Episode 1696 - Kipping during pregnancy

Dr. Jessica Gingerich // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Jessica Gingerich discusses the kipping pull-up as well as modifications to maintain kipping for pregnant athletes & reintroducing kipping sooner for postpartum athletes. 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. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION INTROHey everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PTI Nice Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app.switch. And if you decide to make the switch, don't forget to use the code ICEPT1MO at signup to receive a one-month free grace period on your new Jane account. JESSICA GINGERICH Good morning! Sorry for the late start. Welcome to the PT on Ice Daily Show. My name is Dr. Jessica Gingrich, and I am on faculty with the Pelvic Division here at ICE. My goal for today is going to be expanding on my last podcast that was about gymnastics during pregnancy, and really during the postpartum phase as well. So just a quick review of what defines gymnastics. It is a broad term that encompasses many movements and is utilized in many different sports like gymnastics, cheerleading, yoga, trampoline, and also CrossFit. So today I'm going to expand on the kipping pull-up rather than just a strict pull-up. WHAT IS KIPPING? Kipping is the act of using momentum to help drive certain movements. So we will see this on the rig, on the rings, and even during some handstand movements. So during pull-ups on the rig or the rings, kipping is using your lats and your core to drive into a hollow position, so that looks like a C, and then pulling into an arch position, which would be the opposite range of motion. This taxes the core through active muscle contraction, as well as putting the anterior core on a stretch. We often see coning and doming during the hollow or arch position as it stresses the anterior core during both movements. We see this during pregnancy and postpartum, but we also see this in other populations as well. Now, this is often communicated as something that is bad or dangerous, especially in the pregnant and postpartum women. And just remember, we want to help redefine that language as more of preparedness versus dangerous. Is your client prepared from a musculoskeletal standpoint to perform said movement. This is a less aggressive way of communicating. And remember, we don't want to induce fear around movement ever, but especially in this already vulnerable population of people. WHY IS CONING & DOMING WITH KIPPING SEENAS DANGEROUS? Now, let's unpack why coning and doming is seen as dangerous. So this was based on what we didn't know. a recommendation that came about because we didn't have research, so we erred on the side of caution, especially in the pregnant and postpartum world. We now know that coning is going to happen, and this is because of a mismanagement of pressure in that core canister. Mismanagement of pressure does not only happen in pregnancy and postpartum. It happens in all populations. We see coning and doming, and we use those words interchangeably by the way, in all populations like men, babies, and nulliparous women. That is just someone who has not given birth. Now, with this mismanagement of pressure, there are ways to optimize core recruitment to decrease objective coning or doming and increase co-contraction of the obliques, transverse abdominis, and rectus abdominis. However, you will see that many of your clients don't really care. They don't really take our advice on how to optimize their core. So will they hurt themselves? The short answer is no, they're not going to hurt themselves. Depending on overall core strength and preparedness of a particular task, they may be more susceptible to injury, but we're not scared of injury, right? We know how to rehab injury. What we don't want is to create fear around movement. So how do we negate this? ELIMINATE FEAR AROUND KIPPING So first and foremost, we eliminate fear. So, this can be difficult as mom, grandma, a random dude at the gym, friends, and really most commonly what we are starting to see now with Instagram is the fitness influencer that doesn't know the research. Telling your client that they shouldn't do certain movements. We train their core before, during, and after pregnancy. This includes more than just dead bugs, bird dogs, supine TA contractions, et cetera. Furthermore, we show them modifications in the gym to keep them on the rig and closely mimicking the stimulus of the workout when it comes to kipping pull-ups. The biggest point to make is your client maintains points of performance. This could be during any core movement, but specifically, kipping pull-ups is going to be, are they able to maintain the hollow position? If they are able to maintain that, then we let them go. Do your kipping pull-ups, whether you're coning or you're not. So the points of performance are going to be scapular depression and opposed to your pelvic tilt or that hollow position. This can be maintained. Can this be maintained throughout the pole? If they cannot maintain that, A, they're not going to hurt themselves if they continue. However, if you are educating around core optimizing strategies, then we modify. Modifications can look like feet supported kipping pull-ups, so that could be on the ground with a rack chin or with a box. Single foot supported kipping pull-ups, same thing, most of the time is done on a box so that other leg can hang off the box. Or they can further regress to feet supported strict pull-ups, known as the rack chin. There is always an option to decrease reps or rounds while we are choosing to modify that mimics the stimulus as well. When we choose a foot supported option, we are maintaining the kipping movement throughout a period of time rather than eliminating it. So we are saying, try this to maintain your pulling strength rather than eliminating it completely. This way they have more time or I guess less time between when they come off the rig during pregnancy and get back to it in that postpartum time. So to recap, change your language in the clinic, deal hope not fear. Bring attention to social media and how really we can't trust everything that we see and this may be showing your clients who to unfollow or who to mute in real time in the clinic. You should do the same thing for yourself and also report misinformation. So just like your client is going to be influenced by things that they see, so will you. The human body is resilient, and it does not stop being resilient once they become pregnant. Help your clients understand that. They will move with less fear, and they will come to you if they're unsure, or if they're having pain or symptoms. And so therefore, you're gonna be keeping them in the gym. And we want that, right? We want them to come to someone who is gonna encourage exercise throughout the lifespan, and that includes pregnancy and postpartum. Use modifications as necessary or if your client wants to. Remember that it may not be, they may want to use a modification because they feel better doing it. That's okay as well. Train their core in all positions and all ranges and prepare them for what life is. Prepare them for beyond what life is going to throw at them. Now, as always, we're gonna end with some courses. So if you head over to PTOnIce.com to check out our upcoming courses. In our live course, we dive into pull-ups, we dive into rig work and gymnastics. So if this is something that you wanna better your skills at, head over to PTOnIce.com to sign up. I hope you guys enjoy the rest of your week and I will see you next time. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. 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