Women’s Health Physiotherapy and Pilates

It is not commonly known that Physiotherapists can specialise in problems of the pelvic floor and bladder. This may be a small area of Physio, but it can make a huge difference to those who are struggling with a little (or a lot of) leakage and a loss of continence. This problem can seriously impact on quality of life for many women, and some men too.

Image from www.myphysiowyndhamvale.com.au

The more accurate term for the service is Pelvic Obstetric and Gynaecological Physiotherapist, however, Women’s Health Physiotherapist (WH Physio) is still in wide use so will also be used here. Specialist Physiotherapists specifically deal with pelvic floor issues, but also with associated problems of prolapse and weakened abdominal muscles post-childbirth. A WH Physio can also look at patterns of drinking and toilet visits and help make practical changes to reduce symptoms of urgency. WH Physios also specialise in the ante- and post-natal period, and can help with pregnancy related back, hip and pelvis pain. Then in the postnatal period we can help you return to function if abdominal muscles have split during pregnancy or if you have any aches and pains following childbirth, or repetitive strains from looking after your new baby.

‘Women’s’ health can be misleading, because everyone has a pelvic floor. Continence issues due to a weakened pelvic floor affect one in three women and one in ten men – as it affects many women after childbirth it is more of a women’s problem. A series of simple exercises and some straightforward lifestyle changes can make a huge difference. The exercises, as in most cases, do not work overnight and ask at least 3 months of commitment 3 times a day from you. However, each set should only take a couple of minutes and can be done anywhere (I do mine on the bus!) so it is just a case of remembering or setting and alarm on your phone. Compared to the alternatives – either a worsening problem that needs to be dealt with by using more and more pads, increasing strength medication; or even surgery which has been the subject of controversy recently – a few moments of your day is really a small price to pay.

Image from Advanced Uro-Gynaecology for Physiotherapists: Michelle Lyons

Unfortunately, it has been found that one third of women with weakened pelvic floor are doing the exercises incorrectly and could make their problems worse. Assessment of the pelvic floor by a specialist Women’s Health Physiotherapist can help you ensure you are performing the exercises correctly. You can also be taught different ways to check for yourself that you are doing it right once this has been established. When the exercises are done correctly with other lifestyle changes alongside them, they can be incredibly effective and give you a fantastic way to look after yourself and help prevent any problems arising in future. There are plenty of descriptions of pelvic floor exercise programmes online, however, nothing can match having this assessed individually, especially if you are having persistent problems.

Much rarer than a weakened pelvic floor is a pelvic floor which goes into spasm, due to an imbalance of different fibres of the muscles. This can be incredibly painful, so it important to learn how to completely relax the pelvic floor as well as how to contract it effectively and to be able to do both under conscious control.

In Pilates we talk about the ‘centre’ – this comprises the deep abdominal muscles which wrap around the abdomen like a corset, the diaphragm at the top and the pelvic floor at the bottom. These 3 sets of muscles which form a ‘cylinder’ work together to provide active support for the low back, mid back and pelvis. If you learn to engage the pelvic floor correctly this will lead to the deep abdominals switching on at the same time (keep breathing deep and wide into the ribcage to get the full cylinder working together!). Unfortunately it doesn’t work the other way – if you contract the deep abdominal muscles, the pelvic floor does not switch on automatically.

In any Pilates exercise where you lift up your head, this can push the abdominal contents down on the pelvic floor, which can put undue stress on the pelvic floor, especially when adding in the additional work on the abdominal muscles. It is necessary with any head up position to engage the pelvic floor before performing the lift of head and shoulders; this prevents any downwards pressure on the pelvic floor and helps it to strengthen and improve control at the same time. I bet you’ve never been told to pre-contract your pelvic floor before lifting something heavy, but you want to do that too for the same reason!


There is research that Pilates is effective for those with mild continence issues as it teaches you to contract your pelvic floor effectively and this carries over into everyday life.

So, next time you’re in your Pilates class and the instructor advises you to think about engaging through the pelvic floor, really add this into the exercise! You will be making a big difference to helping your pelvic floor work effectively as part of the whole core system.

If you are not sure if you are contracting your pelvic floor correctly, please come and see me in the clinic to check this for you as well as provide you with a personalised programme and advice.


