10 tips for dealing with pelvic organ prolapse

As some of you are aware, a little while back I conducted a survey of women who had been diagnosed with pelvic organ prolapse. I was thrilled to receive over ONE HUNDRED responses in just a few shorts days! Many of the participants came via a wonderful Facebook group called POP Fitness. This group was founded by Haley Shevener (pictured), a fitness professional that, quite frankly was sick of all the negativity surrounding exercise and pelvic organ prolapse. Instead of all the “don’t do anything” messaging, she wanted to create a safe place where women could actually discuss movement and exercise while living with pelvic organ prolapse.

I digress… (but seriously, if you have POP check out the group – it’s pretty amazing)

I completely acknowledge that the information gathered in this survey cannot be extrapolated to all women. Women joining this FB group are likely to be those that are symptomatic with their prolapse and actively seeking information and support, rather than women who had asymptomatic POP. I did not seek out the demographical details either, but I do believe that the majority of the group are between the ages of 25-40- with more participants who enjoy movement and exercise than those that don’t.

So yes…I know that I can’t publish this information in a journal.

BUT… I believe that the information gathered is extremely valuable. For one thing, I asked a lot of open-ended questions, enabling women to answer in their OWN VOICES. I did not put words into their mouths and as I am not their personal physiotherapist, they were able to be completely truthful without worrying about hurting my fragile ego.

One question that I asked was:

How much improvement have you had in your symptoms?

I found it reassuring that so many women had at least SOME improvement in symptoms, although almost 20% reported no change at all.

I really wanted to know what helped women most in terms of dealing with their symptoms, so the following question was

 

What strategies have you been given (or you’ve figured out for yourself) that you have found the most useful for relieving or avoiding symptoms associated with your POP?

 

As you can imagine, the answers to this question were varied. I dug into the responses and collated the information to come up with a list of the 10 most frequent responses. I have listed them and briefly quoted some of the participants, but will go into more detail about these strategies in future posts.

I hope that these answers are helpful, but feel free to add your own tips in the comments section below.

  1. Pelvic floor muscle strengthening 

This was the most frequent answer that was found within the survey. Of course the way in which women performed their strengthening exercises was variable – some women were given an individual program from their pelvic health physiotherapist, whereas others used online programs such as Dr Sarah Duvall’s Pelvic Floor Perfect.

Image: Continence Foundation Australia

It makes sense that many women found pelvic floor strengthening exercises to be of benefit as we know that strengthening the musculature of the pelvic floor can give a lot more support to the internal organs and relieve tension on the ligaments. Many women also commented that they utilised pelvic floor contractions during specific exercises or activities of daily living (such as lifting up their baby or a pram).

If you want to learn HOW to do pelvic floor muscle exercises, seek out a local pelvic health physical therapist, who can make sure that you are not bearing down during these contractions. We will discuss pelvic floor strengthening in more detail in future blogs.

 

 

2. Breathing

Closely following pelvic floor muscle strengthening was changing breathing strategies. Again, the responses were somewhat varied but included tips such as:

  • exhaling on the challenging part of the exercise
  • Julie Wiebe’s Pelvic Floor Piston  course and breathing strategy (“Blow before you go”)
  • relaxing the abdomen when breathing
  • avoiding holding the breath during exercise

The  diaphragm (our major breathing muscle) and pelvic floor muscles seem to work in synch, with inhalation being associated with a slight eccentric lowering of the pelvic floor and exhalation with an active lift of the pelvic floor muscles. It makes sense that we should try to coordinate these actions – and in many women this is a successful strategy for managing intra-abdominal pressure – but keep in mind that different breathing strategies may be required for different tasks…so don’t be rigid in your approach! We will talk more about intra-abdominal pressure and breathing in future posts.

3. Bowel Management

Unsurprisingly, managing the bowels and avoiding constipation came up very high on the list. For some clients, this meant using stool softeners and laxatives, whereas for other women dietary changes were successful.

Many women mentioned splinting to be a useful strategy when emptying the bowels.  In the case of posterior wall prolapse (rectocele),  inserting a finger into the vagina and putting pressure on the prolapse (ie literally pushing it back where it should be) can assist in emptying the bowels more effectively. Here in Australia, many women use a product called a Femmeze (instead of the finger!) which can make life a little easier.

Other strategies for effective bowel management included:

  • using a footstool or Squatty Potty
  • relaxing the pelvic floor muscles
  • breathing into the side of the abdomen
  • avoiding straining

 

 

4. Posture/Alignment

Many women reported that their symptoms improved when changing their posture or alignment during specific activities. Some women noted that changing their alignment helped them manage their intra-abdominal pressure during exercise. Others stated that they felt better activation and awareness of certain parts of their pelvic floor when adapting their posture (eg the front of the pelvic floor when using a slight forward lean posture).

One woman noted that changing positions and postures regularly helped her manage her symptoms.  Another noted that if she tucked her bum under, she felt worse.

