Archive for September, 2018

EARLY POST NATAL ADVISE

Wednesday, September 19 2018

1. In what ways is the pelvic floor affected during pregnancy? 
Your pelvic floor consists of superficial and deep muscles, which give upward support to your pelvic organs (bladder, uterus and bowel) and assist with urinary and faecal continence. The less talked about fascia and ligaments (which I describe as elastic bands) connect your pelvic organs to the walls of the pelvis, keeping the organs in their normal position….phew! The effect of pregnancy on the structure and function of the pelvic floor is still largely unknown despite advances in obstetric care. What we do know, is during pregnancy hormones can lead to a lengthening of the muscles, fascia and ligaments challenging the normal day to day functioning of the pelvic floor, which is why symptoms of urinary leaking is a common symptom in some pregnancies. Other factors such as advancing age, BMI, strenuous physical exercise and smoking history have also been linked to urinary incontinence in pregnancy, which is an even greater reason to stay healthy and exercise correctly during pregnancy.

 

2. How can your pelvic floor be damaged during birth?
During a vaginal birth, the pelvic floor lengthens to allow the baby to pass through this muscular structure out into our world. The majority of the time it is smooth sailing, however, in some cases, the muscles and ligaments don’t cope as well and can be thinned, torn or pull off the bone to which they attach (avulsion). Nerve injury and vascular changes also occur during birth due to the pressure of the baby moving through the birth canal, and postpartum these can also contribute to slow and sluggish pelvic floor muscles, often resulting in urinary and faecal incontinence whilst the muscle recover. A vaginal birth can also increase the risk of fascia damage, known as pelvic organ prolapse (POP) which is the descent of one or more of the pelvic organs, with heaviness in the vagina being the usual symptom that is experienced. Prevalence of POP can be up to 50% after vaginal delivery, however, only 10-20% of that is shown to be symptomatic.

The majority of women are fine post-birth, however, we do know that factors that increase pelvic floor trauma include; forceps birth, increased head circumference, long pushing phase, 3rd or 4tn degree tears and episiotomy. I absolutely recommend that all women get themselves to a Women’s Health Physio at around 6 weeks post birth, but for any women with these at risk factors, it needs to be a priority. Trust me, your vagina will be very thankful

 

3. How soon after birth can you start doing pelvic floor exercises? 
Day zero… After cuddles and tears of course!
Now I don’t mean going all Arnold Schwarzenegger on those muscles remember you have just pushed out a baby out, so let’s show some TLC to that region as well. Your pelvic floor normally does this amazing thing, that when you sneeze or cough it responds by contracting to stop you leaking, unfortunately, this response can be altered by childbirth. Therefore doing a pre-contraction of your pelvic floor prior activities of increased abdominal pressure – cough, sneeze, sit to stand, or lifting your big ball squidyness, can help to give support to your organs and retrain the reflex. There can commonly be swelling and bruising to the vagina region early after vaginal delivery, therefore performing gentle pelvic floor contractions/relaxations can help improve blood flow and encourage healing. Remember don’t overdo it, especially if you have stitches, we want to encourage recovery, we are not training for the vagina weightlifting championships… just yet!

 

4. When should you start to incorporate core exercises after birth?
The short answer is, as soon as you are able to.
A great way to start is by incorporating gentle core activation into your daily movements whilst moving around the hospital room or home in the week post birth. . Your pelvic floor forms an integral part of your core, therefore from day one if you can start the pre-contraction I discussed above then this is a great simple and functional way to start. Incorporating good posture will also encourage better activation of your core muscles which can help prevent back issues in those early days, help you adopt good movement patterns whilst your body adapts to your new activities of being a mum and training you out of the pregnant posture you had for 9 – 10 months.

An assessment with a women’s health physiotherapist will guide you further on specific core exercises and timeframes for YOUR recovery after birth.

 

5. What pelvic floor + core exercises do you recommend in the first 6 weeks? 
You may be told in hospital to hold your pelvic floor contraction for how many weeks you are postpartum which is a really great starting point. However, what most people don’t realise is that your squeeze and lift is only as good as your relaxation, so thinking of the ‘let go’ as much as the ‘close lift’ will help women to really make good progress with their pelvic floor strengthening. Sometimes caring for your bub in those first 6 weeks is all the core exercises your body needs, so by ensuring you activate your pelvic floor and deep abdominals during movements such as getting in and out of bed at night, or lifting bub then the great news is you have started your core exercises. Woo hoo!

One thing I would like to mention is the sexual pain after childbirth, 64.3% of women reported this in the first year following childbirth, and this should NOT be your new normal ladies. Contributing factors can be hormonal, muscle tightness or psychosocial. Doing lots of pelvic floor strengthening can make symptoms worse. Therefore, the importance of a vaginal examination and management is vital and is something we help women with every day.

 

6. How do posture and breath affect our pelvic floor?
They play a big role in optimising pelvic floor muscle activation. Poor posture can potentially increase symptoms of pelvic organ prolapse and affect how efficiently you contract your pelvic floor muscles. Correct breathing dynamics (diaphragmatic breathing) can assist with normal pelvic floor movement during activities, were upper chest breathing could possibly promote a tighter pelvic floor, or bearing down with exercises can increase pelvic floor muscle weakness and prolapse.

