You might read this post and think - why does it matter? As long as a treatment makes you feel better, it's not important how it works, right?
Well that depends. Let's say you have pelvic pain and have been told that one of your pelvic joints is out of alignment. That belief means that every time you have a relapse, you believe you must see a therapist to have it "put back in", otherwise it won't get better. You might be scared to do gentle exercises or your every day tasks, in case you make it come out further! It may make you scared to move, fearing that you have an unstable pelvis, imagining something similar to a fracture. This fear and belief does NOT help your recovery. Your brain will be on red alert protection mode, provoking pain responses to guard against anything that might worsen the instability.
You see your therapist, they "put it back in" and you feel better. Until next time. Because if in the back of your mind you still have this deep seated fear that there is something fundamentally wrong with your skeletal system, any twinge is likely to set your brain off to guard that part of your body. Guarding = pain.
So yes, how you understand your diagnosis, and the impact of your treatment really DOES matter.
Injuries should not require ongoing maintenance treatments. The goal of physiotherapy is to get you better and help you feel confident in every day life. SHOULD you have a relapse, we will give you the tools and education to ensure you are confident to self treat and manage the flare up.
A tight (hypertonic) pelvic floor can often go undiagnosed because it can present similarly to other pelvic floor problems. Common symptoms include back pain, stress incontinence, urge issues and constipation. These symptoms such as will not improve until the tightness of the muscles is dealt with. For this reason it’s so important to get assessed by a women’s health physio
The piston analogy originally comes from Julie Wiebe. It is a great analogy to help patients understand how their core relates to their breath. As you exhale, your diaphragm and pelvic floor are naturally shortening - the piston is moving up. Performing a pelvic floor and core contraction on the exhale makes it much easier to engage the muscles, because you are joining in with the natural movement of the core. When you inhale, your diaphragm and pelvic floor move down to help make space for the lungs tor fill with air - the piston is moving down. Trying to contract the pelvic floor on inhale is much more difficult, because it goes against the natural direction that the muscles are moving in. For this reason core exercises are performed on the exhale.
Wait at least 6 weeks before starting scar massage. The wound should be completed closed - If you are unsure whether it is healed enough consult your GP or a women's health physio. There is no need to use expensive scar oil; any non fragranced moisturising cream or oil is great. 👍
Your scar may be sensitive to begin with, so start massaging away from the scar and then as you get used to the feeling you can work closer to the scar itself. Your scar tissue is not limited to the scar itself, so it's important to work around the scar on an ongoing basis. Increase the pressure gradually, and spend a couple of minutes on each technique.
Here are some final self massage techniques. This is one of my favourites, because it is done with movement. I find it super effective at improving the mobility of the scar. Often clients report an immediate change when I use this technique in clinic. Start on one side of the scar doing a few strokes and then move along the scar, repeating the same technique until you’ve covered the whole scar.
Carpal tunnel syndrome is a fairly common problem in pregnancy. The good news is that it normally settles post pregnancy as fluid around your body reduces. But that doesn’t stop it being an incredibly irritating problem in pregnancy, especially at night when you are trying to sleep! Here are my top tips for symptom management in pregnancy.
It can be frustrating when recovery doesn’t go quite to plan. Almost every woman I’ve treated has had at least one blip along the way. Whether it’s increased pain from a c-section, worsening prolapse symptoms or leaking when you have a bad cold, it can be really disheartening. But the thing is, we are not robots! Lack of sleep, nutrition, stress and a change in activity can all cause a flare up of symptoms. But that doesn’t mean all is lost. Keep going on your treatment plan and you will find progress does resume! Sometimes you may find you need to take your rehab level back down a step before increasing it again once your flare up settles.
The NICE guidelines recommend a three month physiotherapy exercise programme for prolapse, because research has found that we need to play the long game! Whilst commitment is required, most women find that a course of physiotherapy is effective to manage their prolapse.
Pink and raised scars are pretty common... and people tend not to realise that there is something that can be done about them! Both these treatments can be carried out at home once your physiotherapist has explained how to implement them.
Silicone comes in many forms - invisible gels, plasters and dressings. Some are available on prescription from the GP or you can purchase yourself from amazon. Ensure you use the instructions on use because silicone can sometimes cause skin sensitivity.
Scar massage is important because it helps to break down the excess collagen and mobilise the surrounding tissue. Your Physiotherapist can show you different massage techniques that you can carry out at home.
There are other in clinic options such as laser treatment, but these options are a great place to start.
So, you had your C-section, stayed a couple of nights in hospital and got discharged with (if you're lucky) a leaflet about recovery. You walked around hunched over for a few days (or weeks) and eventually started to feel better. Frankly given that you had a newborn to look after, you were just thankful for the fact that you could now lift the baby pain free! With some much going on, you probably didn't give it much further thought during this early recovery period (this certainly my experience).
A weak core and a non - mobilised scar can lead to an overhang. Women assume nothing can be done to improve this... but there is plenty! However, it does require commitment and perseverence as changes don't happen over night.
Scars are still healing and remodelling 18-24 months after surgery so there is lots of time to manipulate change. Even if you are further down the line, it is still worth massaging your scar if you haven’t done it before. Tissues don’t stop responding to mobilisation until a joint is fused! The overhang isn’t only caused by the scar, so a holistic approach to treatment with appropriate core strengthening will yield the best results.
Any scar can become hypertrophic. This means that the scar is red and raised. In this case silicone can be a useful treatment to improve the colour and flatten the scar. It is worth asking your Physio or GP to review your scar and see if silicone would beneficial.
astasis recti is a defined as the partial or complete separation of the "six pack" muscle. This muscle is connected down the midline of the stomach by the linea alba (connective tissue).
Diastasis is common in pregnancy - a gap in the six pack muscles occurs to make room for the growing uterus. In most cases the gap naturally close within about 6-8 weeks after pregnancy, but for some women the gap fails to close spontaneously.
Diastasis doesn't just occur in women and pregnancy. it can also affect men, sometimes from doing excessive or incorrect abdominal exercises.
Abdominal separation affects your "core cylinder" muscles, and therefore often occurs alongside other core issues such as pelvic floor weaknes,, incontinence, back pain, constipation and prolapse.
The most common symptom is the classic "mummy pooch" or feeling like you continue to look pregnant, months or years after birth. You may also notice a doming or bulging down the midline of your belly when doing activities that engage the abdominals.
Healing a diastasis requires a holistic approach looking at nutrition, posture, soft tissue release and core exercises.
The core should always be rehabilitated as a whole and so effective diastasis treatment will involve exercises that engage the pelvic floor and the deep abdominals simultaneously.
You can start reconnecting to your core by first finding your pelvic floor:
1)Lie on your back with your knees bent
2)Inhale, breathing from the base of your ribs. As you exhale, close and lift your pelvic floor (imagine you are trying to hold in wee and wind at the same time). Try and start the contraction at your back passage first.
3) At the end of the exhale, let go of the contraction.
Once you can achieve a pelvic floor contraction you need to add load to strengthen your entire core cylinder, which will rebuild tension across the midlne of your abdominals. A physiotherapist can direct you to make sure you are doing the right level of exercises.
You can get a referral via the NHS to a women's health physio, or contact us for an assessment and treatment. Our online pelvic floor foundation course is also perfect to start healing your diastasis. Find out more here.