the need to pee after you just peed

Stress urinary incontinence

Stress urinary incontinence is accidental leakage when there is extra stress placed on the pelvic floor. Below are some common reasons that it can occur

  • Pregnancy and childbirth (ie tearing during child birth)
  • Poor breathing form (not using your diaphragm so your pelvic floor muscles are not as active throughout the day)
  • Pelvic surgery
  • Poor exercise or running form

Here are some examples of SUI (stress urinary incontinence)

  • Peeing when you cough, sneeze or laugh
  • Peeing when you jump, lift or exercise

Myths about urinary incontinence

Because urinary incontinence can be an embarrassing condition, those who suffer from it may do so in silence. This is what prevents so many people from getting the care they need — and we want that to end.

Myth #1: Only elderly people, or people who have been pregnant, suffer from urinary incontinence

While it is true that many people who have been pregnant do face increased likelihood of UI, it also can affect those who are pre/post menopause.  Either way, you are not alone. Bladder dysfunctions can start in people regardless of gender, as young as 18 years old. And if people with penises have any type of prostate gland issue,  whether it be serious or minor, they are at a risk of incontinence.

Myth #2: If you suffer from urinary incontinence you should drink as little fluid as possible to improve your symptoms 

The only thing that limiting fluids does is further concentrate your urine, which then leads to a higher chance of bladder irritation — making the symptoms of UI worse. Always drink adequate fluids, you may have to temporarily stay away from any that you have found cause symptoms to worsen, in order to keep urine diluted.

Myth #3: Nothing can be done about urinary incontinence OR surgery is the only option to treat urinary incontinence

In most cases, urinary incontinence can be managed or treated successfully. Surgery is only ONE of the options for treatment — and that’s to be used only after all other avenues have been exhausted. Urinary incontinence treatments include behavioral and physical therapies, lifestyle modifications, and medications. Treatment plans depend on many different factors, including age and gender of the patient.

Find relief from urinary incontinence with ResilientRx

At ResilientRx, we offer modern physical therapy to target pelvic floor pain and dysfunction, which provides much-needed treatment for people who suffer from urinary incontinence. 

We go beyond just the pelvic floor with this therapy. We target your mobility and movement patterns that may help explain why these problems are occurring. By hitting the root cause of your urinary incontinence, we have a better chance of reducing your incidents — and possibly relieving them entirely! Our urinary incontinence and pelvic therapy treatments can be performed internally (intra-vaginally) and/or externally to reduce pain/dysfunction and ensure long-term results. 

If you’re someone who is struggling with UI and has been told that constantly doing kegels is the only way to fix the problem, reach out to us today. We’ll begin a therapy regimen designed to not only to strengthen your pelvic floor muscles but also target the root cause of the bigger issue. 

How to Stay Hydrated During the Summer Months

How to Stay Hydrated During the Summer Months 1920 1280 ResilientRx

60% of our body is made up of water, but when we’re enjoying our favorite outdoor summer activities, all the water inside of us won’t be enough to keep us hydrated. Summer activities and sweltering heat lead our bodies to lose more fluids than normal — through our sweat. If you don’t replace the moisture that your body is losing, you can eventually become dehydrated. 

Hydration is the body’s first defense in maintaining good health, especially as we age. Water isn’t just to parch thirst — it’s critical for our muscles, bones, tissue, and organs. That’s why we are regularly told to drink at least 8 glasses of water a day. In reality, this is an arbitrary number; some bodies might need more and some bodies might need less depending on all different factors.

Let’s dig into what it looks like to be hydrated and dehydrated so you can find the proper amount of water intake for you, your body, and your summer activity levels.

Is your body hydrated or dehydrated? Know the signs

Water is never a bad idea. And while it may feel better to cool off from the scorching summer sun with an ice-cold soda, alcoholic beverage, or juice, these beverages won’t provide anything in the way of hydration. In actuality, they’ll just quench your thirst momentarily while causing further dehydration. 

