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/


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


Keeping motherhood real – Let’s talk about Postnatal Depression

Friday, November 17 2017

Life is busier and we are more ‘connected’ than ever. Who would think that a mum or dad could feel so lonely, anxious or depressed after giving birth to their bundle of joy? The truth is parenting is hard, and feelings of Perinatal Anxiety and Depression such as sadness, guilt, hopelessness and difficulty bonding with your baby are incredibly common. 1 in 7 new mothers and 1 in 10 new fathers are diagnosed with Postnatal Depression, so you should not feel alone with statistics like this.

Becoming a parent is a big deal and whether it was a long, difficult road or a big surprise, it’s a life-changing journey for all parents and one of the toughest jobs you will ever take on.

When preparing for parenthood it’s usually the physical stuff we focus on; is my baby measuring in the healthy range? Which is the right pram for us? Is our car seat fitted correctly? However, it’s important to spend time preparing yourself mentally for the big changes that are occurring. Knowledge is power and through increasing your awareness you can develop skills to help reduce the overwhelming feelings of anxiety and depression postpartum.

At Women In Focus we have fallen in love with an awesome app called ‘What Were We Thinking!’ It is not just for expecting and new parents, but also for those supporting a new parent and/or healthcare professionals.


Navigating your way through the app you will find an endless amount of tailored information from the birth up to six months postpartum, workshops, quizzes, journal writing, practical activities and videos from health professionals. Importantly it also gives you quick access to support helplines in your region of Australia.

For further information visit:

Another initiative we love is ‘Ready to COPE’. It is a free and simple way to help you look after your emotional and mental health. It helps prepare women for the emotional journey of pregnancy and new motherhood with supportive emails and information.

At WIF we are dedicated to helping women with the physical challenges that come with becoming a mother. But almost every one of our clients faces emotional challenges during this time as well. It’s important to remember that being healthy, especially during pregnancy and early motherhood, requires you to look after both your physical AND your mental wellbeing.

For further information visit:

If you or someone you know are showing signs of postnatal depression, please see your GP or a psychologist for professional help, there is support waiting for you.

You can learn more at:
panda.org.au – 1300 726 306
beyondblue.org.au – 1300 22 4636

We wish you the all the best on your journey to becoming a confident parent.

Karen Crudden of WIF Physiotherapy
Women’s Health Physiotherapist

The Two-Second Health Check All New Mums Should Take

Thursday, October 05 2017

We spoke to PopSugar this week about abdominal muscle separation and why so many mums are getting it wrong. It’s about moving away from the ‘closing the gap’ approach and looking at the whole body. There is WAY more to an abdominal separation than measuring how many fingers width. The sooner women understand this, the more likely they can get rid of, or at least improve the ‘mum-tum’. We have great research that shows the importance of focusing on generating tension at the linea alba not about reducing the gap, and women need to know this. It’s a short article, you can read it here now.



Looking after those precious pelvic floors in pregnancy, birth and beyond…

Monday, August 21 2017

Recently Lyz Evans, our Practice Principal and Founder of Women in Focus Physiotherapy, chatted with Nadine Richards from She Births about exactly what the pelvic floor is, how it is affected by birth, and why it is so important that women look after it in the child bearing years. Lyz explains if women learn to connect with their pelvic floor prior to birth it can not only assist during labor, but also prevent ongoing issues such as incontinence in the long term.

A MUST read for any of you that are currently or planning to get pregnant, have already had children or simply are just keen to learn more about your your own pelvic health. Ladies, you only get one pelvic floor so lets spread the word on why we need to look after it.

For those ladies currently pregnant, make sure you also check out the She Births program, a scientifically verified birth preparation course that will ensure both you and your partner feel informed, supported and empowered leading into your birth. Check out their courses here or head over to their birth focused blog.

Pelvic Floor

At She Births we recommend for women to have a pelvic floor assessment prior to birth – can you explain why this is so important? How can a women’s health physio prepare you for birth?