Good posture and breathing dynamics are also vital for passing a bowel motion…who knew!. One of my favourite tools is the squatty potty, and I would encourage all women to check out their website to learn how to poo like a pro (Visit www.squattypotty.com)

 

7. When should you see a Women’s Health Physio after birth?
We advise all women to see a women’s health physiotherapist after birth regardless of delivery (c-section or vaginal), we recommend any time after 6 weeks, mainly because there is a lot of healing that occurs in those first 6 weeks, and you will often have had the medical clearance that stitches etc… are recovering well. Often ladies are thinking about getting back into some form of exercise around this time as well, therefore assessing the pelvic floor, stomach muscles and overall body mechanics allows us to confidently prescribe appropriate exercise, as it’s not a one fits all approach. Some ladies on Instagram might be running at 6 weeks, do what is recommended for your body, not what others are doing. We can put a plan in place to get you back running or doing high impact exercise at the right time for your body if it is a goal you would like to achieve.

 

8. What tools or resources can women use to strengthen their pelvic floor after birth? 
There are so many on the market it can get quite confusing…from machines that zap your pelvic floor muscles to vaginal weights…could you challenge the record holder and lift a whopping 13 kg!? Now that’s extreme!

Your classic pelvic floor exercises ‘kegels’ have got the best research for urinary incontinence and prolapse, and an intensive physiotherapist lead program is shown to be the most successful. There are also many great apps on the market which can help with compliance, I love the NHS Squeezy one, as you can adjust it to your specific program prescribed by the physiotherapist. Sometimes electrical stimulation guided by a physio is needed when the muscles are very sleepy; this requires a probe being inserted into the vagina, which contracts your muscles, whilst getting you to contract to waken them up.

Incorporating your pelvic floor exercises into your regular exercise class is a great strategy for those who find traditional Kegels too much like a chore. Participating in postnatal specific exercise classes, run by a qualified and experienced instructor like the ones offered at Women in Focus Physiotherapy in Bondi are a great way to improve pelvic floor strength, stomach separations and keep that pesky back pain at rest.

If you can’t make it into Women in Focus, then make sure you seek out your local women’s health physiotherapist to help assist you with a recovery program and advise that is specific to your body.

By Karen Crudden
Women’s Health and Musculoskeletal Physiotherapist & Pilates Practitioner

Keep Your Bones Happy & Healthy

Fast facts – did you know?
• Osteoporosis is estimated to affect 200 million women worldwide.
• 2.2 million Australians are affected by osteoporosis, it especially affects post-menopausal women, who have lost the bone protectiveness of oestrogen.
• In Australia, the lifetime risk of osteoporotic fracture after the age of 50 is 42% in women and 27% in men.
• One in five women do not receive an osteoporosis diagnosis until after three or more bones have been fractured
• After first experiencing a fracture, one in eight of those affected by Osteoporosis will go on to break another bone within a year.
• Bone and muscle mass reduces in post-menopausal women, mostly due to the reduction in oestrogen. The more bone and muscles strength you can have pre-menopause the better.
So Ladies keep up that weight-bearing, strength-based exercise.

Not all exercise is bone strengthening or bone protective. Swimming and cycling are great cardiovascular exercises but are non-weight bearing so they don’t help build bone strength. Gentle walking, while a nice exercise, is also not going to have much impact on your bones.

The good news is weight-bearing exercise builds bone strength. Bones respond better to exercise such as:
weight-bearing impact exercises – brisk walking, hiking, stair climbing, tennis, jogging, netball and aerobic dance.
resistance training – exercises using weights and bands, machine weights or hand weights.

Bones also like:
• Short, high-intensity bursts of exercise rather than long, slower, low impact sessions of exercise
• When the exercise gets progressively harder
• Variety in exercise routines
• Lifting heavier weights rather than lifting light weights (though you can build this up over time)
• Balance training – standing on one leg, sitting on an exercise ball, walking on uneven surface, tai-chi and yoga

Be mindful of your pelvic floor health when you exercise, ensure you breathe properly, activate your Pelvic floor muscles and exhale as you lift weights or stand up from a squat. Discuss which are the suitable exercises for you with your WH physiotherapist.

In older or elderly women weight-bearing exercise strengthens muscle, helps maintain and improve bone density, improves balance and coordination, all of which helps to prevent falls. The most common site for osteoporotic fractures is the spine, hips, wrists and shoulders so choosing exercises that load and use these parts of your body is vital. Strong Pelvic and gluteal muscles are particularly protective for hip fractures.

On average 30 minutes of bone-building exercise 3-4 times a week can help build bone strength. A great place to start is the Sassy 60’s class at WIF on Mondays with Clare, 50% off your first class.

Diet and good nutrition are vital for good bone health, calcium is important, as is vitamin D to help absorption, Vit K and magnesium. Dairy products are a good source of calcium as is salmon (especially canned – includes the bones), other oily fish, nuts, green leafy vegetables. Also important are foods containing Omega 3, such as oily fish, chia seeds, flaxseeds, nuts. We can absorb great Vitamin D levels from the sun, so a little sunshine on your skin every day is good for your bones.

