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.
To plank or not to plank, that is the question.
So what is the answer? Well, the answer is..... it depends.
Planks are a popular core exercise in the fitness world and are done by many mums in the belief that planks will build their core strength and flatten their tummy after pregnancy. Unfortunately, this may not be the case and they could be doing more harm than good. First of all, let's move away from exercises being bad or good and think about what happens to our body during the exercise and what that means for the postnatal mum.
Planks create a lot of pressure within the abdomen. Especially if we are holding our breath during a plank! This pressure pushes down on our pelvic floor and our abdominal wall (a big problem for those with abdominal separation (diastasis recti). So this means we need to effectively manage this pressure in order to do a plank safely.
There are some people that should definitely avoid doing a traditional plank. If you have abdominal separation or prolapse there are lots of other core exercises we can get you doing that won't aggravate your condition. Remember to exercise for your weakest link.
So how do you know whether you are ready for planks? Here are some key things to look out for when doing a plank:
Join us on our closed group (Go Mum Community) where we will be looking at different ways to plank that take into consideration various postnatal conditions such as diastasis recti, carpel tunnel and pregnancy.
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.
If there is one exercise to master, it is the squat. Chances are, as a mum, you have an abundance of opportunities to squat in daily life, so let’s maximise this opportunity for some great glute activation while connecting with our core and pelvic floor in an optimal way.
Here are my top five tips for getting the most out of your squats:
This can be a rather personal thing when squatting. People have different shaped hip sockets that can make some squats more comfortable than others or allow some people to have greater range in a certain stance than others. Most people prefer to have their feet at shoulder width, if not a little wider. Also, you may find it more comfortable to turn your toes out slightly which will allow for the weight to be in the heels and a deeper range of motion. It is also recommended that women with prolapse use a narrower stance so that the pelvic floor isn’t as stretched (and compromised) during the movement.
How we breath when under load has a big impact on our pelvic floor. For our squats we want to inhale on the way down and exhale on the way up. It will give you more power as you come up and help lift the pelvic floor rather than pushing down on it during the exertion part of the movement.
3. The Movement
There are usually two errors I see made with posture during the squat. Either mums tip forward too much when they come down into their squat so they are hinging at the hips, or they are keeping too upright and flaring their ribs out with an arch in the lower back. Think about staying tall as you squat but keeping your ribs down. Also, aim to keep your knees behind your toes as you squat down and push through your heels to come up.
When I was first being trained as a PT at 16 years of age, my mentor was big on visualising the muscle/s you are wanting to work. It stuck with me and is possibly why I have always had the ability to activate a muscle on request. Very handy at the physio. Here is a visualisation for your squats. As you descend into the squat inhale and imagine the weight being back in your heels, as you exhale visualise pushing down through your heels, lifting up through the pelvic floor and squeezing the buttocks.
5. Exercise selection
There are a plethora of squat exercises to choose from so you are bound to find some faves. Narrow squats, sumo squats, split squats (aka lunges), single leg squats, etc, etc. Listen to your body, check in with your pelvic floor and pick the squat that feels good for you.
When I attended the Women's Health and Fitness Summit in September I attended a Spin Session for instructors which prompted me to research further into cycling and the pelvic floor. Here are some of the tips I picked up to ensure cycling is safe for your pelvic floor.
Is Cycling Safe for a Weak Pelvic Floor?
The short answer is yes, but like all things pelvic floor related, it is not that simple. When you are cycling while seated the seat supports your pelvic floor, a big plus. However, if you are in a spin class or riding on ground that has steep hills, your pelvic floor is exposed to increased pressure. Here are some tips to help you enjoy this great form of exercise while taking care of your pelvic floor.
Make sure your bike fits your body
Making sure your bike fits your body is the first step, so here are some tips to have you sitting pretty:
Cycling with Pelvic Floor Weakness or Prolapse
Generally, when exercising with pelvic floor weakness/prolapse, the aim is to minimise the downward pressure on the pelvic floor. Our breathing and posture impact the amount of pressure and it is those things we are trying to minimise in our cycling:
What about Spin Classes?
Spinning is a high intensity exercise that can still be enjoyed by women with pelvic floor weakness/prolapse with a few simple modifications. It is a great substitute for running too. So if you are keen to up your heart rate, reduce stress and get sweaty it may be the exercise for you.
Top tips for Spin Classes:
Join our closed Facebook group (Go Mum! Community) for more great training tips and remember to see a women's health physio if you have any concerns about your pelvic floor.
*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.
Mums often list strengthening their core as a priority when returning to exercise after baby. However before you get stuck into training your "core" muscles, there is one simple thing you can do to get you on the fast track to using your core effectively. Breathing!
You take approximately 20,000 - 30,000 breaths per day so it is easy to see how poor breathing habits may impact your health. While the desire to get stuck into core exercises may be strong, if your breathing is dysfunctional you won't be getting the most out of them anyway. Dysfunctional breathing could also make it more difficult to heal a diastasis (abdominal separation) and be putting unnecessary pressure on your pelvic floor.
So What Does Functional Breathing Look Like?
The picture below shows the connection between your diaphragm and the pelvic floor. They move up and down together with each breath. As you breath in, your diaphragm pushes down to make way for the air coming into your lunges and in doing so, pushes your organs down onto your pelvic floor causing it lower also. As you exhale, your diaphragm lifts and so does the pelvic floor.
Ideally, breathing should expand the rib cage in a 360 degree range. Your ribs should go out to the side, front and back to allow air to fill the chest cavity while keeping the shoulders relaxed.