It is wonderful that She births educates its women on the importance of the pelvic floor, as for the majority of women it is not until the child bearing years that they have even heard of the pelvic floor, let alone given it much attention. To understand why it is so important to have it checked prior to birth, first we need to understand what it is and what it actually does…

The pelvic floor is an intricate web of muscles, fascia and ligaments sitting deep within the pelvis spanning the base from the tailbone to the pubic bone. It is actually made up of 8-9 individual muscles that join together with the fascia to close off the pelvic outlet, hence creating the ‘floor’ of the pelvis. Although a relatively small muscle that is hidden from view, its importance should not be underestimated as it has some of the most critical functions in the entire body including:

• Keeping closure around the bladder to prevent urinary leaking

• Keeping closure around the rectum to prevent bowel leakage

• Providing a support system to the uterus, bladder and bowel to prevent downward descent (Pelvic Organ Prolapse)

• Provide sensation and tone required for enjoyable pain free sexual intercourse

• Provide the muscle activation to facilitate an orgasm

• Work with the deep abdominals and ‘core’ to assist with stability of the spine, hips, pelvis and rib cage

• Works with our diaphragm to ensure optimal breathing patterns

• Being able to open and fully relax at times when exiting from the pelvis is required such as when urinating, opening the bowels and of course birthing a baby!

Historically the focus for the pelvic floor has always been based around strengthening, however in recent years year’s we have realized that just like any other muscle in the body the pelvic floor has the potential to a become excessively tight (hypertonic) and this can become incredibly problematic for some women. Clinically, we are now seeing an increase in the number of women presenting with hypertonic pelvic floors and the reasons for this seem to be multifactorial in nature mainly based around lifestyle and behavior choices choices. Factors such as high level participation in exercise such as Pilates, pole dancing and weight lifting can encourage over activation of the pelvic floor, and constipation from poor dietary choices can lead to chronic straining and a pelvic floor that is always in spasm. The impact of today’s fast paced lifestyle has also lead to a pelvic floor that is constantly ‘switched on’ as a result of a lack of relaxation, diaphragmatic breathing and high anxiety and stress levels.

During birth the requirement of the pelvic floor is incredible as it needs to stretch beyond 3 times its normal length, can you imagine if you had to stretch your hamstring 3 times its normal length? It would end up at a 90 degree angle behind your head, not possible! The pelvic floor truly a remarkable piece of anatomical engineering, however in order for this impressive stretch to occur the muscle needs to have good flexibility and be able to completely relax during the crowning phase in birth. If a woman has a hypertonic pelvic floor that cannot fully relax or stretch then you can imagine how this has the potential to impact or prevent achieving a normal vaginal delivery.

One of the main reasons we encourage women to have their pelvic floor checked in pregnancy, is so that we can help determine what type of pelvic floor they have, and therefore how we can best help them. If a woman has a weak pelvic floor then a specific strengthening program will be given so that the pelvic floor can continue to support the bladder, bowel and uterus throughout the pregnancy and in the post natal period.

If a women however has a hypertonic pelvic floor, then we will work with her to restore optimal breathing patterns, work manually through the vagina and pelvis to help release overly tight muscles to ‘ down training ‘ and help restore normal mobility and length required for birth. This can be incredibly empowering and life changing for a woman who has always held tension in her pelvic floor.

Regardless of what type of pelvic floor a woman has once in the final stages of pregnancy, a Women’s Health Physio can work with her to teach her how to achieve full relaxation of the pelvic floor to achieve opening of the pelvic outlet rather than closure, which is what is required in birth.

We also recommend that women have one assessment with a Chiro or Osteo prior to birth – How is physiotherapy different from Chiropractics and Osteopathy?

Chiros, Osteos and Physios all have very different training so approach the body in differing ways, in many cases we can work harmoniously together to help women achieve optimal outcomes.

The main difference when seeing a specifically trained women’s health Physiotherapist is that we will do an internal check of the muscles, ligaments and organs within the vagina to check their tone and function and how this may impact the rest of the pregnancy and upcoming birth. We also utilize sophisticated real time ultrasound equipment that provides women with a visual of how their abdominals and the pelvic floor function, a wonderful way for us to educate and teach women.

Specifically trained Physios will undertake a thorough inside – outside ‘Pelvic Health Check’ for a pregnant woman. This will usually include:

• Checking the alignment and stability of the pelvis and hips to ensure it is has symmetrical mobility required to minimise any pelvic girdle pain in pregnancy but also to prevent restriction of pelvic opening required during birth.

• Assessment of the abdominal wall, rib cage and breathing patterns to address achieve optimal abdominal support and prevent excessive loads whilst the abdominal anatomy is so dramatically altered.

• Internal assessment of the pelvic floor muscles via a vaginal exam (After 12-18 weeks gestation)

• Use of real time ultrasound on the pelvic floor and abdominal muscles for feedback on activation – a wonderful teaching tool for women.

• Education on what that individual woman needs to do to optimise her pelvic floor and pelvic health for the pregnancy, birth and postnatal period.

• Prescription of a home exercise program to encourage pelvic floor and abdominal strength or relaxation.

• Discuss regular exercises habits and what is suitable for the individual.