The key is to drink enough plain old water to hydrate your body properly. Whether that’s 8 glasses of water or 12, your body will also give you signs that you are properly hydrated. These include:

  • Improved brain performance and function
  • Reliable digestive harmony 
  • Decreased/eliminated joint pain 
  • More energy
  • Weight management 
  • And so many more! 

When you’re dehydrated, though, your body will begin to show warning signs, some more obvious than others. Some of the dehydration dangers that you should look out for include: 

  • Muscle cramps – When you become dehydrated your body can no longer send water to your muscles, causing them to be more likely to constrict and cramp involuntarily due to hypersensitivity. 
  • Constipation – Dehydration will make it harder for your body to break down food as it moves through your intestines. Because your body is in panic mode, it will start extracting what liquids it can from the food waste, essentially making it harder to move through your body. 
  • Depression – Dehydration doesn’t just affect your body, it also affects your mind. Your brain requires the most water out of any other part of your body (your brain is made up of 85% water). When there’s a deficiency in that water supply, your brain will lack the energy it needs to fight fatigue and, yes, depressive thoughts from occurring. 
  • Color of your urine- If your urine is a dark yellow, this means that you are dehydrated. In other words, your kidneys are retaining water from being excreted (peeing it out), in order to keep the body hydrated. This is why the urine is concentrated. The goal is to have your urine be a slight yellow color, not dark yellow and not clear. 

The importance of electrolytes in staying hydrated

Electrolytes are minerals found in your blood, sweat, and urine. The minerals are dissolved in fluid and form into electrolytes – which are the positive or negative ions used in metabolic processes (turning food into energy).

There are several different types of electrolytes found in the body that are responsible for keeping up with important bodily functions, including nerve and muscle function, acid-base maintenance, and keeping you hydrated

Within your body, you have electrolytes like sodium, potassium, chloride, calcium, magnesium, phosphate, and bicarbonate. Of these, sodium is the most important to the process of staying hydrated. 

Without the proper amount of sodium, your body cannot maintain fluid balance (your kidneys are in charge of this) — because sodium is needed to carry H2O across our cell membranes. Remember high school biology? This process is called osmosis.

Without osmosis, your body doesn’t know which cells to send water to and which ones need to be filtered through. Without this information, cells are at risk to either burst from too much water or to shrink due to dehydration. 

The most common cause of electrolyte imbalance is dehydration caused by extreme heat exposure (other causes include being physically ill, like vomiting or diarrhea). Electrolyte imbalance can be anywhere from mild to fatal, which is a scale that should be taken seriously.

Side effects of an electrolyte imbalance include:

  • Fatigue (this is the most common)
  • Irregular heartbeat
  • Muscle cramping
  • Headaches
  • Convulsions 

This delicate balance happening within your body is not something you want to challenge. Electrolytes are more than just a word you read on a bottle of Gatorade — they can impact your health and wellbeing.

How to rehydrate with food and water

Dehydration during the summer doesn’t have to happen. While sweating is great for removing toxins from our body and even proving that we’re getting a great cardio workout, sweating too much is not necessarily a good thing. You’ll need to replenish everything you sweat out by drinking water (no, drinking a Gatorade after a workout isn’t necessarily what your body needs!).

If you are sweating or intensely working out for over an hour, supplementing electrolytes is recommended. We often use nuun tablets (less sugar) after completion of exercising for an hour, or Liquid IV if you are continuing to exercise over an hour because it has sugar (glucose) to help provide extra energy to keep moving. 

How much water should you drink?

By taking half of your body weight and turning that number into fluid ounces, you have the perfect amount of water that your body needs to operate at functioning capacity at a baseline.

You’ll also want to consider your activity level or heat outside. Whether you’re playing sand volleyball one day or walking outside another, you should add 12 ounces of water to your daily water intake for every 15-20 minutes you work out or are sweating in this Texas heat!

Water-rich food sources

However, hydration doesn’t only have to be about incorporating your 8 (or more) glasses of water into your day. You can also include more water-rich foods in your diet. Summer fruits such as watermelons, strawberries, cantaloupe, and peaches are great water-rich options for snacking during hotter months. Most vegetables also fall into this category, too, with the top three water-rich veggies being cucumbers, lettuce, and celery. 