There is no perfect answer when it comes to posture and alignment, so it is important to try different positions and see what works best for you. We often talk about stacking the rib cage over the pelvic floor, or the sternum over the pubic bone. Ultimately end range positions of the pelvis (ie extremely rotated forward or backward) seem to produce a poorer contraction of the pelvic floor in comparison with the more neutral positions of the pelvis.

5. Use of a pessary

Many women noted that using a pessary reduced their symptoms and enabled them to return to higher level exercises and sports. Some women stated that they only used their pessary for activities such as running, whereas others used their pessary throughout the day. Most women did not specify what type of pessary was used, but rings and sponges were mentioned.

In most countries, gynaecologists or pelvic health physical therapists fit pessaries. Although traditionally pessaries have been recommended for the more elderly population, they have been recognised more in recent years as being a highly effective tool for the young, active population with pelvic organ prolapse. It is important that pessaries are professionally fitted and that the vaginal tissues are regularly checked. Often women will be prescribed topical oestrogen at the same time.

6. Low impact exercise

It was wonderful to read so many statements about how exercise and movement helped women feel better symptomatically. Some were specific in the types of activities that they did (such as walking or Pilates), whereas others were more broad in their description.

Again, many women noted that they found online programs such as Pelvic Floor Perfect or the Girls Gone Strong (Moms Gone Strong) program to be of benefit.

Regardless, it would seem that the benefits of exercise were substantial, including improved mental health, quality of life and overall fitness.

 

7. Rest

I was happy to see that so many women acknowledged the role of rest in their recovery. You have to understand that this is not a group of women who like to do nothing. They would probably not choose to spend their days lying down on the couch… (well, maybe occasionally, but who doesn’t?!).

Many women stated in the survey that they just HAD to listen to their body and rest.

In terms of how they chose to rest, it included things like:

  • lying down towards the end of the day
  • sitting down for regular rests if on her feet for long periods
  • lying on her back with hips supported on cushions
  • lying down in the middle of the day

It seemed to be particularly important for women in the earlier postpartum period….so make sure that you take up all the offers for cooking and cleaning from your friends and relatives!!

8. Relaxation of the pelvic floor muscles

Contrary to #1, there were a lot of women who stated that they had overactive pelvic floor muscles and actually felt a heck of a lot better learning how to RELAX them. Many of these women would have gained this knowledge from having an internal examination with their pelvic health physical therapist, and would have learnt strategies for “downtraining” these muscles.

For some women, overactive pelvic floor muscles present as painful sexual intercourse, difficulty insertion tampons or problems with bladder and bowel function. Some women in the survey mentioned that they felt that what they believed were the symptoms associated with the prolapse actually felt better by relaxing their pelvic floor muscles.

9. Strengthening other muscle groups (eg glutes)

As someone who is super passionate about exercise (and teaches it for a living), I was stoked to see strength training make the list! Many women reported that they felt BETTER by getting stronger. Some were specific in the muscle groups that they targeted (eg abdominals or glutes) whereas others were more general or stated that they felt better by “lifting weights”.

Although performing strengthening exercises was mentioned multiple times, it should be noted that a number of women also stated that they felt better by “not lifting heavy weights”. As with any exercise program, the intensity should be based on the woman’s individual circumstances, but it does seem that many women cope well with light to moderate strength training.

10. Relaxation/meditation/positive mindset

It would appear that many women get symptomatic relief through the use of meditation and specific relaxation techniques.

“Less stress helps”

“Meditation – mental connection to my pelvic floor and self care routines have helped massively. Stress will exacerbate symptoms for me”

“Staying as low stress about everything as possible ”

“Staying positive”

I do feel that the way in which the diagnosis is made may have a significant impact on the way in which a woman approaches her recovery. If she has been given a more positive prognosis and some strategies that may help her in her journey, then she may be more likely to approach the diagnosis with a positive mindset.

Some clients with POP require more professional attention in this regard, and if you do feel that the diagnosis of POP has hit you hard, please do get a referral from your GP to a psychologist or other mental health practitioner. You are not alone if you feel depressed, angry, frustrated, devastated by learning that you have pelvic organ prolapse.

In fact, I made up a video on some of the responses that women had to receiving their diagnosis.

Click on the picture to watch the video

 

Conclusion

The results from this survey of over 100 women with pelvic organ prolapse show that there are many strategies that women can utilise to help reduce symptoms. The variety in answers shows that there is not one true solution and that an individualised approach is key. However, the frequency with which some of the answers came up (in particular pelvic floor strengthening, breathing strategies and bowel management) lead me to think that these should be at minimum mentioned to women upon diagnosis.

I recommend that all women with symptomatic POP reach out to the pelvic health physical therapy community and learned what strategies will best help you. And don’t be afraid to reach out to a few health professionals – it certainly seems to be the case that many women need assistance from physios, gynaecologists, fitness professionals, dieticians  and/ore psychologists in their journey.

 

(NB re Affiliate links. I do have a couple of affiliate links within this article. Please note that I do make a small commission if you purchase via the links. However, I did NOT add them to the article for this purpose, they were genuinely listed within the survey responses)

Finding purpose with prolapse (interview with Kylianne Farrell)

I’ve got to admit …this was one of my favourite interviews.