Why should a Physio teach you Pilates?

Let me begin by making it clear that I’m not saying that only a Physiotherapist should teach Pilates. There are some incredible Pilates instructors out there who are not Physios who have great skills and dedicated clients. We have been taught by some of these instructors; their style greatly influences our work and has helped us develop in our own teaching.


Not all Pilates training courses are created equal. Joseph Pilates had the vision not to trademark the specific movements and style of Pilates and that has allowed the Pilates movement to flourish and develop. The downside of this is that you can become a Pilates instructor in a weekend.


Physiotherapists have long recognised the benefits of Pilates and modified Pilates (adapted to suit a population of clients who are unable to do classical Pilates due to an underlying health condition or injury) in treating and preventing injury. Pilates can be used to retrain muscles where habitual movements are causing a problem, improving posture and function following adaptations to an injury, for example a limp following knee surgery. Pilates builds strong bodies which are less susceptible to injury as this exercise style creates balance between muscle groups, lengthening short muscles, strengthening long muscles and encouraging optimum function throughout the body.

A physiotherapist will train for a minimum of three years at University level, studying human movement in great detail. Many Physiotherapists use Pilates-based exercises within their practice and see the benefits of this to their patients before deciding to train as a Pilates instructor alongside being a Physiotherapist. The training specifically for Physiotherapists typically takes an additional 9 months and the Physiotherapist has to practice Pilates themselves during this time.


As a Physiotherapist will have a background in treating injuries, postural problems and chronic pain they can help a client who has a particular problem adapt exercises as needed within a class or one to one setting. For example, if a client has had a hip replacement operation, a physiotherapist will have an understanding of exercises to benefit this as well as certain movements which may be difficult at least in the early stages. Physios are uniquely placed to help these clients to work on the movements which promote rehabilitation and avoid movements which are not suitable in the early stages following hip replacements. We also help to rehab from surgery where you may not immediately think of physiotherapy. For example, we had a client who was recovering from breast surgery and was very tight around her breast tissue. Our knowledge of tissue healing gave us the confidence to help her gradually stretch out the tight tissues within the Pilates class.

If a client has a habitual postural problem which causes them discomfort, the physiotherapist can help by prompting the client into an improved postural alignment. The physio can focus on exercises which help to build the muscles which will improve posture outside of the class as well as gently stretch our muscles which can pull you into a poor posture in the first place. By combining these approaches, an improved posture can lead to better functioning in day to day activities, reduced incidence of aches and pains and generally feeling and looking better.


Our clients regularly turn to Pilates following sporting injuries. Because our classes are small and taught by physiotherapists, the physio can assess whether the client is suitable for a mainstream class, with or without appropriate adaptations to the exercises, or if the client will need a one to one session to work on their specific needs. In the early acute phases of an injury, a client may turn to us for Physiotherapy treatment to maximise function and enable them to return to their Pilates practice and training as quickly as possible and work on preventing further injury.


We can bring our specialist knowledge to a range of conditions. Working with ante and post natal clients, we have specific knowledge of how to modify exercises antenatally while having the confidence to supervise and tailor exercise. We focus on specific areas which can be problematic for pregnant women and incorporate these into an exercise routine which challenges them appropriately at different stages of pregnancy. Postnatally we assess the split between the abdominal muscles (known as rectus diastasis) and can advise on precisely what a woman should be working on to achieve optimum return to fitness. We have knowledge of muskloskeletal issues which can arise postnatally and we know how to tailor and modify exercises to the individual, progressing on to more challenging exercises as the client’s body adapts to the demands of Pilates.

With increasing incidence of low back pain and a recognition that Pilates can be incredibly beneficial, clients will find they have confidence in a Pilates Instructor who is also a physiotherapist as they will know which specific exercises are suitable for rehab with particular conditions and which exercises will not be beneficial. For example, if a client has a facet joint irritation, the physiotherapist will know to avoid any exercise incorporating excessive arching of the back and will train the client to recognise when they are in neutral, increasing comfort and reducing risk of worsening the condition.

You’re in good hands being taught Pilates by a Physiotherapist.

Images thanks to http://www.darrochphotography.com