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
“The only reason I can do what I’m doing…Milltown Physio! My life would be very different without her! I cannot thank her enough”
It’s great to see the importance of pelvic physiotherapy in sports medicine highlighted here by professional cyclist Matt Teggart in an article in the popular cycling magazine Sticky Bottle.
A recent systematic review on footballers showed that a static stretching warm up reduced subsequent performance while a warm up that included dynamic stretching and the FIFA 11+ can show positive effects in footballers. The review also noted that there is good benefit in doing a re-warm up again during half-time.
The FIFA 11+ is a complete warm-up programme to reduce injuries among amateur male and female football players aged 14 years and older. The warm up programme was developed by an international group of experts and its effectiveness has been proven in scientific studies
If you would like to know more about the FIFA 11+ and use it in your club then click here for some good free resources such as videos and posters http://f-marc.com/11plus/exercises/