(and yes…I was a little misty-eyed at the end. I could lie and say that I had been cutting onions, but I must admit that I got a little emotional).

Why did I love this interview so much?

In part it was just because Kylianne is just a lovely person to talk to – we could have chatted for hours and hours. But also I just loved hearing about her journey in living with pelvic organ prolapse (POP) and how she has created an incredible business helping other women.

When I talk to Kylianne I am reminded of how POP is influenced by so many things – not just the muscles and connective tissue (something I discussed in this recent video), but also things like stress, support networks (or lack thereof), sleep and general health.

I feel like women do need more emotional support when dealing with a diagnosis like POP, but this doesn’t always seem to be possible within the health care system. We need to get better at finding ways to support women …

So, hope you enjoy the video and definitely go and check out her website and FB page below!

Some classic statements from KA:

“You have prolapse, you are NOT prolapse”

“Don’t pin your happiness on the healing of your prolapse”

 

 


To learn more about Kylianne, you can follow her on FB and learn more through her website.

The Movement Room website

Facebook page

If you want to learn more about Robin Kerr and Ian O’Dwyer, you can head to their websites.

Robin Kerr – Alchemy in Motion

Ian O’Dwyer – OD on Movement

Common misconceptions around nutrition in pregnancy

“Don’t eat fat – you’ll put on too much weight”

“You need lots of milk to build strong bones”

“You need to eat twice as much when you’re pregnant – you’re eating for two now!”

“You need lots of carbs to grow a baby”

 

You’ve probably heard a few of these statements made in relation to eating in pregnancy. But what is real? What is just old news? (Or “fake news” hehe).

Lily Nichols (aka the Pilates Nutritionist) took time out of her crazy busy schedule to talk to me about some of the science around things like:

  • macro and micronutrient recommendations in pregnancy
  • why fat is important to consume in pregnancy
  • why eggs are good for you!
  • how to lower your risk of listeria (and it may not be what you think!)
  • how the guidelines are (very slowly) evolving to take into account the scientific research

Lily is a research nut – she has over 900 (!!) references in her new book. She has read just about everything that you can read when it comes to nutrition in pregnancy. She has done all the hard work for you, cutting through the science and summarising it for you in one spot.

Part two of the interview, where we cover supplementation and how to easily add real food to your diet, can be found here.

 

If you are pregnant, or a health professional who wants to learn more about real food in pregnancy, you can go and get Lily’s book on Amazon.

 

(NB – the max carbohydrate load recommended in the Czech Republic is 200g, not 100g.)

The top 5 questions I get asked about exercise in pregnancy

As a physiotherapist who teaches exercise to women who are pregnant or just had a baby, I get asked many questions about the ins and outs of exercise. Most women are aware that exercise is probably good for them in pregnancy, but just aren’t sure how to go about it.

  1. Is it good for me?

Oh my goodness, yes. Exercise has SO many benefits for women who are pregnant, that in fact many of the guidelines are changing because the risks of exercising in pregnancy are so low in comparison to the huge benefits that can be gained.

If we start with the physical and psychological side, exercise in pregnancy can help

  • reduce your risk of gestational diabetes
  • relieve some aches and pains
  • improve your quality of sleep (reduce insomnia)
  • prevent excessive weight gain if you are overweight/obese
  • maintain (or improve) your muscle strength and cardiovascular fitness
  • improve body image and self esteem
  • manage anxiety and depression
  • improve your mood

Now if those aren’t enough reasons to exercise, how about this?

Women who exercise in pregnancy have better labours – they have fewer rates of c-sections and instrumented deliveries .

And…they have quicker recoveries from birth.

Sounds pretty good huh?

 

2. When should I start and when should I stop?

Many years ago, we used to recommend that women didn’t start any new form of exercise in pregnancy. Now those recommendations have changed and women are encouraged to start exercising in their pregnancy as long as there are no medical reasons against it.

Some women find that they are too tired or nauseous in the first trimester and prefer to wait until the second trimester, but that is totally up to you.

If you have never been a regular exerciser, I would encourage you to seek out a health or fitness professional to help guide you in this journey. That way you will learn exercises that work well with your body and how to progress or regress your program as needed.

In terms of when to stop, it really depends on how you feel. I have many ladies exercise right up until the day they give birth (literally!) and you can do that as long as you are feeling well.

There are times when you should stop exercising and most of the signs are obvious, such as if you have bleeding, chest pain, contractions, headache or leaking of fluid. There is a full list in the ACOG guidelines (link), but really if anything doesn’t feel right to you, then make sure that you follow up with your health care professional.

Many women suffer musculoskeletal pain, especially in the low back, pelvis and wrists, during pregnancy. Most women can continue to exercise despite these problems, but adaptations are often made to the program to make the exercises more comfortable. I recommend my clients have treatment of pain during pregnancy, as often pain is received or reduced with things such as manual therapy, acupuncture or massage.

3. Is it ok for the baby?

I saw a video earlier in the year that showed a very athletic pregnant woman doing some boxing and weights. The comments from the general public were scathing – “how could she be so selfish? She’s going to kill that baby? The umbilical cord will wrap around it’s neck.”

