 It can be tempting to avoid exercises that cause you to leak. Physios aim to modify, rather than stopping you doing an activity altogether. This is because if you can find a level where you can perform the activity symptom free, it will actually aid your rehabilitation and help you to return back to doing it in it's entirety, quicker. These are some modification ideas. ✅1. Avoid bracing - bracing your abdominals actually increases the pressure that the core has to manage. Try and stay relaxed, trusting your core to do what it needs to. ✅2. Two foot jumping creates the largest ground reaction forces. If you can, modify to hopping from one foot to the other instead. ✅3. Reducing the height of the impact decreases the ground reaction forces , so making your jump smaller may help to reduce leaking. ✅4. Keep breathing - this helps pressure to escape up through your mouth and not force the pelvic floor to have to manage the pressure created from the breath hold. ✅5. Ask your physio for specific loading exercises for the sport or activity you're struggling with. Impact training forms part of your rehab, it's not just about kegels!It can be tempting to avoid exercises that cause you to leak. Physios aim to modify, rather than stopping you doing an activity altogether. This is because if you can find a level where you can perform the activity symptom free, it will actually aid your rehabilitation and help you to return back to doing it in it's entirety, quicker.
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 Cueing is so important. It can be the difference between great engagement and recovery of core related issues and just engaging other local, overworking muscles.
I have lost count of the number of exercise classes where I've vaguely been told "Pull your belly button to spine". When? All the time? When I'm inhaling? When I'm exhaling? Fortunately as a physio I know what I should do, but many other people in the class must be totally confused! Key aspects for core rehab are: Use your exhale to engage the diaphragm and reduce intra-abdominal pressure. Make sure a pelvic floor contraction is included. Make it bespoke! People do not respond the same way to an exercise. Check their engagement - how well are they achieving tension? Is tension generated along the whole of the TVA, or is one area better than another? Can you change the cue to improve the engagement? I'm constantly playing around with visualisation and cueing to see what works best. We're not robots, everyone is different, but that's what keeps the job interesting!  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.  |
AuthorClaire is a women's health and sports Physiotherapist. She is the owner of Spring Physio and is based in East Sussex. Archives
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