This post follows on from our post on Pelvic Floor Exercises, Are you doing them correctly? Once you have mastered your technique and are engaging the right muscles, you might be wondering what exercises you should be doing and how many. Remember, we always recommend having an internal exam from a Women's Health Physiotherapist so you know how your pelvic floor is performing but here are some general guidelines on the types of exercises that can help and how many we should be doing. If you are in Brisbane, we have a list of pelvic floor physios here.
Ideally our pelvic floor should react to various real life situations. We should therefore train our pelvic floor in different ways and in different positions. You can do these exercises lying on your side, on your back, kneeling on all fours (cat position), while sitting, standing or while walking. Here are 5 different exercises women should be using for their pelvic floor:
1. Lift and Hold
While coordinating your pelvic floor lift with your breath, lift and hold for up to 10 seconds while continuing to breath. You may only be able to hold it for 2 seconds to start with but once you feel like you are no longer holding the lift, relax, rest and try again. Gradually over time, with consistent training your endurance will improve.
2. The Quick Flicks
Lift then relax (don't hold the lift at the top). Repeat 10 times.
Imagine you are going to sneeze and you have to lift your pelvic floor quickly before your sneeze.
3. The Elevator
When your pelvic floor is fully relaxed it is on the Ground Floor. As you exhale gently and slowly lift your pelvic floor to Level 1, Level 2, Level 3 then as you inhale slowly lower you pelvic floor back down through the levels, Level 2, Level 1, Ground Floor. Remember to fully relax your pelvic floor for 10 seconds before attempting another set.
4. Relax it!
We have said it before, but we will say it again. Being able to relax your pelvic floor is just as important as being able to contract it. We want our pelvic floor to have a wide range of motion. Here are three great pelvic floor mobilisations to help your pelvic floor chill out. A great relaxation exercise is to lie on the floor with your feet up the wall (bottom will be up against the wall). Be warned though, if you have a crawler or toddler in your house you might want to do this when they are asleep as they will see it as an invitation to lie on your face!
Squats can be a great exercise for your pelvic floor. Let's compare it to a bicep curl. As you straighten your arm, the muscle stretches, and as you bend your arm to lift the weight, the muscle shortens. This is the same action that happens to the pelvic floor as you squat. As you descend in a squat, you stretch/lengthen the pelvic floor, and as you rise back up, the pelvic floor shortens. And not a single kegel in sight! The trick though is in the squat technique. You can read more about pelvic floor activating squat technique here.
How many Pelvic Floor Exercises should I be doing?
Treat your pelvic floor like any other muscle group. If you were wanting to strengthen your biceps you wouldn't do a set of bicep curls in the morning, then one at lunch and one at night. You would do all of your sets in relatively close duration. Treat your pelvic floor exercises the same way.
General pelvic floor guidelines:
Technique No Nos
Want to know more?
Our friends at Pelvic Floor Exercise have lots of info on pelvic floor health and also sell a range of devices to help with pelvic floor strengthening and incontinence management. Of course, it is best to see your local pelvic floor physio so you can have a full assessment first. You can find a list of Brisbane pelvic floor physiotherapists here. You can also find useful information at the Pelvic Floor First website. Your Go Mum trainer can also work with our physio to ensure your workouts are safe for you.
The guidelines above are of a general nature and may not be right for your specific situation. Please see a women's health physiotherapist.
If you would like more postnatal exercise tips and to connect with a group of like minded mums, then join us in our closed Facebook group.
If you have been pregnant, then chances are at some time in your pregnancy or postnatal journey you have been advised to do pelvic floor exercises (aka kegels). In my role as a postnatal trainer I follow up with PT clients on how they have been going with the pelvic floor exercises they have been prescribed by their physiotherapist. Nine times out of ten I hear "Good, but I haven't been doing them as often as I should". This is usually code for, I haven't been doing them at all! I get it, I have been there myself. But the reality is, if you want it fixed, then you have to do the work, and consistency is key.
In my experience, there are two main reasons why women don't do them regularly:
In this post, we are going to show you a clever trick to help your brain connect with your body to maximise your pelvic floor exercise training.
We are going to use our breath along with a visualisation of a peanut and an elephant. Yep, an elephant. Here is how it works:
1. Get into position. You can do this sitting, standing or kneeling on all fours, but for beginners it helps to lie on your back with one hand on the side of your ribs and the other on the middle of your belly. Try to rest your elbows on the floor and relax.
2. This is where the elephant comes in. An African elephant has two 'fingers' on the end of its trunk that it uses to pick things up (an Asian Elephant only has one finger so he is no good for this exercise). Visualise that your back passage (anus) and front passage (vulva) are the lips of the elephants trunk.Still with me?
3.As you inhale just relax your pelvic floor and breath into your ribs (letting them expand out to the sides) and gently into your belly.