I’m not sure where some of these beliefs come from, but there is no evidence that that kind of exercise is dangerous for the baby in utero. Of course we don’t put women on treadmills or bikes and push them to maximum heart rates for long periods of time to see what happens…but most women self limit their exercise in pregnancy anyway. What I mean by that, is that the majority of women back off during pregnancy because they physically can’t push themselves that hard and because it doesn’t feel right. Remember that you have an increase in blood volume of 40% and your lungs are working harder too (poor diaphragm is getting some resistance!).

There are a few guidelines to follow when thinking about safety for your baby:

  • be mindful of temperature – avoid hot yoga/pilates, saunas and spas and be careful when exercising in the height of summer.
  • don’t scuba dive or water ski
  • don’t do contact sports past the first trimester
  • avoid sports that have a high risk of falls
  • avoid exercises lying on your baby after 16 weeks (the baby can lie on one of the major blood vessels returning blood to the heart.)

If you stick to those guidelines, the risk to baby is incredibly low.

Previously there was some ambiguity about whether or not doing aerobic exercise might lead to women having smaller babies. A recent literature review in the American Journal of Obstetrics and Gynaecology showed that women who exercise regularly did NOT have smaller babies and were NOT more likely to go into premature labour than those that didn’t.

4. What is the best kind of exercise to do?

My personal view is that the best kind of exercise that you should do in pregnancy…is one that you enjoy, that makes you feel good and is convenient (ie that you will actually do!).

The most common forms of exercise are probably walking, yoga, pilates, swimming, hydrotherapy and gym exercises.Pregnant woman standing on one leg

Current guidelines recommend that you try and fit in 150 minutes of moderately intense exercise per week, preferably with a combination of aerobic and strengthening exercise. We use the “talk test” to monitor intensity – if you can continue with a conversation, you are working at a good level. If you are so breathless that you can’t talk, then you should back off a bit.

I think group classes are fantastic in pregnancy, as the psychological benefits of exercising with other women who are pregnant are fabulous and the instructor can guide you through appropriate exercise in pregnancy. A good instructor will also be able to adapt the exercises to accomodate wrist pain, pelvic pain or any other specific requirements that you have.

5. Is exercise in pregnancy good for the pelvic floor?

Great question…and the answer is “it depends!”

Generally speaking, exercise is good for pelvic floor muscles. Inactivity and obesity are both significant risk factors for things like prolapse and incontinence.

If we talk about pelvic floor exercise itself, there is pretty good evidence for doing specific pelvic floor training in pregnancy. Some studies have shown that it can significantly reduce the risk of having incontinence during pregnancy and after birth.

But what about other types of exercise? What we have to take into account during pregnancy are the hormonal changes that occur in the muscles and connective tissue, as well as the increase weight of the baby sitting on those tissues. Some women manage to run, jump and lift during pregnancy without issues. Others find coughing to be enough pressure to cause leakage.

So what do you do? If you are having any issues related to the pelvic floor, such as pain, heaviness or leaking of urine/faeces, then you should go and see a Women’s Health Physiotherapist. They will check the function of your pelvic floor and guide you as to the best exercises for you. You may even have an overactive pelvic floor that needs relaxation, so this individual management is best.

For those who are not having any pelvic floor symptoms, monitor your body and continue exercise if it feels good. Any of the above symptoms are signs that the pelvic floor is not coping with that load, and it needs to be reduced or the technique adapted. I recommend avoiding a breath hold when lifting weights. Use the exhale and pelvic floor activation through the challenging part of the lift, and get your technique assessed if you are not sure.

Want to learn more about exercising in pregnancy?

Head to our Pregnancy Club (link) where you can sign on and receive regular exercise programs and education sessions specific for where you are at in your pregnancy.

These exercise programs have been designed by a physiotherapist and include adaptations for common issues in pregnancy.

Pelvic Organ Prolapse – is it all about the diagnosis?

I was recently challenged by my buddy Antony Lo (aka the Physio Detective) to do a 5 minute video on the Biopsychosocial model and how it influences the language that we use with our clients. Although I was free to choose any topic that I liked, my brain immediately went to pelvic organ prolapse.

Why? Because I see women crushed by this diagnosis. I see the mixed messages that they receive. I hear their distress.

I’m perplexed that when it comes to low back pain, the biopsychosocial model (which takes into account multiple factors that can influence our health, well being and pain) seems to be in full effect. But when it comes to POP, we seem to be still just talking about the muscles, ligaments and organs. Do they not live inside a living, breathing, feeling human being?

 

To say that talking about this in under 5 minutes was impossible is evident by the fact that I did it in 7 minutes …and I feel like I barely scratched the surface!

Check it out and tell me what you think! What have been your experiences as someone living with POP? Or if you are a health professional, how do you think your communication influences your client’s experience with POP?