Active all year-round? We want to help.

We know that, for many people, summer is a very active season. Alongside dehydration comes the risk of injuries, from muscle strains to unidentified pain and even bone breaks or ligament injuries.

Here at ResilientRX, we believe that you can recover from your injuries — and even prevent future injuries with the help of a physical therapist. 

When working with one of our Doctors of Physical Therapy, you will undergo a comprehensive evaluation that will look beyond one body part and assess multiple regions that may be contributing to the problem. We’ll talk about your activity levels, hydration and diet, history of injury, and more.

Your physical therapist will walk you through every step of the assessment and will ensure you feel comfortable, but push you when needed during each treatment session.

If you want to make sure you can stay active and strong throughout the year, now’s the perfect time to start working with a performance-focused physical therapist. Learn more about our PT services for athletes and active folks here.

And remember, all of this is general advice, please consult your physician if you have any questions about whether or not these supplement suggestions are right for you.

The Benefits of Dry Needling

The Benefits of Dry Needling 2560 1707 ResilientRx

Have you ever had a deep tissue knot in your shoulder or back? Or perhaps you’ve had a muscle strain or even a herniated disc that was causing you significant pain. Others may even experience nerve pain in parts of their body that physical therapy and exercise don’t seem to relieve. Rather than using different exercises or manual therapy to treat these problems alone, many PTs are turning to dry needling to help their patients recover faster and restore mobility to the body.

Dry needling can mitigate pain caused by a number of issues – arthritis, nerve pain, trigger points, ligament strains, headaches, muscle spasms, and more. Before we dive into the benefits of dry needling, though, let’s start with the basics of what dry needling actually is.

What is Dry Needling?

Dry needling can be used as a part of a comprehensive plan to help restore movement and function in the body. It’s a skilled practice that uses filiform needles to penetrate the skin and stimulate trigger points. A trigger point is a place of muscular dysfunction, causing pain and impacting mobility. They can be tender to the touch and difficult to eliminate as these tight bands of skeletal muscle can cause pain to permeate into other parts of the body. 

How do trigger points form? Inflammation builds up in muscles that are injured or overused, causing tension and depriving the muscles of oxygen which occurs from the impaired blood flow. This causes the muscle to be taut, limiting normal movement of the muscle.

How Dry Needling Works

To perform dry needling, a PT will insert super-thin needles into the skin. The needles stimulate the myofascial trigger points, creating twitches and muscle reflexes. These reflexes decrease muscle tension, reducing irritation and pain while improving flexibility. This increases blood flow to the area to promote healing.

By using dry needling, a Doctor of Physical Therapy can target these areas and stimulate them in a way they can’t do with regular physical therapy techniques. It can be painless but most people say the cramping is more of the sensation which can be slightly painful for some. Some patients also report some soreness around the needle sites for around 24-48 hours, while others don’t feel any soreness.

Benefits of Dry Needling

By inserting needles into trigger points on the body, the muscles relax, boosting blood flow, diminishing inflammation, and triggering an immune system response. There are four specific benefits to dry needling:

Relief of pain

Looking for immediate pain relief? Pain improves as blood flow is restored, moving acidic wastes away from the muscle and providing those areas with oxygen and nutrient-rich blood. Many people report immediate relief after one session, but some do require additional sessions.

Improving mobility

When you have tight knotted muscles, the tendency is to stop moving and limit your mobility and movement to avoid pain. By combining dry needling with physical therapy, strength and mobility are restored and future trigger points can be avoided.

Quicker Recovery 

Regardless of the injury or pain, restoring movement is the best way to heal and recover. While physical therapy can be the main component of treatment, adding dry needling to the treatment plan can help speed up your recovery time. 

Assists with Chronic pain

Dry needling specifically helps with chronic conditions such as back or neck pain. This can result in trigger points and tenderness. Patients with chronic pain who have had dry needling report significant pain improvement. It helps to increase blood flow to these areas that are impaired and help improve mobility

Dry Needling vs. Acupuncture 

While both dry needling and acupuncture use the same filiform needles, they are vastly different practices. Acupuncture is based on eastern medicine principles, and it’s focused on different points and meridians throughout the body. Needles are used superficially to assist with the flow of energy. Based on western medicine, dry needling inserts needles into a specific part of the muscle that is causing dysfunction and pain. 