After birth, what happens to your pelvic floor? How can you strengthen it?

A vaginal birth is essentially the biggest load that your pelvic floor will EVER have placed on it, and studies show an average of 25 – 35% reduction in Pelvic floor strength following birth. We also know that in 80% of women the nerve the innervates the pelvic floor (the pudendal nerve) is bruised and some times partially damaged from the birth so the messages it sends to achieve activation of the pelvic floor occurs much much slower.

As a result greater than 50% of women will experience urinary or bowel leaking in the first few weeks and months following birth, so don’t be alarmed if this occurs. If the birth was slightly more complicated requiring an episiotomy, forceps, venous, long second stage, or a very large baby then these women are often more likely to feel the impact to the pelvic floor in the months following birth.

The good news is for the majority of women if a specific pelvic floor program is performed daily then good pelvic floor strength and control will return. In the early days, Women should reconnect with the pelvic floor on the post natal ward as this is an essential part of encouraging the pudendal nerve to regenerate and the muscles to reactivate. Starting by activating and holding gently for 1 second and repeating 5 -10 of these a few times a day is enough to get started. Timing this at that same time as feeding baby is a great way to remember to do them.

Once this becomes easy then the endurance and hold time should be increased. The term ‘ use it or lose it’ definitely applies to the pelvic floor, and if you want it to be with you and support you through life then you need to give it a little love and TLC in its time of need!

How do you know if you’re doing pelvic floor exercises correctly?

Unfortunately the answer to this question really is that you need to have it checked by a Women’s Health Physiotherapist to be 100% sure you are doing it correctly. Even the ultrasound cant 100% confirm a correct activation and breathing patterns will come into play.
We know from research that when the general population are given instructions on how to do a pelvic floor activation that greater than 50% will do it incorrectly, of which 25% were found to be actually bearing down rather than lifting up (Eeek!) If a woman doesn’t have access to a Women’s Health Physiotherapist and wants to check herself the best way would be to insert a clean finger into the vagina, and when activating the pelvic floor she should feel a tightening and a ‘suck’ up of the finger inwards and upwards. She should be able to breathe and hold for 10 seconds without the finger being pushed out.

My advice to women is to be proactive in their childbearing years is to find yourself a good Women’s health Physiotherapist and be sure to see them at least once in pregnancy and then again at 6 weeks post natal. These appointments will potentially save your pelvic floor in the long term.

It really bugs me that women are not routinely sent for pelvic floor rehabilitation following a birth, if you were to undergo surgery for a hamstring tear you would 100% be sent by the surgeon to a Physio for months of post operative rehabilitation, why does this not happen for the pelvic floor?! ?We have a long way to go in Australia and I would love us to look towards France whose government provides 6 -8 sessions of routine government funded pelvic floor Physiotherapy to help restore function post birth. Go France! Perhaps one day we will get there, but for now we either need to move to Paris or be proactive with our pelvic floors.

After all you only get one of them so please make sure you look after it!

Read the full blog post via She Births here.

An interesting read on the wave of new generation pelvic floor treatments

Friday, November 18 2016


Click on the link below for an interesting read from the November issue of ELLE magazine on the wave of new generation pelvic floor treatments, quoting our practice principal Lyz Evans:

Elle Magazine – The Way, Way Down

It certainly is an exciting time with new treatments for the pelvic floor such a laser for ‘pelvic floor tightening’  coming into the mix, at WIF we are hopeful that these new treatments may have a role to play in SOME pelvic floor conditions such as stress urinary incontinence. Trials for the laser are still being undertaken in Australia, so for the meantime we need to keep with the ‘traditional approach’ of pelvic floor muscles strengthening and watch this space for outcomes of clinical trials. If you find Pelvic floor exercises just that bit too ‘ traditional’ then why not mix it up a little with pelvic floor weights or funky blue tooth devices?! Have a chat to our pelvic floor Physio’s next time you are in the clinic to learn more. :)

Jogging 3 weeks post birth?! Please don’t.

Friday, January 15 2016

To mums out there who have seen Michelle Bridges recent post about the exercise she is doing at 3 weeks post natal, then you would be right in feeling confused by her recommendations.

It boasts about her 56 min interval work out, which is comprised of 32mins of jogging and 24 minutes of walking. She goes on to say “Remember! I’m a professional trainer & have been training for 30yrs. So! For you please dial this down to 15 – 20 mins of total work.”

Michelle recommends you reduce the length of her workout, however has failed to identify that the real issue is not the length rather the type of exercise: Jogging!