 

Watch the video on YouTube: https://www.youtube.com/watch?v=3U-hZe5uaIQ

What you need to know about the early days post C-section…

C-section recovery advice is often pretty rubbish. It just amazes me that my clients get given a couple of token exercises and then are told

  • don’t lift anything for 6 weeks (ummm…what about my baby?)
  • don’t drive for 4-6 weeks
  • after 6 weeks, just “gradually get back into doing what you did before”

 

Now, as someone who has worked with literally hundreds of new mums, I get that it is difficult to give more specific guidelines. Some women find that they have minimal pain after a c-section and are up and about quite quickly. Others have a lot of pain and find that their day-to-day activities are a real struggle. There is no one answer.

But I reckon we can do better.

Let’s just think a little bit about tissue recovery first.

So let’s go through the first 6 weeks

But first, let’s just take into account the actual surgery itself. We’ve got some superficial skin cuts to heal, but also the deeper layers of the abdominal wall. The linea alba (the connective tissue between your 6-pack muscles) is separated, but often not stitched back together. Now mother nature does do a wonderful job at scarring this tissue back up again, but I’m fairly certain that that tissue isn’t back to normal strength by 6 weeks!

In these early stages we want:

  • lots of rest. I don’t want to get all preachy here ladies, but you’ve GOT to rest in the early weeks wherever possible. Listen to your body and don’t feel guilty about lying down and putting your feet up (literally!). Pregnancy, labour (some will labour prior to having c-section), surgery, general anaesthetic, sleep deprivation, feeding your baby, hormones ….woah, that is a LOT for someone to go through. So please please please…give yourself the time and space to rest and heal. I find that women actually recover FASTER by starting out SLOWER!
  • optimal breathing patterns. I find that many women have altered breathing patterns postnatally (well – at any stage of life, but definitely postnatally!). I do think part of this is due to the changes that occur during pregnancy – the rib cage lifts and separates, and the diaphragm is pushed up by the baby, placenta, extra fluid etc! After birth, it can take a little while for the rib cage to settle back down again. Also, postnatally many new mums like to suck their tummies in! Yes, yes I get it – we all look a little pregnant after giving birth and the temptation is to pull your belly in. But you’ve gotta let it go, mamas! Tensing your abdominal wall makes it very difficult to breathe naturally and may put more pressure down through the pelvic floor. Discomfort after abdominal surgery can also make people nervous about taking deep breaths, but these are super important for our lungs and should definitely be encouraged! So try taking different types of breaths – feel your tummy move, feel your rib cage move, take shallow breaths and take deeper breaths. Try them all!
  • some effort on posture. Now I don’t mean “sit up straight and pull your shoulders back”. Those that know me know that I am not rigid when it comes to posture. I believe that there are many different variations of posture that are suitable and I don’t prescribe to there being a “perfect posture”. However… post abdominal surgery, the temptation can be to curl up into a ball on the couch in an effort to “protect” the scar. Grow tall through your spine when you are sitting and standing. Change postures frequently. Slumping from time to time is a-okay! Just don’t do in 24/7!
  • some pelvic floor muscle activation. I can hear you thinking, “but I didn’t have a vaginal delivery!” But guess what? You’ve had the weight of the baby sitting on your pelvic floor for 9 months. New mums also have to contend with a pretty physical new role in life – lifting and carrying for the new few years! We need and want good pelvic floor muscle control. In the early few weeks you can try and get some connection happening between your brain and the pelvic floor muscles and work on the endurance of these muscles. Please note that many women have pelvic floor muscles that are too active though, so if you can’t feel a difference between “on” and “off” then go see your friendly Women’s Health Physio!
  • to start some gentle walking…as able.  Many women will find that ten minutes is the maximum that they can handle in one bout when they first start walking. Start with a small walk in your neighbourhood and then gradually increase this as your energy allows. You may find it easier to do two lots of short walks rather than a long walk. If you can get out and about sometimes without your pram, that is a bonus. Get the arm swing happening and feel that beautiful rotation through your spine as you walk.
  • look after your bowels. It is really important that you avoid constipation and adopt good pooping habits early on. Have you seen the Squatty Potty unicorn video? Get yourself a stool (I use the ikea kids stool) to get those knees up high. Make sure that you stay well hydrated (esp if you are breastfeeding). If your poop starts to get hard and cracked, go see your doctor or pharmacist for advice. Do NOT strain to empty your bowels!

  • get moving…gently! Our bodies like to move, so adding some basic movements and stretches will probably make you feel better. This might mean some pelvic tilts and shoulder rolls when you’re sitting down. It might be some of your pregnancy pilates/yoga stretches in standing. Try moving your body gently in all directions and see how you feel.

Once you crack that six week mark, then yes you are probably more likely to be ready for a structured exercise program. But this doesn’t mean that you are ready to jump straight back into boot camp or running!

Want to learn more about creating your exercise program, then contact [email protected]

 

 

Can’t postnatal exercise just be a little more thought out??

Ok, so you guys have all heard me rant a bit about what I feel is inappropriate exercise for the postnatal population. It is always a challenge to get it right – to find the Goldilocks zone, where you are putting good load through the tissues and creating strength and mobility…but not too much that it causes damage.