Is Pain Holding You Back?

Are you limited in mobility and function because of pain impacting daily activities? We can evaluate your movement, strength, and function to form a plan of care, whether that’s dry needling, PT, or home exercises, that can get you back to doing the things you love. If you are struggling with pain or an injury, our physical therapists can help! Start moving again with help from ResilientRx. Book a consultation online today!

How Stress and Anxiety Affect Pain

How Stress and Anxiety Affect Pain 2560 1707 ResilientRx

Anxiety disorders, commonly associated with chronic stress, are the most common mental illnesses in the United States. In fact, anxiety disorders affect nearly 40 million adults each year. People suffering from anxiety are three to five times more likely to visit the doctor than those without anxiety disorders.

The reason?

Stress and anxiety do not just have an impact on the mind. Together, they cause or enhance chronic pain. Many of us forget that anxiety or worry can cause several painful physical symptoms — chronic fatigue, heart palpitations, muscle aches and weaknesses, headaches, and more. 

Here’s a deeper look into the impact chronic stress and anxiety have on the body.

Man really feeling how stress and anxiety affect pain

How can stress and anxiety impact pain response? 

Have you ever noticed that your muscles hurt more when you’re worried about work or family? Do you get headaches more as you think about something too much? These are all small signs of how anxiety and stress can impact our body’s pain levels.

Research has also proven that stress and anxiety can influence pain perception (how we perceive pain). Some people, when their cortisol levels spike, experience stress-induced analgesia — which suppresses our sensation of pain. 

Stress-induced hyperalgesia, on the other hand, occurs when stress, anxiety, or even fear, are already present, elevating pain and increasing intensity and duration. 

The fight or flight response affects pain

We all know the “flight or fight” response our bodies experience when we undergo stress. When our bodies activate this response, it dumps higher levels of cortisol into the bloodstream which spikes our blood sugar. Your body also experiences an increased heart rate and adrenaline output. Over a period of time, this influx of cortisol can harm your body and cause you to be more susceptible to injury and pain. 

In the fallout of this response, people tend to feel exhausted, which can heighten mental and physical ailments and decrease their immune system response. 

The nervous system and stress

Stress is very closely aligned to the nervous system. Your body’s reaction to stress can tip off pain perception in the body and, because the nervous system extends into the brain, can impact the way your body responds to pain. Over time, your body may develop a more sensitive nervous system reaction to stress and anxiety, which could be the cause of chronic pain. 

Woman sits at computer looking very stressed out and anxious because of how stress and anxiety affect pain

Common physical symptoms of stress and anxiety

The longer a person experiences chronic stress and anxiety the more intense the symptoms may be. You could equate it to heart health — the longer you eat fatty, high-sugar, and highly processed foods, the greater your chances are for heart disease. So, the more often you’re stressed, the more vulnerable your body becomes because of the wear and tear that results. 

Symptoms of stress and anxiety often go unnoticed or are mistaken for something minor. However, consistently experiencing the following systems can wear out your body. 


This is the most common symptom associated with stress and anxiety. Because the mind is in a constant state of alertness, it tires out much faster than the mind of someone who may not often experience stress and anxiety. Even after healthy sleep, people can still feel exhausted because of mental fatigue or the physical symptoms that come along with prolonged high-cortisol levels in the body. 

Heart palpitations

Having heart palpitations can be distressing, which may cause a continued increase in cortisol levels and can increase heart rate. Heart palpitations feel as though your heart is pounding too fast and skipping beats. 

Muscle aches and weakness

Tension is usually to blame for muscle and joint pain caused by stress and anxiety. Prolonged periods of these emotions cause muscles to tense up and leave you feeling stiff. A high level of stress consistently can impact immune system functions, making it more difficult for your body to fight off inflammation. 