The reduced 20 minute workout would still include 12 minutes of jogging, which for a woman who has just had a vaginal birth or cesarean delivery is quite simply irresponsible, and would NOT be recommended by an experienced health professional.

If an individual decides to jog soon after giving birth, this is their choice. However as a public figure encouraging women who’s body types, birth and fitness histories are unknown, to start jogging is quite frankly concerning. It could potentially cause a woman more harm than good in these early stages, especially to the pelvic floor and the ligaments that support the bladder, uterus and bowel

After seeing this post on Tuesday, and letting it sit with me for a few days, I have become increasingly frustrated by the incorrect message that are promoted by the fitness industry especially for women in their childbearing years. As a health professional working in Women’s Health for over a decade, there is a duty of care to provide women with the correct information on how to best look after their bodies. I cannot tell you how many times I’ve heard comments like “If only I knew about the damage returning to exercise too early could cause. I might not have ended up with these problems.”

As I’ve noted in the past, I’m a great supporter of Michelle and the work she does in building healthier communities throughout Australia. But now what I’d love to see is Michelle using this time as opportunity to promote a positive post-natal message to her audience. Like rebuilding of the pelvic floor, deep abdominals and postural muscles that are so dramatically weakened during pregnancy. Or instead of jogging, encouraging more appropriate low impact cardio options such as the stationary bike or cross trainer.


So what exactly is wrong with jogging at 3 weeks post-natal?

Jogging is an exercise that results in a high impact force called a ground reaction force that travels through the body when the foot strikes the ground. This impact requires strength and stability from the joints, ligaments and muscles in the body to maintain good control, preventing injury and tissue damage.

In the post-natal body the ligaments and muscles have a reduced ability to generate strength due to the physical and hormonal changes of pregnancy and birth. These changes coupled with the downward force of gravity with vertical exercise such as jogging or jumping means that if undertaking high impact exercise, then excessive strain is being placed on already weakened structures including the pelvic floor and pelvic girdle, potentially causing a new mum long term damage.


Pelvic Floor Diagram


So what exercise can you do safely?

The most important thing to remember is that all women have different body types, have had different birth’s and have different levels of fitness leading into the pregnancy, so returning to exercise at the right intensity is individual. Start with low impact exercise such as pelvic floor exercises, pilates, yoga, stationary bike, cross trainer, and swimming (after your 6 week check) and build gradually from there.

If you are a runner or keen to return to more high impact exercise, then I highly recommend you see a Women’s Health Physiotherapist from 6 weeks who will assess your pelvic floor, postural alignment and abdominal muscles to ascertain the right exercise for you. Then to keep motivation up, find an experienced trainer or fitness group who specialises in the post-natal body who can guide you in your safe return to full fitness.

Ladies, remember you only get one body and one pelvic floor, which has been gifted to you to enable the growth of your special little human. So please, show it some respect and look after it.

We’ve all heard of Pilates but I think the biggest question that comes up is; What’s the difference between mat and equipment Pilates?

Wednesday, August 07 2013

I think the best way to answer this is by going back to the origins of Pilates.

The term Pilates is actually named after Joseph H Pilates who was born in Germany in 1883. A sickly childhood led Pilates to pioneer his unique training system, with which he hoped to rid all of his students of physical limitations. He spent time in a camp hospital during World War 1 where he worked with patients to employ the springs in the hospital beds to create rehabilitation equipment.

Pilates migrated to the United States in 1925. His studio just happened to be housed in the same building as a number of dance studios. Naturally the dancers flocked to learn the method and they were soon followed by many devotees. But Pilates had the intention that his unique system of physical conditioning, originally known as Contrology, was to be practiced by everyone.

Pilates is uniquely adaptable and the moves in the method were created to address total fitness. Each exercise has a strength component as well as a flexibility component.
In its first incarnation Pilates consisted of floor exercises. Experimentation with springs and equipment followed.
The resistance created by the pulley and spring system can provide a more challenging strength and endurance workout than mat classes.

It may also provide visible results sooner; arm, leg and abdominal muscles can look more toned after a dozen or so regular sessions . The flexibility of equipment and the many attachments of the Pilates apparatus increase the range of modifications that can be made to the exercises and allow additional exercises beyond what can be offered on the mat. This combined with the support afforded by the resistance the machine provides allows people with limited range of motion or injuries to safely perform modified exercises.

I personally practice both mat and equipment Pilates and love the variety of exercises and the challenge and control required to work against the springs of the equipment.
The best way to know which form of Pilates is right for you is to give both a go and then see.

I look forward to seeing you in the studio!

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