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!

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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.

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Pilates for life!

Image from lifestylebylindsey.com

At the start of a new year, we thought we’d take a bit of time away from focusing on how Pilates can benefit different conditions, aches & pains and instead look at how Pilates can be a life-long habit, incorporated into your lifestyle. We are all meant to exercise for at least 30 minutes on most days of the week (yep, at least 5 days a week!), and children should exercise at least double that.

How many of you hear that and are put off because you don’t like gyms, don’t enjoy zumba/jazzercise/whatever exercise trend this year is going to throw at us? Does the thought of going out for a run makes you want to velcro yourself to the couch?!

If you already attend a Pilates class, why not increase the good feeling you get after a class by incorporating it into other days of the week and fitting it around your schedule? Listen to two clients who have come to Pilates for different reasons, and are sticking to it, not only to prevent recurrence of problems, but to boost overall health, give some ‘me time’ every day and incorporate enjoyable exercise into their lifestyle.

Chloe, 35, first came to Pilates when pregnant with her second child. ‘I didn’t have any problems during my first pregnancy but then had quite a short gap between pregnancies. I was very surprised when early on I started to get low back pain and started to struggle bending down to look after and play with my toddler. This got to the point where I was unable to walk for any distance without pain.

‘I went for a one to one Pilates session with a physiotherapist and was helped out with some exercises to do at home to help relieve my discomfort, I was also shown some safe strengthening exercises to help improve the power in my leg and bottom muscles which made walking slightly more comfortable. I was also reminded to get started with my pelvic floor exercises!

‘I was hooked! Although I was so busy at work and with my toddler, I was encouraged to take some time for myself every day, sometimes 5 minutes was all I could manage, but it was so important to me to get that time. I was able to get through the rest of my pregnancy keeping the pain under control.

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‘As soon as I had the baby I signed up for postnatal Pilates as I knew how much I needed to do to get back into shape and be fit for my little ones. I started soon after my six week check and again made sure I took the time to do a little bit at home each day as well as my weekly class. It was even tougher to fit that in! I really think that’s what helped me recover so quickly from the birth.

‘I am now back to work and managing to fit in some running and trips to the gym in my lunch breaks. I’m even busier at home, but still try to get that daily five to ten minutes to myself as it gives me such a mental boost and helps me know I’m looking after my body long-term.’

Alan, 40, is a former rower turned triathlete. ‘Years of rowing and repetitive training had taken its toll on my back. Yes, I was fit, but I was inflexible and would get frequent bouts of pain all through my spine and often into my shoulders and hips. I saw a Physiotherapist who explained that my core muscles were not as strong as they could be and the load was being taken by muscles which weren’t supposed to work so hard to hold my posture. The physio suggested Pilates and I eventually tried a class.

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‘I could have kicked myself for not going sooner! After my first session I felt better already – taller, stretched out and much more comfortable with moving than I had felt in a long time. I couldn’t wait to go back again the next week and eventually signed up to two classes a week.

‘As part of my training I had always done some daily stretching, first thing in the morning and last thing at night. I wondered if maybe my routine was right for me as I had been doing the same stretches for years – hamstrings, quads, calves, shoulders. I booked myself in for a one to one Pilates session where we went over what I did, how much time I had to work at home and what I was hoping to achieve, The Physio designed a programme which really goes for the areas where I tend to stiffen up regularly and also gave me some exercises to support these joints in my spine to prevent them from stiffening up quite so readily.

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‘Even though I’m 20 years older than when I started rowing, I feel in better shape than ever. The one change has been the Pilates and it’s been a great addition to my training!’

So Pilates is not only if you are recovering from an injury or working through pain, think about how good it makes you feel and how you could experience that more frequently. If you’re not sure what you should be doing at home, see us for a one to one where we will personalise a programme for you.

Postnatal Pilates

It’s not Pilates for babies, but how cute is the latest addition to the Pilates Plus team!

It will hardly be a surprise that women’s bodies go through huge changes during pregnancy and that some problems can arise postnatally. These can escalate when a woman has two pregnancies relatively close together.

Pregnancy changes a woman’s posture, pulling the pelvis forward into an ‘anterior tilt’, arching the low back into an increased curve which can be painful. This posture can stick around long after the birth, sometimes years later a woman can still be in a ‘pregnant posture’! In this position, the abdominal muscles and bottom muscles are not used effectively and can become weak. The muscles at the front of the hips become short and tight, keeping the pelvis tilted forward.