Muscles also tend to become weak, especially in the legs and arms. During a fight or flight response, blood flow is increased to the limbs to make it easier to take action against a perceived threat. After the adrenaline response has ended, muscles can become sore and painful. 

Woman laying down clutching her head and stomach feeling sore from stress and anxiety


Headaches and migraines are other common results of chronic pain and anxiety. Because other systems, such as teeth grinding, tension in the face, and poor posture often accompany stress and anxiety, prevalent headaches and migraines that are extremely painful are likely. Sharp pain or dull aches accompanied by pressure in the head and eyes are usually the headaches caused by stress and anxiety. 

Find relief for your pain

Stress and anxiety are common ailments in the U.S., but if you’re experiencing pain that you believe is associated with stress, it’s time to get help — for both your brain and your body. The key is to manage daily habits to ensure this type of pain does not get out of hand. 

If you are experiencing pain that is impacting your daily life, our team can help. With extensive training in treating patients with chronic stress and anxiety disorders, we can get you back on track to feeling calm, relaxed, and healthy in no time. 

To find relief from your chronic pain, book a free consultation today!

Understanding Insurance

Understanding Insurance 1080 1080 ResilientRx

When searching for the right physical therapy clinic, many prospective patients will want to know whether or not that practice takes their insurance. 

In fact, it’s such a common question that we receive at ResilientRx, we thought we’d make this video to help you gain a better understanding of how the insurance process typically works with PT.

What is covered anyway?

In traditional, insurance-based PT clinics, also known as in-network clinics, there can often be limitations depending upon the specific carrier and plan a patient has.

For example, there may be certain situations where some services are not covered. You could receive additional bills long after you’ve completed physical therapy or only a certain number of visits authorized by the insurance company.

And when certain services aren’t covered, or visit counts are limited, there are many times when the physical therapist has to get on the phone with someone from the insurance company, to justify medical necessity for continued services. 

This takes precious time away from what matters most: caring for our patients.

Transparent Pricing 

Since ResilientRx is out of network with all insurance carriers, we have the ability to have transparent pricing. There are no surprise bills that you’d ever receive later on. 

And we have the freedom to work with our clients on their own time, without the insurance company placing restrictions on services or the number of visits.


Let’s talk briefly about deductibles. A deductible is a specific amount of money that the patient must pay before an insurance company will pay for a claim. 

If you have a high deductible plan, let’s say $5000, then you may be paying out-of-pocket anyway for each visit during your entire course of PT.

Let’s say your copay (the amount you owe every visit) is $50. 

In the traditional in-network model, you are often coming 2-3 times per week and spending $100-$150 weekly.

And we’d argue that if you are not seeing a physical therapist 1:1, your visits tend to be less efficient and it may take you longer to get better.

More Efficient care

Since we only offer 1:1 care with Doctors of Physical Therapy, we feel our visits tend to be more efficient. This means our clients come less often and get better faster.

Less expense in the long-run

Less time away from work or home

Better quality care.

What’s the main takeaway?

We work for YOU and not the insurance company.

We hope you found this video to be helpful in answering any questions you may have about insurance.

Feel free to reach out to us and we’ll be happy to walk you through this process and answer any questions you may have.

How We’re Different

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We’re ResilientRx- a physical therapy practice here in Austin Texas. We’ve helped hundreds of people just like you get back to doing what they love to do- while keeping them away from pain medication or surgery.

We’d like to take a moment to tell you how we’re different than your typical physical therapy practice. First, we need to take a look at how traditional PT clinics are run.

Traditional Physical Therapy

Traditional, “big box” physical therapy clinics that accept health insurance are very common in our healthcare system. Most clinics in the United States that accept insurance are designed to accommodate a high volume of patients, in order for the business to stay profitable.

The big reason these PT clinics need to see a high number of patients is because the amount that insurances reimburse these clinics for their services is often low and inconsistent.

So what tends to happen is your case is assigned to a physical therapist who can be double, triple, or quadruple booked.

They are managing multiple patients and other responsibilities all at once, which requires the use of Rehab assistance or technicians. 