I spoke to another lady this week who is 12 weeks postnatal and has been doing sessions with her personal trainer since 6 weeks postnatal. She had a c-section, there was no assessment and bam…she was doing running, burpees, crunches, planks…the whole nine yards. Now, I have nothing against these kinds of exercises – as a martial artist and someone who just generally enjoys my exercises being a little more towards the hard-core end of the spectrum, I totally get it. I like to feel a burn. I want to leave an exercise session feeling like I’ve done something.

So ladies, I hear ya. Some of you just want to get a sweat on, to feel that you are achieving something, to feel that you are on the road to recovery. Because it is a recovery – you just went through 9 months of growing a baby and then you birthed it. Any which way your baby came out into the world you still need to recover from that process!

So I jumped in front of my computer (with my new whiteboard – exciting!) and created this little twelve minute video just for you. I hope that you can use it to plan your postnatal rehabilitation. If you need help, drop me a line! I can help you via skype or (if you live in Perth) in person.

 

Gadgets for improving pelvic floor strength, pain and sex life!

Have you seen the cracking articles online these days about pelvic floor strengthening gadgets and tools, made famous (apparently) by one of the Fifty Shades books?

Now I personally am all for women taking control of their sex lives and seeking out knowledge and tools to help them out with this. But…(and it is a big but) how do we know which products are of good quality? How do we know what size we need or what kind of device would suit us best? What do we do if we need advice on how to use our new product?

This week I asked Fiona Rogers, from www.pelvicfloorexercise.com.au  to talk to me about the products that she sells that can help women with a weak pelvic floor, painful intercourse and incontinence. I have to say that Fiona is such an amazing resource and was SO easy to interview. Her decades of experience as a physiotherapist and her passion for helping women was evident in this interview.

(yes, she is holding a vibrator in the photo!)

 

Here is what we talked about:

0.00    Introduction to Fiona Rogers, her clinical experience and her online store (www.pelvicfloorexercise.com.au)

7.16     Who shops at the website? How is it different to shopping on ebay or at a sex shop?

10.25   The categories of products that you can buy on the website.

14.10   Products you can buy that can help you strengthen your pelvic floor.

  • balls, weights, pelvic floor educators, PFX2
  • how to use these products

31.38  Products for those who need stimulation of the pelvic floor muscles (eg nerve / muscle damage or pelvic floor overactivity) – to be used in conjunction with advice from a health professional

33.05  Heavier weights for pelvic floor training (PelviBar)

34.24  For those who like high tech devices (Elvie)

37.20   If you have pelvic pain and need some extra help (dilators, vibrators)

45.30  Comparing different types and brands of lubrication

50.40  For those who have incontinence and need some extra support (Contiform)

52.30  If you have a rectal prolapse and need help emptying your bowels (Femmeze)

 

Please share this post far and wide so that we can let women know that they that these products exist! There is no need to suffer in silence. With the help of a Women’s Health Physiotherapist (and sometimes a device like those shown in the video), women can often get back to doing the things in life that they enjoy…

and have a little fun in the process ;)

The story of my back pain (the hardest blog I’ve ever written)

Ok, so this post has been one YEAR in the making. Yep, a whole year to get myself together to write this.

Every time I have sat down to write about how I recovered from back pain, I have stopped myself.

You see, when you have experienced agonising pain that has affected your job, lifestyle, mood (well, everything)… you never really feel like you’re cured/healed/recovered. There’s always this little part of your brain that tells you “pfff, you aren’t better. It will only take one bad movement and bam…that pain is back”.

You live in fear. Fear of that pain. Fear of that disability.

So I couldn’t bring myself to write about it for such a long time…because I felt that somehow the Universe would say “who the hell do you think you are?” and curse me with another acute episode. Yep, I know how crazy that sounds, but this is what happens to your brain when you have experienced significant pain. It re-wires itself – and not in a helpful way.

But yet here I am. So how did I get to this point? How did I get confidence in my body again? Why do I finally feel like I can write about it now?

I want to tell my story (and it is a long one!) so that perhaps it might help others who are experiencing something similar. Even as a physiotherapist, working with people in pain and knowing something about the science of pain and how the brain works…I still found it really challenging to experience it myself.

But I did get through it and here is my story…

The back story

Marika Corporate

Me in my professional gear ;)

I have been working as a physiotherapist for a fair few years now – mostly in private practice, treating back, neck and knee pain – so it is fair to say that the concept of back pain is not new to me. I had a few acute episodes of low back pain in my younger days (20s!) but never lasting for longer than a few days and usually requiring minimal treatment.

Fast forward a few years (and a couple of pregnancies and births later!) and I had my first episode of severe back pain. Given that my current job is teaching pre and postnatal exercise (it wasn’t back then), I can kind of shake my head at my stupidity in retrospect.

Hitting the slopes with family and friends in Colorado

So, I was about 8 months postnatal…I had been doing some basic postnatal pilates and gentle gym work. We went on holiday to Colorado and I desperately wanted to go snowboarding. Never one to take things lightly, I went hard core – off piste, moguls, you name it.

I was so friggin excited to be boarding again – nothing was going to hold me back! Unfortunately my body didn’t react so well from this workout and I couldn’t move for about 3 days. Literally couldn’t walk (challenging looking after a little baby, but luckily I had lots of family with me at the time!).

