Pelvic Pain

Peta was lucky enough to be able to attend an amazing one day work shop on pelvic pain. It was great to see that the subject was being addressed by a multidisciplinary team. The presenters included gynaecologists, an anaesthetist, specialising in chronic pain, a women’s health physiotherapist, psychologists, and a pharmacist. It was great to see that they all saw the need for women to stay active when living with this condition. A great resource has been developed by by the Pelvic Pain Foundation of Australia. Check out their website (http://www.pelvicpain.org.au) It covers so many aspects of both women, teens and men living with pelvic pain.

We are starting to see more and more women in the studio with pelvic pain, and it was great to see that with input from their medical and allied health team they are able to put some movement back in their routine.
In many cases stretching can help with the pain. The Pelvic Pain Foundation have some stretches on their site.
We have developed some active stretches so that they can be easily done at home.

If you have pelvic pain it is so important to have it assessed by a professional, these stretches should only be used if they do not increase your pain. Start with a visit to your G.P so you can get a referral to your friendly gynaecologist. Another great resource is the Continence Foundation and women’s health physiotherapists.

  1. Start by lying on your back with both legs straight. Bring your left knee in towards your chest, hold the knee with your right hand. Now bring your left knee towards your right shoulder then bring the knee down to the floor on your right side. Transition into a rest position, lying on your tummy, keeping the knee bent. Return to lying on your back and repeat with the right leg.

  2. Glute stretch in motion Seated on a dining chair, cross your right ankle onto your left knee. Keeping your spine in a neutral position, rock forwards and backwards 10 times to help release the pelvic floor. Repeat on the opposite side.
     
  3. Rocking in 3 positions Start on all 4s, hands underneath your shoulders and knees underneath your hips. Starting in a parallel alignment, start to rock forwards and backwards, keeping your spine in a neutral position. Now bring your knees together and feet apart then rock forwards and backwards. Lastly, bring your feet together and your knees apart then rock forwards and backwards. Repeat 10 repetitions in each position.
  4. Frog pelvic curls Lie on your back with your knees bent and your feet resting on a stool. Bring the soles of the feet together, allowing the knees to open, like frog legs. Initiate your pelvic curl by tucking your pubic bone towards your nose then roll up through your spine. Roll back down, ribs, waist, hips then bottom. Repeat 10 repetitions.
  5. Roll down with frog Standing with your feet hip-distance, drop your chin towards your chest and start to roll down through the spine. At the bottom, place your hands on the floor with your knees apart, arms inside your knees. Keeping your hands on the floor, try and straighten your legs then begin to roll back up to standing. Repeat 10 repetitions.

     

Feet

We have all heard the stories about women’s foot size increasing after pregnancy, I always thought it was an old wives tail and would never happen to me. Well it took me about 3 years to realise, mainly due to the fact that I had not had the opportunity to wear my going out shoes (after having 2 children close together) but low and behold I do not fit into my going out shoes anymore!

After researching this topic further I wish someone had explained to me the importance of looking after my feet during pregnancy. I know we have so many other body parts to concentrate on during pregnancy and generally we might get a foot rub from our partner if we are lucky. The main concern in most pregnancy are that our feet will swell and we will not fit into our shoes. This is a really common occurrence and we instantly revert to wearing the easiest thing to slip on our feet, Flip flops or thongs, dependant on where you grew up.

So I am here to tell you especially as its summer, don’t wear thongs unless they have some arch support!
There is limited research into this topic but the research that is available is well worth looking into.

It has been found that foot length and width can increase due to pregnancy and also that your foot arch can drop by up to 1cm!
This has been attributed to an altered gait pattern (the way you walk).

This can all be traced back to the fact we have an increase of weight when we are pregnant and also the change in our hormones. Our feet take a beating! The majority of change in feet seems to occur during our first pregnancy. There is a fantastic article: Pregnancy leads to lasting changes in foot structure ( 2013) where the researchers have suggested that the incidence of hip and knee issues are more common in older women who have had children, and they are suggesting this all relates to the fact our arches have dropped.

So when you are pregnant look after your feet!

Give them support, if you have to wear thongs there are whole heap of new thongs around with arch support. Do foot exercises to wake up those little muscles in your feet so your arches get a little extra support.

We use these hard yellow massage balls to wake up the feet. Try 10 to 20 presses on the ball of your foot, repeat on the arch and then the heel. Remember you arch is generally more sensitive so be gentle. We have our pregnant ladies sit down to do this work, just so we can ensure their pelvis does not shear with the movement. You can also substitute a franklin ball if you need something a bit softer.

Another exercise to try is scrunching your toes on a towel. Try to get the towel to move, focus on lifting your arches when preforming this exercise.

Diastasis During Pregnancy

Did you know that between 66% – 98% of women will have a diastasis during their pregnancy!
The amount of pressure placed on your abdominal muscles during this time leads to a thinning, or in some cases a separation of your stomach muscles resulting in a diastasis. Do not panic if this happens it is quite normal.