Working with Rehab Assistance or Techs

Techs will spend anywhere from 30-40+ minutes with patients while the supervising physical therapist cycles through their patients for the hour, perhaps spending only 10-20 minutes with each of them.

Technicians are often high school educated with “on the job training” who hold no professional license or advanced clinical training.

Let’s think about that for a second…

The bulk of your direct care is in the hands of someone who is not a formally trained healthcare professional. Even under the watchful eye of the physical therapist in a busy clinic setting, is this something you feel you should be paying for and are comfortable with? We sure don’t think so.

Less direct care, more cost over time

What this system results in is that patients spend less time receiving direct skilled care, which usually means that more visits are required to get them feeling better and meeting their goals. 

And more visits means more cost to you in the long run, even if you have a copay.

Most patients will attend at a frequency of 2-3 times per week.

That’s 3 hours of PT per week, not counting the driving and waiting room times.

And even if you have a low-ish copay, that adds up quick.

How we’re different

Here’s where we are different: At ResilientRx, it’s just you and your Doctor of Physical Therapy. That’s it. 

No unskilled providers and no other patients sharing YOUR time.

The majority of our clients only attend PT once a week. Because you have one on one skilled care for a full hour, our treatments are more efficient and client-specific. 

You are making the effort to be here, investing your time and money to get better. Therefore we feel it is YOUR hour, not to be shared by anyone else, and to be fully customized to YOUR needs.

We offer high-quality, customized treatments and leave the filler stuff out

That means, no generic exercise sheets, no annoying egg timers going off telling you when it’s time to stop an exercise, and no more wasting time on things you can easily be doing at home. 

This may sound like a bad business model (trust us, it’s not)…but our goal is to work ourselves out of a job -to get you better as quickly as possible.

We make it easy too!

We will provide a structured plan for you, but also provide you the flexibility needed in scheduling. Life get’s hectic outside of physical therapy – we get it. We’ll meet you wherever you are at and come up with what works best for you!

Our goal is to provide you with the highest quality experience,  using a modern, evidence-based approach. 

Come experience for yourself, why we’re different.

The Benefits of Pilates

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Have you tried Pilates? It could be the perfect complement to your current workout regime, or the start of one. 

Pilates may be a bit intimidating, especially when you see the equipment available in most studios. But that doesn’t mean Pilates is out of reach for you —  it’s great for people of any fitness level! With the right instructor, you can actually see a number of benefits. But first…let’s clear something up: What exactly is Pilates? And why would you want to give it a try?

What is Pilates?

Founded by Joseph Pilates in the early 1900s, Pilates was originally created for dancers and athletes. Today, though, Pilates is for everyone! That’s because Pilates focuses on lengthening and stretching all major muscle groups, centered around the core then working outward. The exercises bring the body and mind together to improve flexibility and strength throughout the entire body. 

Benefits of Pilates

Pilates is both a therapeutic and preventative exercise, perfect for anyone who wants a great workout or who is looking to recover from an injury. It brings awareness back to the breath and body, while strengthening muscles, starting in smaller areas that “normal” workouts don’t necessarily hit. We also love Pilates because it can help you elongate your spine muscles and body as a whole, which can improve posture, reduce pain, strengthen muscles, and (of course!) improve mood. 

But let’s dig into all of the technical benefits of this amazing exercise method:

Flexibility and mobility

Flexibility is the amount of stretch in a muscle, whereas mobility is the range of motion in a joint. We strive for mobility in the body, but you must have a balance of flexibility and strength to really improve your mobility overall. The great news is that Pilates helps to address both. The slow, yet fluid and controlled movements in Pilates exercises combine both strength and stretching at the same time. Plus, it feels amazing!

Core strength

When you think of your core, most of us think about just our abs, but your core is so much more than that. The core muscles include the diaphragm, deep muscles of the back and abdominals, and pelvic the floor. They support a strong back, good posture, and every movement of the body. 

With its emphasis on the core, Pilates helps to improve core strength which then has a cascading impact on every other muscle in the body. Core strength has been shown to be vital in reducing back and hip pain, pelvic floor dysfunction, and supporting “explosive movements,” like running or jumping. 