Things settled with time, gentle exercise and movement…and I felt pretty normal again within a few weeks.

After we moved to Melbourne, I decided that I missed my old Taekwondo life and found an amazing school that enabled me to jump back into it (about 18 months after number 2!).

With Master Spiridon Cariotis – USMA Melbourne– achieving my Second Dan in ITF TaeKwonDo

I found it challenging physically, as I had taken 11 years off martial arts and had had a couple of babies – my flexibility was poor and my core strength was…well, not great. Even though I taught pilates at a sports medicine clinic at the time, I found it hard to find time to do much for myself. I worked part-time, had two small children, no family nearby and a husband who worked away a lot. It was difficult to prioritise myself (something I hear from my clients all the time!).

But I LOVED TaeKwonDo – I loved the movement, the intensity, the people, the philosophy. I worked hard, I sweated, I burned and I smiled.

Bit too far away ;)

I somehow found myself competing in some tournaments. Even though I didn’t know the rules and perhaps lost a few points on penalties (you aren’t allowed to grab people’s legs and sweep them…I must have watched too much Karate Kid!), I managed to win the sparring in my first ever tournament! It was the Victorian championships and most of my competitors were at least 10-15 years younger than me (and much fitter), so I was stoked to come away with the gold … (plus some bruised ribs).

 

The Big One

As with many people with back pain, I had one episode that eclipsed all others. One that dropped me to the floor. One that stopped me sleeping, had me taking strong medication…one that made me cry.

Selling a house while still living in it with two small children = stressful!

In retrospect, of course I can see how all the pieces of the puzzle slotted together to create the perfect storm. We had just auctioned our house in Melbourne (HUGE amount of stress getting everything perfect for that) and we had purchased a house in Perth and were moving our life there. The Dockers had just lost the Grand Final of the AFL (ok, not so relevant but may have added to my mental state!).

I had made the Australian team for the World Championships in ITF TaeKwonDo! I had booked my flights to Rome and had chosen a club in Perth to train with. I had enrolled my daughter into her new school and started to settle into life here. Oh..and I decided to start a new business teaching pre and postnatal pilates.

Yeah…to say that it was a stressful six months is an understatement.

So one weekend I did a myofascial release half -day course. We foam rolled and stretched – my back went into positions that it hadn’t for a long time. It felt a bit sore, but wasn’t too bad.

I drove straight to a three-hour training session after that. We did heavy kicking on bags – I basically tried to kick a 100kg male from one end of the gym to the other. I felt sore, I stopped. That night my back felt pretty darn achy.

The next day I tried to ride my bike. As I went to push down on my pedal with my right leg, something went “clunk” and I couldn’t move. I was stuck straddling my bike by the side of the road, trying to yell at my husband to come and help. I literally couldn’t lift my leg over the cross bar.

I went home and cried. Took some anti-inflammatories, rested and did some gentle movement. I was devastated. I felt that Rome was out of the picture. I worried that I wasn’t going to be able to teach pilates in my new business. I was also doing a locum for a sports physio clinic – would I be able to work? How was I going to get the kids to and from school. I felt sick with the stress and the pain. My physio thought I had a stress fracture and wanted scans. I didn’t want scans as I knew that I would have degenerative changes (because pretty much everyone does!) and I thought they would impact negatively on my recovery. Long and short of it – I had scans, there was no fracture and of course there were degenerative changes.

I had treatment on my back over the next few months – I had manipulation, acupuncture, massage and craniosacral treatment. All helped a small amount. I felt better bit by bit and week by week…but it was slow going. Every day I would have a few episodes where I would move and an electric shock would shoot through me. It would take my breath away and kept me on edge. I pulled out of the World Champs…and cried some more.

Perth has so many beautiful places to walk!

I could sense that my anxiety about the pain was really ramping up my nervous system and I needed to do something to calm it down. So here’s what I did:

I started walking mindfully. Sounds weird I know, but I just put my headphones on and walked down to the river.I focused on my arm swing first – and I noticed it was completely asymmetrical. My right arm pretty much didn’t move! So I got my swagger on (as Robin Kerr – physio extraordinaire calls it!) and felt my thoracic spine start to move again.

I learnt to breathe again. Yes of course I was breathing …but I was so tense through my abdominals that my belly didn’t move! I learnt to relax my abs and get my lower ribs to expand. This style of breathing helped calm my mind and my body (and I’m sure I got better oxygenation as a result!)

I danced. I had a friend’s wedding during this time. I remember

At a friend’s wedding, I found that dancing really helped my pain.

going out to buy some flatter shoes as I knew that I wasn’t going to be able to manage heels! At the wedding I felt consumed by thoughts of my back. I worried that I wouldn’t be able to sit down. I couldn’t concentrate on the conversations around me. Then the music came on…

Once a started dancing, I felt things start to ease. The rhythmical movements soothed my nerves. The pelvic tilting and weight shifting eased my spine. The endorphins released by having such a great time with my friends and moving with the music calmed my soul.