You may notice when you sit up quickly or are getting in and out of the bath your stomach looks like a triangle instead of a nice dome shape, this is a DRAM (diastasis of the rectus abdominus).
Once the muscles have separated during your pregnancy it will not come back together until after the baby is born (due to the fact that your tummy continues to increase in size).

What you do want to do is try and keep the separation to a minimum while you are pregnant.

One explanation we use for our pregnant mums is to compare the separation to that of a broken bone. If you set a broken bone as soon as it happens it will heal better, if you don’t set the bone for a few weeks it will be harder to get back together, may take longer to heal and have complications.

If your tummy muscles do separate you want to look after them and try and reduce the separation as early as possible. You can start this while you are pregnant. If you see your tummy going into that triangle shape you are putting too much strain on your tummy! Try give your baby a gentle hug (bringing your baby back to your spine) you are not trying to crush the baby, just a gentle hug. Remember to roll in and out of bed and to support your tummy when you are lying on your side.

 

 

Here are two of our amazing mums to be. This is both their second pregnancy and each has around a 4 finger separation at the moment. We are working with them and in general they now have more control over the separation. When both are lying on their side you can see how the lower side of their tummy dips down, keeping their stomach muscle apart and putting lots of pressure on an already strained muscle. We have popped a Pilates ball under their tummy to bring that separation back together.

So please be careful when you are lifting (especially toddlers!), getting in and out of the bath and exercising. If you can keep more tone in your tummy it WILL recover better after the baby. If you are pregnant or have just had a baby and would like some help getting your diastasis back together please contact us, we CAN help!

We would like to thank our beautiful pregnant clients who allowed us to use their pictures in this blog post and wish them both the best for their impending arrivals!

Diastasis

When you google diastasis you could become overwhelmed with the amount of advice being given. Everyone seems to be an expert in this condition, lots offering 8-12 week exercise programs to fix your separation. For those of you who have not heard of a DRAM (diastasis recti of the abdominal muscles), it’s a separation of the ‘six pack muscles’ (rectus abdominus). It has been reported the incidence of diastasis in pregnancy to be as high as 66-100% in the third trimester, with a diastasis persisting in up to 53% of women after delivery! (Benjamin, van de Water & Peiris 2014)

When we googled female abs images, this is a screen shot of the first results you see. Many people perceive that the deep gap running down the centre of the stomach as a toned healthy tummy. In most cases it is a DRAM.

If you flip open a magazine ad you will see that many of the ‘fit mummies’ and even women who have never had a baby feature a prominent DRAM. This weakness puts them at risk of back pain and pelvic instability. How sad is it that the bodies our culture holds up for us to admire and aspire to are too often damaged and compromised!

Can you pick the more functional tummy muscles from these photos? Many of you may choose the wrong pictures. All the women in these photos have had children but the ones on the top do not have a diastasis, the other two do.

It is so important for women to regain healthy, strong, functional bodies that will serve them for their whole lives, rather than getting six pack abs in a twelve week program but weakening the structure of the abs in
the process. I would like to thank our gorgeous tummy models! They are all working with their bodies to achieve the best outcome for themselves. Everyone’s body is different and unique, that makes us special. We should not all look the same or aim to achieve the same bodies. If you do have a diastasis and have had one for over 6 months, there is no magic quick fix. It will take work to change your posture and a life time of habit which maybe keeping it apart! DRAM is fixable in most cases, we all want our bodies to be working well and can achieve this with time and work!

New pregnancy exercise guidelines – no more singing while you exercise!

I think I need to get out more!  It is sad to say but I was so excited by the release of the new Sports Medicine Australia (SMA) guidelines* on exercise and pregnancy.

So what do the new guidelines mean for us in the studio? 

Well the reason I am so excited the changes support what we have been advocating for years.

The first thing to note is that the statement by SMA is only aimed at women going through a bulk standard pregnancy with no complications, and to consult your health care provider (GP, OBGS, midwife or Physio) about physical activity during and after pregnancy. Which is as always sound advice!

 

The key changes to the current recommendations are:

  1.      An increase in the amount of aerobic activity recommended (now 150 – 300 minutes per week!)
  • During this aerobic activity you still should be able to talk (12 -14 on the BORG’s scale), with a special note that you should not be able to sing. Maybe I have been doing it wrong all these years and should have been trying to belt out a tune!!
  1. Types of exercise recommended
  • Brisk walking/jogging/running (see my thoughts on running below), Cycling but only on a stationary bike, and swimming.
  • The SMA have suggested moderate to vigorous exercise, which I find confusing as if I did vigorous exercise I would not be able to talk which is saying a lot! They also have said that every minute of vigorous exercise is equal to 2 minutes of moderate exercise.
  1. They have included light weights (I assume they are referring to hand weights) and resistance bands.
  1. As expected they have included the reasons not to exercise such as ruptured membranes and many other pregnancy complications.
  1. The other new addition is to avoid wide leg squats, lunges and unilateral leg exercise, anything that places excessive shearing or force on the pubic symphysis. Exercises which we have been avoiding in the studio for years for our pregnant clients!