Muscle tone

As you strengthen your core with Pilates work, you will notice its impact on other parts of your body, too. For example, lower back pain which can be reduced or relieved through Pilates workouts.

Of course, this also means that you’ll notice more definition in your muscles, from your arms and legs, to smaller muscles along your side, on your shoulders, and more. It’s not just about “ripped muscles,” though. With Pilates, improving overall muscle tone can make such a difference in your daily experience — creating a body that is stronger and more flexible, reducing overall pain and improving mobility.

Injury prevention and rehabilitation

Keeping the body well-balanced is crucial for all injury prevention. Pilates helps to balance the body’s muscles so they are supple and strong. For athletes specifically, research has shown that Pilates is effective for reducing sports injuries during play, as it focuses on dynamic strength that is necessary for quick movements. 

The movements in Pilates are also considered low-impact, thanks to equipment like the reformer and the cadillac, which absorb most of the weight of the body. This means that people with joint and muscle pain or past injuries can heal without additional irritation. What’s more: as your core and strength overall improves through practicing Pilates, increased stability in the body helps to protect joints while running, jumping, or simply doing activities of daily living. This makes Pilates the perfect addition to a physical therapy regimen.

At ResilentRx, we integrate Pilates into our practice with each and every client who comes to us for physical therapy. Our Pilates instructor, Amberly Jayde, has the unique opportunity to work with our clients, knowing their past injuries and history with PT, which helps her address their specific needs during Pilates sessions. 

Sleep and stress reduction

Quality sleep is something we talk about a lot at our practice, as it is a huge factor in preventing injury and helping the body recover. Practicing Pilates regularly has been shown to lead to better sleep along with helping reduce overall stress, taking you out of that “fight-or flight” feeling.  

While general exercise helps reduce stress as it increases endorphins, Pilates also utilizes breath control. Not only does breath work address stressful feelings in the moment, but it balances the body’s autonomic nervous system which reduces the development of anxiety or depression. By integrating breath work with movement, taking time to practice Pilates can really improve your overall mental wellbeing.

Let us help

Remember, everyone’s health journey is different, but Pilates can be beneficial for you — no matter your athletic ability or fitness level.

If you are having pain that limits you in your day to day life, reach out to us for support. Our team of PTs have extensive training that addresses anything from athletic injuries and pelvic floor dysfunction to knee and hip pain. Combined with our in-studio Pilates, you’ll find whole-body care and relief. Book a free phone consultation today!


Sleep and Athletic Performance

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Quality sleep is an important consideration when it comes to pain, injury and recovering after a workout. Research supports that individuals who get a bad night’s sleep (especially those with chronic sleep issues, insomnia, etc.) are more likely to have pain the subsequent day. In fact, two thirds of people with chronic pain suffer from sleep disturbances.

Sleep influences our pain experience and internal function.

Studies suggest that disturbances in sleep may hinder key physiological processes in the body that contribute to the development and maintenance of chronic pain, including your body’s ability to inhibit or regulate pain. A recent review showed the role poor sleep patterns can play in causing acute injury to transitioning into chronic pain in adolescents. Many of the substances in our bodies that help regulate our sleep-wake cycles such as serotonin also regulate pain signals (Andreucci, et. al, 2021). So if we constantly are in a depleted state due to lack of sleep, this can disrupt the balance of these processes in our bodies and therefore lead to persistent pain and inability to recover from an injury in a reasonable amount of time.

Poor sleep, especially over time, can also have negative impacts on things like cognitive function, emotions, immune function, energy conservation and synthesis, immune function, and cardiovascular health (Wei, et. al., 2019).

Injury Risk in the Athletic Population

Even for patients without chronic pain, the risk for overuse injury increases with lack of quality sleep. A recent 2020 study showed that less than 7 hours of sleep led to an increased injury risk in endurance athletes (Johnston, et. al., 2020). They found that there was a 2 week delay from the period of poor sleep to the time of the new injury!