There are three main ways that breathing can become dysfunctional:
1. Belly breathing
This is where the belly expands outwards with each breath (to look like you have swallowed a balloon) with very little movement of the ribs. This type of breathing is particularly detrimental if you have abdominal separation as the connective tissue is being stretched each time you inhale.
2. Chest breathing
This is where you breath high into your chest or shoulders. This is usually a tense, restricted breath that sees your shoulders rising and doesn't allow correct rise and fall of the diaphragm and pelvic floor. This style of breathing is also often related to 'sucking it in' (see below).
3. Sucking it in
If you are sucking in your tummy your breathing is going to be restricted (see point above). The air is going to have nowhere to go. In the video below, Harriet the chook demonstrates what happens to your pelvic floor when you suck in your tummy. Poor Harriet.
An Exercise in Breathing
Try this breathing exercise daily or whenever you think about it.
1. Place your hands around your ribs (like photo) Inhale and try to feel a 360 degree expansion of your lower ribs and into your tummy. Your hands should go slightly further apart.
2. Now exhale for 6 counts and feel your ribs lowering and coming together and tummy deflating. This should bring your hands slight closer together.
3. Repeat 2 x 10 repetitions.
If you have any concerns about your breathing there are osteopaths (and some physiotherapists) that specialise in dysfunctional breathing correction.
What happens when a group of trainers and allied health practitioners get together to discuss women's health? Inspiration, information and a whole lot of fun!
Last weekend I was lucky enough to attend the Women's Health and Fitness Summit in Melbourne. To be honest, this is the second year in a row I have attended and I would sell my left kidney to get there. But fortunately I had enough Flybuys Points to get me there and my sister put me up for two nights so no kidneys had to be sold.
The event opened with some inspiring guest speakers (all of which made me cry like a baby with heartache and happiness for their journeys). A real highlight was hearing Kerryn Harvey share her story of recovery after a minor bike accident in 2013 left her with an aggressive bacterial infection that resulted in the amputation of her arm and shoulder. Since then, she has rebuilt her body to achieve a silver medal in the amputees triathlon world championships. If that doesn't inspire you to overcome your barriers to exercise, I don't know what will.
We then got stuck into the sessions. There were a couple of real highlights for me. The first was a practical session by Kylieanne Farrell from The Movement Room entitled Moving with Prolapse. She talked about the impact that environmental factors such as sleep, nutrition and stress can have on a women's prolapse symptoms on any particular day. I think this is an important point, not only for women with prolapse but for all women. Training within our boundaries and being in touch with our bodies can have a great impact on the effectiveness of our exercise choices.
An eye opening session was conducted by Antony Lo from The Physio Detective entitled Stop Hurting Women with Exercise. Antony likes to challenge popular beliefs about exercise and encouraged us to challenge the status quo and think more broadly about how we train women. For example, he believes that physios and trainers "hurt" women with exercise by:
Over the weekend I also attended a much needed seminar on marketing (I much prefer to move than to market) but it was a great presentation and I promise to add the ideas to my long list of 'to dos'. I also attended a session on diastasis recti from a Melbourne physio. This a topic close to my heart (and stomach) and there was plenty I took away from this session. I also felt great admiration for the presenter as she kept her composure and diplomatically managed questions from accomplished physios in the audience that challenged her points.
Possibly the biggest difference to last year's event is that this time I was not in a room of strangers. Along with the connections I made in 2015, there was also a small contingent of Brisbane practitioners and trainers as well as other contacts I have made via social media in attendance. It was great to put a face to the names and we all enjoying talking at every opportunity we could get. Melbourne of course is never short of a good place to eat and we all braved the fashion police and went to dinner in our #activewear.
If you are a fitness professional that trains women, I strongly encourage you to attend this event. Feel free to drop me a line and I will connect with you there next year.
If you have been following my blog for a while you will know that my interest in postnatal exercise came from my own personal experience with abdominal separation, pelvic floor weakness and a rectal prolapse. I want to share with you today something that has always bothered me about the post-operative care I received after my prolapse surgery.
While I am incredibly grateful that the surgery was a success and my surgeon was skilled and thorough in his operating technique, I was disappointed by his comments during my follow up appointment. I expected a list of do's and don'ts as well as some kind of rehabilitation program or referral to a women's health physiotherapist to continue my recovery after surgery. But there was nothing, not one single recommendation. He just gave me a post-surgery check up then said I was good to go. This didn't feel right to me, so when I pushed him further about exercises I should avoid or exercises I should do his reply was "Oh, nothing in particular, although I wouldn't recommend gymnastics or trampolining". Well no risk of that!
I have no doubt that had I returned to Crossfit or boxing before relaying the foundations of pelvic floor health, then the good work of my surgeon would have come undone.
My pelvic floor and abdominal separation (and hernia which he actually discovered and was missed by previous midwives and physios) still had some way to go in the healing process after my surgery and it was only because I followed my instincts that I saw a physio and started to make progress towards recovery. It was also the catalyst that prompted me to start Go Mum! as I began to research pelvic floor and prolapse safe exercise options and realised that the local mums bootcamp just wasn't going to cut it.
Regardless of whether you have pelvic floor weakness or not, here is my advice for postnatal recovery and getting the most out of your health care providers:
Have you had an experience of good or poor postnatal and post-operative care that you would like to share? I would love to hear it. You are also welcome to contact me should you have any questions about my pregnancy, birth and recovery experiences.
About the Author
Christine is a mother of two and the head trainer at Go Mum! Group Fitness. She is passionate about restoring health and balance to the lives of mothers. She is a member of the Continence Foundation of Australia and is registered with Fitness Australia.
You can find her on Facebook or Instagram @GoMumGroupFitness.
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