Most important for your bone health, enjoy your exercise & move regularly, stomp your feet, use some weights, keep your muscles strong, stand tall, breathe well, smile & eat wholesome food.

For more information have a look at the Osteoporosis Australia website https://www.osteoporosis.org.au/exercise
You may want to try their ‘Bone Health Assessment Tool’ https://www.knowyourbones.org.au/

DRY NEEDLING

What is Dry Needling?
Dry needling is a treatment technique which involves inserting fine needles into altered or dysfunctional tissues to stimulate a healing response and restore function.

How does it work?
Often this involves dry needling of trigger points, what we commonly refer to as ‘knots,’ those hard and taut bands you may feel within a muscle. Muscles with trigger points may ‘appear’ weak, they may be associated with a constant dull ache or pain, have reduced the range of motion or be sensitive to stretch. By dry needling these trigger points, it essentially “resets” the muscle, allowing restoration of normal function and strength.

What causes trigger points?
Trigger points will often occur because of poor posture, muscular strain, overuse, fatigue, poor or incorrect movement patterns, emotional stress or altered breathing patterns.

What will I feel?
When the dry needle releases a trigger point, a muscle twitch response often occurs, and you will feel a sharp cramping sensation just momentarily followed by an immediate improvement in pain, the range of motion and function.

If you are keen to see if dry needling may be helpful for your body book an appointment with one of our dry needling queens, Hayley, Clare or Sarah.

Exercise during pregnancy

It’s time to get those bumps looking good for summer! but more importantly, keep you and bub super healthy throughout your pregnancy and beyond.

 

During pregnancy, our body gradually changes due to the increase in hormones. Therefore, keeping strong, flexible and maintaining or improving overall fitness is very important for your body to manage these changes.

Why should I exercise?

Benefits for mothers:

• Improves physical fitness and mood with long-term benefits
• Aids weight management during and after the baby is born
• Reduces risk of gestational diabetes, pre-eclampsia
• Decrease caesarean and operative vaginal delivery
• Better labours (reduced pushing phase) and recovery time
• Can help to relieve low back/pelvic girdle pain
• Manage stomach separation
• Relieve constipation… You can thank me later

Benefits for bub:

• Boosts brain health
• Reduced chances of diabetes and lower BMI

 

How often should I exercise?

This depends greatly on your starting point. The ACOG guidelines state ‘an exercise program that leads to an eventual goal of moderate-intensity exercise for at least 20-30 mins per day on most if not all days of the week’. If you have just started to exercise in pregnancy, we would advise you gradually build up to this over a period of time.

We encourage women to get into some type of exercise during pregnancy, even if they have never exercised prior pregnancy. Yes, you read that correct! you can start to exercise during pregnancy even if you have never exercised prior, under the guidance of a women’s health physiotherapist. If you have been exercising prior pregnancy, we do advise seeing a women’s health physiotherapist go through a thorough evaluation of your current program to make sure it is appropriate.

 

What’s the best exercise?

There isn’t a one fits all approach. Find an exercise that has a strength, flexibility and aerobic component, something that will compliment your body type, you find fun and convenient for you. Some great forms of exercise when pregnant are:

• Women in Focus Pregnancy Pilates classes
• Swimming/aqua aerobics
• Brisk walking
• Pregnancy yoga
• Stationary bike riding
• Strength-based gym classes

“You haven’t mentioned running or other high impact exercises”, is what you’re thinking….You can continue with high impact sport if you were doing it regularly prior pregnancy, however, I believe pregnancy is such a short period in a women’s lifetime, that staying off the high impact exercises and trying different forms of pelvic floor safe exercises, to decrease the risk of incontinence and prolapse… what’s a what?… prolapse?… that’s another blog!

At Women in Focus, we offer pregnancy Pilates classes. They are a great way to strengthen your body, prevent or reduce rectus abdominal diastasis, to prepare you for late-stage pregnancy, birth and being a mum… ekkkkk… The classes utilise a combination of Pilates and functional strengthening exercises, specifically designed to target the pelvic floor, deep abdominals, back and buttock muscles.

There are however a few exercises which you should avoid:

• Hot yoga or hot pilates
• Skydiving/ or activities performed over 6,000 feet
• Scuba diving
• Activities with a high risk of falling or getting hit in the stomach – surfing, gymnastics, off-road cycling, water skiing, skiing or horseback riding, netball, boxing, soccer, basketball, contact sports

I recommend asking your G.P, midwife or obstetrician on your next review, ‘do I have any medical issues, that would affect me participating in exercise?”, as there a small population where exercise is not advised.

Please read the American College of Obstetricians and Gynaecologists (ACOG) website for a more comprehensive guide on exercise during pregnancy: http://www.acog.org/Patients/FAQs/Exercise-During-Pregnancy

Let’s get moving ladies so that shaving your legs, getting out of bed and managing that trolley which has a mind of its own continues to stay easy.

Karen Crudden
Women’s Health Physiotherapist and Pilates Practitioner