I started dancing more at home with the kids. We put on funky tunes and just grooved away in our living room (yes, we still do!).

With two of my buddies from TKD

I got back into TaeKwonDo. This was a big challenge. I was really nervous about starting up again, but I have wonderful instructors at Platinum TaeKwonDo who supported me and encouraged me to come along and just do whatever I could. They knew that it was important for me to build my confidence again, but to also be surrounded by my friends in the club. Those who have experienced pain, know all too well how isolating it is to be removed from the social circles that are linked to physical activity.

So I started up again really slowly (it was many months after the “big one”) and realised that I was ok. Sure some days I ached afterwards, but I didn’t get crippling pain. Yes I couldn’t sprint or kick high, but that was ok. I was there. I was moving. I found ways to move that weren’t painful….and I did more of them.

One of the great things about martial arts, yoga, qi-gong and tai-chi are the sequences of movement. In TaeKwonDo we call them patterns. In Karate they are called katas. They can be almost meditative in nature, depending on speed and focus, and I certainly found them helpful in my recovery.

I challenged myself. When we were putting our new pool in, we had to move wheelbarrow loads of cement from the front to the back of the house (via a ramp that went down a few steps). My first thought was “I can’t do that, it will hurt”. I took a few minutes to think about it and realised that I was completely capable of the task and I gave it a crack. I was tired, but fine. I learnt so much about my body that day – I was NOT broken!

Beautiful trails in Dwellingup, Western Australia.

So we tried hiking. I just carried a smaller pack (poor hubby carried the big one!) and just did about 20km in 2 days. Sleeping on a hard surface was pretty uncomfortable and I woke up stiff and sore. But guess what? I was fine!

I went mountainbiking  – well, no real mountains in Western Australia, so let’s just call it cross-country cycling! I was a bit nervous about the bumps and how it might jarr my spine. I reminded myself that if I tensed up, I was not going to be a good shock absorber, so I chilled out and had a brilliant time.

I started to lift. I really felt that if I wanted to continue doing TKD (and certainly if I wanted to get back into competing), then I needed to be a LOT stronger. I contacted an exercise physiologist (Tristan Hellings) and started doing weights at home. At first, I was kinda shitting myself (technical term) at the thought of deadlifting…especially off the floor. But I started with light weights and soon afterwards could easily pull 40kg off the floor. The knowledge of that achievement gave me great confidence. If I can lift 40kg easily off the floor, then I certainly can lift the laundry basket without too much difficulty!

The snow in Japan is so forgiving… very different to the icy roads in France that I learnt on!

I asked Tristan for a snowboarding program around 12 weeks out from a trip to Japan. Believe you me, I was focused on being in great condition for that trip! I worked hard in my home gym and managed to snowboard 10 days in our 14 day holiday (I still can’t believe it – really grateful that our kids loved the snow!). Again, my back was great. I had so much more strength through my whole body and I felt relaxed. It was amazing!!

I did a course with the amazing Antony Lo (Physio Detective) who further not only challenged my thinking, but taught me some strategies for how to use alignment, deep muscle activation and breath in lifting (#spreadtheload).

Do you notice a theme here?

Do you see that for every new thing I tried, I had to overcome my own fear and limiting beliefs? I had to try the movement and prove to myself that I wasn’t broken. With every new thing that I tried, my confidence in my body grew and grew.

So where am I at now?

Well, it’s now three years since the “big one” and I continue on. I do TaeKwonDo and I have my sights set on the World Cup in Queensland in 2018. My plan is to build up my muscle strength and power so that I can increase my kicking speed.

I’m keen to try CrossFit and have been working on my lifting technique in order to be able to do so safely.

I no longer live in constant fear of pain. I can play soccer in the backyard with my son without discomfort. If the kids want to go for a ride on their bikes around the river, I am happy to jump on mine without thinking twice.

We are planning a hike in New Zealand at the end of the year, plus another ski trip to Japan (I need to work my butt off this year to earn some money for these holidays haha!).

I have to continue to work on my breathing and relaxation techniques every day. I try and make sure that every week I do something for myself that is enjoyable, whether it is coffee with friends, reading my book outside or going for a walk.

And I use this experience to help my physiotherapy clients. I see women every week who have pain during pregnancy or the postnatal period and I can truly empathise with what they are going through. I help them manage their pain and find ways of moving comfortably.  I have just started working in a personal training studio in Perth and I love seeing people achieve goals that they never believed were possible – whether it is just moving without pain or running a marathon.

I can’t say that I am never going to experience pain again. I probably will, because I am alive! But I no longer live in fear everyday, and I now feel that I have the tools to manage the pain if it does return.

 

Exercise for gestational diabetes – the essentials

This week I had the pleasure of interview Esme Soan, an exercise physiologist from Brisbane (Australia) about the role of exercise in the management of gestational diabetes (GD). I know from my research and from my client’s experiences, that exercise can be VERY beneficial (in addition to dietary changes) for women with GD. But what KIND of exercise is ideal? HOW MUCH? HOW INTENSE? HOW OFTEN? These are the kinds of questions that people want to know the answers to.