4. As you slowly exhale, close your anus and vulva as if you are trying to pick up a peanut with your 'trunk' then gently suck the peanut up your trunk (pelvic floor lift) as you continue to exhale. It is important to relax your buttocks and tummy. There should be no contraction of the buttocks or six pack during this exercise. You may feel a very slight tension between the hip bones, this is OK (this is your transverse abdominis engaging).
5. Inhale, and let everything drop down again.
So to recap, here is the wording to help talk you through the exercise. "Inhale, relax. Slow exhale, close front, back, pick up the peanut and suck it up, inhale relax." Repeat 4-5 times.
So how did you go? Now, if the elephant doesn't float your boat, you can try other visualisations and find one that works for you. Here are a couple I have heard of:
If you are having trouble feeling any contraction or relaxation through your pelvic floor, it is definitely worthwhile making an appointment to see a women's health physio that does internal exams so you get a good idea of where your pelvic floor is at.
Keep an eye out this week for other follow up posts on pelvic floor exercises such as:
About the Author
Christine is a pregnancy and postnatal trainer with a passion for pelvic floor and abdominal safe movement. Her interest in this area was sparked after her own battles with prolapse and diastasis.
If you have any questions about postnatal exercise or exercising with prolapse or abdominal separation feel free to contact Christine.
Our Go Mum trainers love connecting with women's health physiotherapists both in Brisbane and around the world. One of our favourite local physios has written this article on one of our biggest pet peeves. Thanks Bronwyn!
I have a small confession to make.
I tear pages out of magazines in waiting rooms. And it’s not because they are articles about how to look 30 when you’re 55 or the latest on Angelina or even 101 recipes with quinoa.
I rip out advertisements about continence pads for ‘Light Bladder Leakage’ or ‘LBL’!
You know the ones: ‘It’s okay women – leaking is fine – just wear a pad’. And the models in these ads have been getting younger and sexier - no longer is it only the ‘senior’ looking lady! Now it’s younger women in tight dresses. Disclaimer: I have nothing against continence aids. It’s the normalisation of incontinence that makes my blood pressure rise.
Have you noticed how subtly in the feminine hygiene aisles at the supermarkets, products progress from tampons and menstrual pads to continence pads? LBL is being used to normalise a very real problem.
Here is my advertisement: leaking urine is never fine, never okay, never normal. It is a sign that something is not quite working to its full potential in the pelvic area of the body. That wonderful hidden part that contributes so much to our quality of life. It is often a sign of pelvic floor dysfunction.
As a physiotherapist with a special interest in pelvic health, I care a great deal about those bits ‘down there’ and their impact on women’s health.
How should a normal bladder behave?
Well we should have the ability to control the functions of our bladder and bowel throughout all stages of life. This is continence. Incontinence is any loss of bladder and bowel control, irrespective of amount or frequency.
Here is a breakdown of the facts: normal bladders should hold approximately 500 mls. Each emptying of the bladder is 350-700 mls of urine. We wee four to seven times a day and may wake to go once at night.
Going to the toilet should not be urgent – rushing off, feeling you can’t hold on – nor frequent (going to the toilet more often than outlined above). The bladder should fully empty with a strong, continuous stream and no strain. And there should no urinary leakage. Yes, that’s right, you should be able to jump on the trampoline with the kids!
Your bladder should be functioning efficiently in the background. So if you have read the above paragraph and can’t recognise your bladder, you may have a problem.
What should you do?
Well consulting with a physiotherapist experienced in pelvic health is a great starting point. This involves detailed history taking and assessment of what exactly is happening for you. Treatment is based on your individual needs and may take three to four appointments over several months. And there is good research to prove it works!
Now, while I’m not advocating carte blanche magazine destruction I am suggesting that next time you are in a waiting room, spend some time thinking about your bits ‘down there’.
About the Author
Bronwyn Jest is a physiotherapist with a special interest in Women's, Men's and Pelvic Health.
Bronwyn has a positive approach to pelvic health concerns and is passionate about getting the message out that these issues can be treated effectively and people should not have to suffer in silence.
She provides management for bladder issues: stress and urgency incontinence, pelvic organ prolapse, bowel issues: constipation, urgency and incontinence ,sexual dysfunction and pelvic pain, guidance for pelvic floor safe exercising, problems during pregnancy and after childbirth, advice before and rehabilitation after gynaecological and other pelvic surgery including for the bowel.Bronwyn works in her own private practice at Chermside - www.bronwynjestphysiotherapy.com.au
When not working, she enjoys exercising, reading, music, admiring (and collecting!) pottery, swimming at the beach and spending time with her husband Martin and three adult offspring.
Squats are a movement for life. We have opportunities to use them in everyday activities and are vital to remaining active as we age. My love affair with the humble squat started during my recovery from prolapse surgery. I was still having incontinence issues and didn't see any significant improvement until I got my squat technique right. I was hooked.