After giving birth, looking after baby requires spending time in lots of static positions. The upper back curves forward when breastfeeding or holding baby and can become very stiff. With a lot of time spent bending forward bathing and changing baby, this can add to back pain. Standing and walking with the baby on one hip can make this even worse! Wrists can also become sore with holding baby’s head when breastfeeding.

Abdominal muscles stretch massively during pregnancy and do not snap back into place immediately (although for some lucky women, they do appear to). Also, two thirds of women will experience a split in their rectus abdominis (the external abdominal muscle – six pack muscle), for some this will return to its original position with no additional effort required. For others, it requires careful progressions through a well-designed exercise programme to bring the sides of the muscles back together. Some women’s split will not completely zip up, this can be due to having a wide split in the first place, exercising too early at a relatively high intensity or simply due to lower elasticity in the muscles. The pelvic floor has also gone through big changes and can take time to recover, although women are increasingly aware of the need to do pelvic floor exercises during pregnancy, as soon as able after birth and ideally before getting pregnant in the first place.

Pain in the pelvis during pregnancy can still remain after giving birth as the hormone relaxin continues to circulate round the body for several months after birth. In addition to all of this, there can be added complications if the woman has had a c-section or stitches.

Many of these problems can be resolved within weeks of giving birth, however, full remodeling of the tissues can take up to 18 months.Because of this, among other reasons, the World Health Organisation recommends waiting two years between pregnancies (for more information see this briefing).

Pilates can help with all of these problems and is also a relaxing way to get back into exercise postnatally. For you as the client, there are several benefits:

Pilates improves postural awareness and muscle control, reducing the split in abdominal muscles by building the abdominal muscles from the deepest muscles outwards. With a stronger core and improved awareness of muscle control, it can reduce pain in the low back and pelvis. It also helps to improve control of the pelvic floor, reducing risk of stress incontinence and other problems. For any women reading who do not have children – now is the time to start your pelvic floor exercises, whether or not you plan to have children. In fact, everyone should be doing them, including men!

As well as this, Pilates can help you return to your regular fitness regime and get back to the activities you want to do. The focus on the deep abdominal muscles, which we sometime refer to as ‘corset’ muscles, helps to regain your pre-pregnancy figure. As a client recently said to me: “I just want my body back!”

Postnatal Pilates will help prepare your body if you plan to get pregnant again in future.

As well as benefits to you, postnatal Pilates will benefit your baby too. Because the exercises make you stronger with better control around your low back and pelvis, you will have more energy and less pain, therefore you will be able to play with your baby and give baby the time she/he needs with you to develop.

Your baby gets to see you exercising from early on, which gives a positive message about exercise and can help them choose healthy habits themselves. You are also able to breastfeed and tend to your baby during the class as needed, so you can exercise whilst your baby is still very little.

What should you expect from a class? Most Mums are able to join our classes after their six week check. Our classes are informal and you can bring your baby. We have babies aged from six weeks through to toddlers (although the older babies tend to come to the post-beginners/intermediate class). The class is relaxed, a few Mums worry if their baby will be disruptive, but are quite relieved when they arrive to see that everyone is in the same boat!

Pilates is relaxing in itself – as you concentrate on good alignment during the exercises, your mind can switch off from the millions of little thoughts which occupy it at other times. There is the opportunity to stretch and release through tight areas throughout the class.

The classes are taught by physiotherapists trained in ante- and postnatal Pilates so specific problems can be addressed. Any split in your abdominal muscles can be monitored and exercises modified as required if there is a split.

If joining a class is not for you, you may prefer to come for one-to-one sessions. These sessions will address your personal needs and can either be a regular session or infrequent sessions where you work on an exercise programme at home in between. Some Mums who attend our classes come for occasional one-to-one sessions to work on individualised exercises or to discuss any problems they would rather not bring up in class. Babies are welcome to the clinic too!

This month, we are launching a postnatal exercise guide. This will be for sale along with your first block of postnatal Pilates classes, and also available separately. The guide contains a series of exercises which are presented week by week, with gradual increases in challenge through the weeks. It is designed to be used alongside our classes and will help you get the most from the weekly class. For great results, do the exercises three times a week between classes.

Psst!… Week eight’s exercises are all about stretching, so if you feel the need to stretch out after your exercises, you can dip into week 8 at any point in the programme.

If you have any questions about the exercises in the guide, please see your Pilates instructor.

 

 

 

 

 

Please get in touch if you would like to know more.

Images thanks to Darroch Photography