Women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before, during, and after pregnancy. Regular physical activity helps with weight management, reduces the risk of gestational diabetes in obese women, and enhances psychological well-being. An exercise program that leads to an eventual goal of moderate-intensity exercise for at least 20–30 minutes per day on most or all days of the week should be developed and adjusted as medically indicated.
Here at Milltown Physiotherapy we offer ante and post natal Pilates classes for women from 16 weeks pregnant and from 6-8 weeks post natal. Women can enjoy Pilates in comfort and safety, knowing they are exercising correctly under the care of a Chartered Physiotherapist with experience in Women’s Health. Click here for further information on our classes
Swimming, walking, modified Yoga, stationary bike and low impact aerobics are all safe exercises in pregnancy. Some Yoga positions should be avoided later in pregnancy. Avoid Hot Yoga.
If you were lifting weights before you got pregnant, keep going as long as you go easy. Avoid heavy weights or routines where you have to lie flat on your back.
High intensity sports: If you regularly run or play tennis, you don’t need to stop. As you get closer to your due date, run on flat, groomed surfaces to reduce impact and avoid falls.
Risky Sports are the contact sports such as basketball, hockey, and soccer and activities that increase your risk of falling, such as off road cycling, roller-skating, downhill skiing, and horseback riding.
In consultation with your doctor running, jogging, racquet sports and strength training may be safe for pregnant women who participated in these activities regularly before pregnancy (ACOG 2015).
Engage your core i.e. your abdominals pelvic floor with impact or you might leak, get pelvic girdle pain or low back pain. If you are not sure how to do this find a Chartered Physiotherapist in your area.
When to slow down: As long as you can talk comfortably and aren’t short of breath while exercising, you’re moving at a good pace. Don’t exert yourself to the point of heavy sweating. Drink plenty of fluids. If you have any of the following symptoms, stop exercising and call your doctor right away:
Calf pain or swelling
Less movement by the baby
Fluid leaking from the vagina
The American College of Obstetricians and Gynecologists, Womens’s Health Care Physicians Number 650 • December 2015
Congratulations to our physiotherapist Noreen Dockery and the Irish masters hockey team on their victory in the Home Nations tournament last weekend. Noreen was vice-captain, and helped lead the Irish team to three wins from three, beating Wales, Scotland and England.
Noreen will now travel to Amsterdam in August representing Ireland in the European Championships.
Well done Noreen and the team, we’re very proud of her achievements and wish her all the best in the Europeans.
Antenatal digital perineal massage reduces the likelihood of perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain. Women should be made aware of the likely benefit of perineal massage and provided with information on how to massage (Beckmann & Stock 2013).
This is based on a review including four studies (2497 women) comparing digital perineal massage with control. Antenatal digital perineal massage was associated with an overall reduction in the incidence of trauma requiring suturing and women practicing perineal massage were less likely to have an episiotomy. These findings were significant for women without previous vaginal birth only.
No differences were seen in the incidence of first- or second-degree perineal tears or third- or fourth-degree perineal trauma. There was a reduction in the incidence of pain at three months postpartum in women who had previously given birth vaginally. No significant differences were observed in the incidence of instrumental deliveries, sexual satisfaction, or any type of incontinence for women who practiced perineal massage compared with those who did not massage.
The basic perineal massage technique is the woman or partner performs daily 5-10 minute perineal massage from 34 weeks. One to two fingers are introduced 3-4 cm in vagina, applying alternating downward and sideward pressure using sweet almond oil (Labreque 1994). Other descriptions are to perform massage for 4 minutes 3-4 times per week from 34 weeks, 5cms into the vagina and sweeping downward from 3 o clock to 9 o clock (Shipman 1997).
The Epi-No® has been designed to assist women with antenatal perineal release and it is recommended to use it from 37 weeks. It is recommended to insert the balloon 2/3rds into the vagina and to contract and relax the muscles against the balloon, which provides resistance. It should then slowly be inflated to the point of stretching and comfort each day and the muscles are stretched more. After the stretching phase the pelvic floor muscles are relaxed to allow the inflated balloon to be gently expelled from the vagina. A randomized controlled trial on this product showed that antenatal use of the Epi-No® device is unlikely to be clinically beneficial in the prevention of intrapartum levator ani damage or anal sphincter and perineal trauma as diagnosed with ultrasound imaging (Atan et al. 2016).