Here are the main physiological reasons why squats are a MUST DO exercise.
Check back this week or join our closed group on Facebook for more tips on tuning your squat technique.
Should you go to the toilet “Just in Case”?
The answer = A BIG NO!!
A bladder, when functioning normally, gives us two signals to go to the toilet. The first is the “gentle warning” that gives us a vague sensation that we need to go and you can think of this as your “warning system” that within the next hour or so, you will need to find a toilet. We can resist this first urge if our bladder is healthy. The second signal is a stronger and urgent feeling low in the abdomen, that tells us we need to find the nearest toilet asap.
If you go to the toilet “just in case”, you are emptying the bladder before either of these signals have occurred. If you do this frequently, and over an extended period, the bladder becomes used to this lower threshold for capacity and the “I’m full” signal will be sent sooner and sooner. Hence, it becomes a vicious cycle of you emptying when you don’t actually need to, and your body telling you that you need to empty when the bladder is at low levels.
What you should do if you feel your bladder control is not what it should be:
Seek help: A physiotherapist with pelvic floor experience can give you the education you need and discuss your individual circumstances!
When you feel the urge to go….ask yourself if it is a “warning” and if you can, try to hold or distract yourself and the urge may pass. A legitimate “I’m full” signal will NOT pass. When you empty your bladder, always sit down and fully relax (close the door because the you know the kids are going to come in with a crisis the minute your pants are down!). No hovering in public toilets by the way! Ensure that you fully empty your bladder by relaxing your tummy and pelvic floor.
Caffeine, alcohol and fizzy drinks are all bladder irritants so you may want to cut back on these.
And please, let’s not teach the next generation of little girls to go to the toilet “just in case” before they leave the house. You will be doing them a huge favour!
About the Author
Kate Boucher is a physiotherapist with over 14 years’ experience and mother of 3. She is a strong believer in a comprehensive, integrated approach to health. Kate enjoys working with mothers both pre and postnatally – whether it be to treat back and pelvic pain and instability or in addressing pelvic floor and core strength. She also understands the desire some have to return to high level sport and exercise and has intricate knowledge in establishing safe pathways for these goals to be reached.
You can find Kate at Go2 Health at Everton Park.
*Names have been changed to protect the innocent and the guilty.
Today I was horrified by what one of my clients told me. So much so, I haven't been able to think about anything else since, and I am now writing this article madly before school pick up when I should really be tidying the house and prepping for dinner. But the need to get this off my chest trumps domestic duties.
Cassie* was contacted recently by a major women's fitness franchise (you can probably guess which one) because a friend had listed her when they joined up as someone who might be interested in joining. Nothing unusual about that, it is common practice in major gym chains. The sales person (which turned out to be the owner of the gym) asked my client if they had any concerns about commencing exercise at the gym. Also not unusual and a responsible question to ask. The shocking part was to come. Cassie informed them that she had some pelvic floor issues and needed to adjust her exercise accordingly. So here is the bit that freaked me out...the sales person told her to do some skipping to strengthen her pelvic floor. Oh the horror!
So here is why I have got my knickers in a twist:
1. There is no text, course, seminar or Google Search I have done on pelvic floor safe exercise the suggests skipping as a strengthening exercise, EVER. Skipping is a high impact exercise and listed in the "Exercises to Avoid" Section of the Pevlic Floor First website by the Continence Foundation of Australia.
2. This advice was given over the phone without any knowledge of Cassie's medical history or a pelvic floor assessment.
3. This is a major franchise whose target market is women. It is estimated that 1 in 3 women experience pelvic floor weakness so they really should be making pelvic floor safe exercise a priority.
Before I started writing this blog article I posted Cassie's experience on a Facebook Group that is made up of trainers and health professionals that have a specific interest in pelvic floor safe exercise. I wanted to make sure I wasn't crazy and hadn't missed some recent research on skipping and the pelvic floor. The members of this group were also horrified but not entirely surprised. There comments speak for themselves:
"Wow. Just wow. I can feel myself prolapsing just thinking about it."
"Yep, horrified, but I've heard it before."
"That is pretty bad conduct and you have the right to be terrified. There is no excuse to give such advice - and over the phone - in today's information rich world. Especially in a ladies gym...oh dear..."
The saddest thing in my eyes is that it isn't entirely the salesperson's fault. Education on the pelvic floor is not included in the Cert II or Cert IV in Fitness in Australia and from the feedback I received today it is the same in other many other countries (except France, they have really nailed postnatal care). As both men and women have a pelvic floor and both sexes can sustain damage from improper exercise technique, there is no reason why this information should only be limited to women's focused fitness education. Here is what some of my Facebook colleagues had to say about pelvic floor training in the fitness industry:
"I have a degree in Exercise Science, multiple certs and courses. But it wasn't until I went through rehab with The Tummy Team nearly 6 years ago that I started really learning about the deep core. I went home and cried. I screamed in my car. And I hear the same from women around the world when they first figure all this out. It's slowly starting to shift. Slowly."