Oliver, et. al. in 2009 found that for athletes with 30 hours of total sleep deprivation, they experienced a 2.9% decrease in running performance. Another study looked at 2 groups of endurance athletes performing a stationary cycle test to failure. One group had normal sleep and the other group was sleep-deprived. The athletes in the sleep-deprived group showed a 9% reduction in endurance (Temesi, et. al., 2013).

How about effects on weightlifting performance? One study showed that limited sleep to 3 hours per night for just 2 nights, reduced lifting performance in multiple upper and lower body exercises (Reilly & Piercy, 1994). Other important factors such as motor control, coordination, and athletic response time have also been shown to be negatively impacted due to lack of quality sleep, all of which can lead to injury (Mah, et. al., 2019).

The take-home message for the above examples is that with poor sleep not only are you at increased risk for injury, but your athletic performance will suffer.

Adequate sleep can increase athletic performance.

A great example of what consistently good sleep can do for you can be found in Stanford’s men’s basketball team. The players participated in a 2011 study by Mah, et. al. where they increased their sleep an average of 2 hours per night for 5-7 weeks, with the goal of getting about 10 hours of sleep per night. As a result, the team saw a 10% increase in sprint performance and 9% increase in 3-point and free-throw accuracy!

Helpful Sleep Tips
  1. Go to bed and wake up at the same times every day
  2. Go to bed and wake up at the same times every day
  3. Keep your bedroom dark and cool
  4. Limit screen time – no cell phone or TV 30-60 minutes prior to bed
  5. Keep caffeine intake to early in the day
  6. Meditation/mindfulness practices

If you are struggling with pain or an injury, physical therapy can help! We can evaluate your movement, strength, and function and come up with a plan to help get you out of pain and back to doing what you love!

Written by Nick DiSarro, PT, DPT, OCS

Sources: Wei, Y., Blanken T.F., Van Someren. Insomnia really hurts: Effect of a bad night’s sleep on pain increases with insomnia severity. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30210367/

Finan, P., Goodin, B., & Smith, M. (2013, December). The association of sleep and pain: An update and a path forward. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046588/

Johnston, R., Cahalan, R., Bonnett, L., Maguire, M., Glasgow, P., Madigan, S., . . . Comyns, T. (2019, November 01). General health complaints and sleep associated with new injury within an endurance sporting population: A prospective study. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1440244018308545

Oliver, S. J., Costa, R. J., Laing, S. J., Bilzon, J. L., & Walsh, N. P. (2009). One night of sleep deprivation decreases treadmill endurance performance. European journal of applied physiology, 107(2), 155-161.


Andreucci, A., Groenewald, C. B., Rathleff, M. S., & Palermo, T. M. (2021). The Role of Sleep in the Transition from Acute to Chronic Musculoskeletal Pain in Youth—A Narrative Review. Children, 8(3), 241.


Temesi, J., Arnal, P. J., Davranche, K., Bonnefoy, R., Levy, P., Verges, S., & Millet, G. Y. (2013). Does central fatigue explain reduced cycling after complete sleep deprivation. Med Sci Sports Exerc, 45(12), 2243-53. http://karen.davranche.free.fr/pub/Temesi,%20Arnal,%20Davranche_et_al_MSSE_2013.pdf

Reilly, T., & Piercy, M. (1994). The effect of partial sleep deprivation on weight-lifting performance. Ergonomics, 37(1), 107-115. https://pubmed.ncbi.nlm.nih.gov/8112265/

Mah, C. D., Sparks, A. J., Samaan, M. A., Souza, R. B., & Luke, A. (2019). Sleep restriction impairs maximal jump performance and joint coordination in elite athletes. Journal of sports sciences, 37(17), 1981-1988. https://pubmed.ncbi.nlm.nih.gov/31122131/

Mah, C. D., Mah, K. E., Kezirian, E. J., & Dement, W. C. (2011). The effects of sleep extension on the athletic performance of collegiate basketball players. Sleep, 34(7), 943-950. https://academic.oup.com/sleep/article/34/7/943/2596050?TB_iframe=true&width=370.8&height=658.8

Sleep for Rehab; YouTube video presentation by E3Rehab https://www.youtube.com/watch?v=OAaAnWB-3jY