At first I was shocked that they had put forward jogging as safe, but if you read the statement in full it states that there is actually no evidence to either say it is safe or not.

So really ladies, common sense should prevail, your pelvic floor is already under increased strain just with that extra baby and baby weight, why put it under further strain? We only get one pelvic floor please look after it!  Experts advise not to bear down or strain when you go to the toilet as it puts your pelvic floor under too much pressure, so why run? There are lots of other types of exercise you can safely do during your pregnancy.

 

What about exercises using weights?

The SMA have now stated that anything that increases abdominal pressure is considered unsafe and have made a strong statement in regards to weight lifting being contra indicated during pregnancy.

This is great news as there have been lots of images of pregnant weight lifters giving people the impression it’s a safe exercise for pregnant mothers.
The amount of times I had to argue with people about this point as people say, “they did it before they were pregnant so they can do while they are pregnant.”

What about exercise during the post partum period?

I was quite disappointed in the lack of guidance for the post-partum period. I truly believe this is one of the most neglected areas around the whole giving birth process and we get so many women come into our studio who have injured themselves during this period as they have not been guided correctly.

Hopefully research and guidance for this will come in the next version of the guidelines. Until then we will continue to recommend safe exercises for our clients during pregnancy and the post partum period!

Peta

 

* The last update from the SMA guidelines was in 2014

Why we don’t do planks or take both feet in the air in our mums and bubs classes

We all want to feel good about our bodies, including after giving birth. The pressure on new mums to look pre-pregnancy fit and toned is incredible. For some of us, pregnancy has been a frustrating time when we have had to wind down our running, strength training, mountain biking and other activities. We are looking forward to getting active again, for our bodies and for our headspace, brains and mental health. There are so many exercise programs, classes, books, online courses for mums trying to get their pre-pregnancy tone and fitness back by doing things like planks. But unfortunately not many health and fitness instructors deeply understand and respect the changes during pregnancy and the post-partum period.

“Can I do planks and crunches after giving birth once my doctor gives me the 6 week all-clear?”
Well yes, it might be possible but it’s probably not the best exercise for your body after 40 weeks of tremendous change. There will be time for planks, we promise, but first we need to address any internal issues like diastasis recti, pelvic instability, postural changes.

Most women are aware of avoiding tummy work like stomach crunches during pregnancy and after giving birth, but it seems that having your legs in the air or planking is not commonly addressed. The reason we avoid these positions during pregnancy and in the post-partum period is because the strain on your rectus abdominus (six pack muscles) of having your legs in the air can further separate a diastasis, and it also puts an incredible amount of downwards pressure on your pelvic floor. Yes we want to work your pelvic floor but it has just been through a tough time, and we want to avoid any further strain. It is important to keep loading of these areas within safe limits. Try doing a pelvic floor lift standing – how well do you do? If your pelvic floor can’t adequately lift yet solely under gravity, then loading it up further with exercises could be unsafe. You would not start skipping six weeks after you broke your leg, so why put your pelvic floor and stomach muscle under unnecessary tension?
Remember that when the pelvic floor is overloaded, the ligaments of pelvic organs (bladder, uterus, bowel) can take the strain and become stretched, leading to organ prolapse, which is much more common that you think.
Immediately after you have had your baby your stomach muscles and pelvic floor are not in the condition to plank. Chances are you tummy is pressing out instead of lifting in and up and other tissues (like ligaments) are working harder to compensate. So it kind of defeats the purpose of planking in the first place, in fact sadly some mums find they create further issues by jumping into certain forms of exercise before their body is ready.

“We can also design programs that will strengthen and challenge you whilst looking after pelvic floor.”

Your pelvic floor and abdominal muscles are keeping your pelvis together, whether you had a vaginal birth or a cesarean delivery your pelvis still got ready to give birth, the ligaments softened and in most cases the baby engaged. Your pelvis enlarges to get ready for delivery. All of these changes do not instantly resolve six weeks after giving birth, but the good news is that you can work on it, even if it has been months (or years!) since your baby arrived.
Being kind to your body and using correct techniques will allow you to rebuild your core muscles from the inside out. There are so many other exercises that are safe for your body and will achieve the same goals. Remember we only get one body, look after it.

What can I do?
The good news is that at 3 Degrees we specialise in working with women to help repair and tone their cores safely, both in our studio classes and in our Mums and Bubs and Mums without Bubs mat classes.
We can assess your diastasis recti, and help you to work to close it, or help to improve your pelvic stability so that you no longer have SIJ or pubic symphysis pain.
We can also design programs that will strengthen and challenge you whilst looking after pelvic floor.