"The reality is that we aren't given enough knowledge in our fitness courses about safe pelvic floor training methods...unless we are curious enough to do research about the subject...we wouldn't know anything about pelvic floor from the fitness course programs, that's the root of the problem. And that's why we hear these sorts of comments...not enough knowledge."
"This is exactly why I would love to see every women's only gym being represented at the Women's Health and Fitness Summit. They need to be there. They need to be SEEN there."
So there are a few ways we can approach this problem and ensure more women get the help they need, don't live with incontinence unnecessarily or create a prolapse.
If you have a story, opinion or solution related to this topic, we would love to hear it.
By Samantha Cattach - Physiotherapist
Pelvic Pain is a common condition that a lot of women experience during and after their pregnancies. This is due to the numerous physical changes that occur in your body, most notably:
• Hormonal changes leading to ligament laxity (particularly around the pelvis).
• Increased load and weight around the abdomen as your baby grows.
Like everything in this world, you don't get something for nothing, and in this case, the trade off for more joint mobility during pregnancy is usually less stability and this can lead to pain if the surrounding musculature is too tight, or unable to provide adequate support to the joints. Without a strong, stable core, well functioning pelvic floor and gluteal muscles, the added load of a growing baby can pull your pelvis forward, out of an aligned posture and increase the stress on your spine and pelvic structures. The position of your baby can also be a factor if they are putting direct pressure on sensitive tissues and nerves.
The most common types of pelvic pain that I see as a Women’s Health and Perinatal Physiotherapist are:
• Sacro-Iliac Joint Pain (toward the back and either side of the spine and sacrum)
• Pubic Symphysis Dysfunction (pain right at the very front of the pelvis)
• Tailbone Pain (often most painful when sitting or getting up after sitting for a certain amount of time)
For some, the lower back, hip, and pelvic pain is very quickly relieved after baby is born! But for others, pelvic girdle pain can be a lingering issue that can have a huge impact on their lives as a new mum.
So, you may be asking yourself - I thought it was just supposed to happen during pregnancy! Why am I in pain postpartum?
Post-natally, the deep core muscles of the abdomen and the pelvic floor often need a bit of time and attention in order to recover from the incredible feat of carrying and birthing a baby. This can mean that your still extra-mobile pelvis (the hormonal effects of pregnancy on the ligaments can last up to 12 months or until you have finished breastfeeding) has potentially less stability at this time. In addition to this, there are a lot of new duties and often awkward positions required as a new mum - like lifting your baby out of low cots, car seats and prams, and carrying your little one (and the car seat AND the nappy bag all at the same time).
It is important to know that pelvic pain is not normal and does NOT have to last forever!
So, how do you fix it?
1. Move Well!
Learning how to move well and carry your baby in a way that facilitates a strong core is key. Try to set up your environment in a way that doesn’t require you hold sustained or awkward positions. For example:
• Ensure your baby’s changeable and cot is at an appropriate height for you
• Consider kneeling on the floor to change nappies
• Avoid trying to be superwoman and carrying everything from the car to the house at once - make separate trips for baby and for the car seat/carriers/groceries/nappy bag if you need to
• Avoid slouching or slumping while breastfeeding - find a comfortable set up that helps keep your spine long and neutral, and bring your baby up to you with pillows to avoid hunching down to them
2. Check Your Alignment!
Start to pay attention your alignment while standing and holding your baby:
3. Restore muscle function and strength
Specific exercises to help restore balance to your muscles and symmetry to your pelvis can also be very helpful in relieving pain, as can strengthening the muscles that help to provide support and stability to these joints. In my experience, a lot of women with pelvic floor issues and pain actually have muscles that are dysfunctional because the are too TIGHT, not that they are just weak. Therefore, simply doing pelvic floor Kegels and abdominal exercises is not necessarily the best way to strengthen your deep core muscles, and in some cases can actually cause more harm.
If you are experiencing pelvic pain, my recommendation is to see a Women’s Health or Perinatal Physiotherapist who can assess your pelvic floor and core, help you relieve your pain and restore your function effectively.
Please feel free to contact me with any questions by visiting my website here: www.bodyandbirthphysio.com
Sami Cattach is a Women’s Health/Perinatal Physiotherapist and Restorative Exercise Specialist who practices out of her studio, Body & Birth Physiotherapy in Paddington, and provides home visits around Brisbane. You can visit her website www.bodyandbirthphysio.com and connect with her on Facebook at www.facebook.com/bodyandbirthphysioaustralia and Instagram at www.instagram.com/samicattachphysio
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