It has been shown that almost 60% of women who have never given birth report some pelvic floor symptoms (Durnea et al 2014) and clinically it can be observed that many women present with high tone and sometimes painful pelvic floor at this stage. At www.milltownphysiotherapy.com we teach breathing release for the pelvic floor from 34 weeks gestation and gradually increase to include perineal massage, connective tissue manipulation of the external perineum and extend to manual therapy of the deep pelvic floor muscles. We recommend 3-4 sessions as needed with a chartered physiotherapist with a special interest in women’s health depending on the resting position and tension of the pelvic floor. We teach a home exercise program for daily practice.
A recent study by Enda King and Dr. Éanna Falvey the next head of the British and Irish Lions medical team, and published in the British Journal of Sports Medicine (BJSM) compared the research on physiotherapy versus surgery on return to play for Athletic groin pain.
Athletic groin pain has been shown to be quite prevalent among players involved in gaelic football.
They divided the groin injury up into pubic related, adductor related and abdominal related groin pain.
The review suggested better results and quicker return to play with physiotherapy rehabilitation over surgery for pubic-related groin pain.
They also found no difference between surgery and physiotherapy rehabilitation for the adductor and abdominal groups.
You can see why the groin comes under some strain with all the side stepping seen in Gaelic football, rugby, hurling and soccer. With Colm Cooper today retiring from Gaelic football I thought I would share some of the side steps, points and goals throughout his career.
Is your child complaining of recurrent heel or knee pain with no specific cause and it gets worse with activity?
Aisling Dolan, one of our physiotherapists here at Milltown Physiotherapy, has a special interest in treating and managing such injuries, having done a recent thesis on this topic as part of her Masters.
According to her review of recent research, the rise in children participating in organised sports has brought about an overall increase in over-use injuries. With this increased participation rate, there is also a growing pressure on children to perform at high levels and this can lead to inappropriate levels of training intensity, frequency and duration.
“Calcaneal apophysits”, (more commonly known as “Sever’s disease”) is the lead cause of heel pain in children. This condition causes intermittent pain where the Achilles tendon joins the heel bone at the growth plate. When the load at this junction has exceeded its tolerance level, it can cause an inflammatory response. Other common symptoms can include tenderness on palpation of the back of the heel, swelling and pain provoked by activities such as jumping and running.
The growth plates can be weak links and prone to this injury due to an increase in muscle tightness which occurs during growth spurts and increased levels of sport and activity. Aisling’s research reported that physiotherapy modalities are commonly used to manage these types of overuse conditions. Successful physiotherapy management includes activity modification, manual therapy and a home stretching programme specific to each child’s needs.
Preventative strategies for these type of injuries include monitoring growth spurts, muscle tightness and ensuring that sport participation is managed appropriately with these variables.
The pelvic floor muscles have many different functions and dysfunction within them can present itself in many different ways. During a vaginal delivery the pelvic floor muscles have to stretch to three times their normal length, so it’s no surprise that they may need a little bit of help regaining their function post-natally.
Do you have difficulty controlling urine when you cough, sneeze, laugh or exercise?
Do you have a feeling of urgency to go to the loo, which you sometimes can’t control?
Are you unable to fully empty the bladder and often have to go back?
Have you noticed any heaviness or aching around the vagina?
Have you felt any bulging in the vagina or felt that something might ‘come out’?
Do you have difficulty controlling wind?
Do you struggle to completely empty your bowel?
Do you have a sense of urgency to empty the bowel?
Do you experience discomfort or pain during intercourse?
Do you have pain in any of the following areas: pelvis; lower back; hip; groin; abdominals?
If you are 8 weeks postnatal or over and the answer to any of the following questions is yes, then we strongly advise that you make an appointment to talk to one of our Women’s health physiotherapists.
The symptoms below are not normal because you have had a baby. It has been shown through research that practicing Pilates exercises has many benefits. However, Pilates exercises on their own will not strengthen the pelvic floor muscles: to be effective exercises must be taught and guided by a women’s health physiotherapist.
Thanks to our physiotherapist Stephanie Crossland for putting this information together
We were delighted to host renowned myofascial and chronic pain expert physiotherapist Dr. Jan Dommerholt for a course on dry needling in back and pelvic pain on Wednesday the 30th of November.
Dr. Dommerholt is a Dutch trained physio and a recognised expert in the physiotherapy diagnosis and treatment of persons with myofascial pain syndrome, chronic pain syndromes, and whiplash associated disorders. He has published several books, over 60 articles, and nearly 40 chapters in medical and physical therapy textbooks on myofascial pain, chronic pain conditions, fibromyalgia, complex regional pain syndrome, and whiplash.