Great work from Gráinne Donnelly, Emma Brockwell and Tom Goom have helped develop this brilliant guide for returning to running post-pregnancy.
We were delighted to be asked from some feedback in its development and would thoroughly recommend the guidance for a variety of health professionals including GPs, musculoskeletal and pelvic health physiotherapists.
It covers such things as
Return to running strategies
Key considerations such as breastfeeding, sleep and psychosocial factors
Signs and symptoms of pelvic floor and/or abdominal wall dysfunction
Risk factors and contra-indications to return to running
And much more
Did you know that 43% of women with pelvic pain and immobility said they felt their symptoms were never taken seriously?
Every woman with pelvic girdle pain has a right to be assessed and treated. We were delighted to link up with Pelvic Partnership to help spread the word that #PGPistreatable and help to #getamummoving.
Telford in Birmingham was the venue for the UKCS and Pelvic Floor Society first Pelvic Floor Summit. Presentations included sexual function, urogynae, urology and colorectal they were varied and most informative. We headed over for the conference as the African heatwave hit Birmingham.
In the photo from left to right Sarah Mullins, Helen MacDevitt, Grainne Wall, Sharon McNally and Maeve Whelan. Eimear Murphy not in the photo was also at the conference.
Probably the most topical and frequently appearing at the conference was the question of mesh which appears in the media so often at the moment. There was reassuring information on the safety through the data on mid-urethral sling (MUS) procedures for stress incontinence where other mesh procedures for pelvic organ prolapse are falling in number. It varies from country to country whether mesh for prolapse is allowed and it is still allowed in England and Ireland but not in Scotland. Gynaecologist and Urologists now fear that a surgery for stress incontinence which should be beneficial where conservative treatment has failed will be banned because of lack of knowledge and fear rather than on data that is collected by the profession and on the recommended guidance. The profession is now watching what happens at a political level to see what is going to happen going forward.
In the meantime, physiotherapy gains more recognition for its role in chronic pelvic pain and theories for chronic pain continue to be researched.
Sexual health is promoted and never better than by physiotherapist and comedienne Elaine Miller who through Twitter has get up #pelvicroar to promote better awareness of pelvic floor problems as a barrier to optimal sexual health.
For more information on mesh see https://www.rcog.org.uk/en/news/rcog-response-to-nice-guidance-on-transvaginal-mesh-repair-for-prolapse/
Milltown Physiotherapy is delighted to announce that the renowned sexologist Emily Power Smith has started clinic at Milltown Physiotherapy. Emily Power Smith is the only clinical sexologist in Ireland and as such has a unique skill-set and knowledge base. Emily runs a busy private practice in Dun Laoghaire as well as attending clinic in Milltown Physiotherapy.
Emily has a Masters Degree in Sexology and a Post Graduate Diploma in Art Psychotherapy, with years of experience as a facilitator, educator and trainer. She teaches at third and post graduate levels, trains, writes, runs seminars and is a regular contributor to Irish National Press, radio and TV. Emily’s mission is to normalise sexuality and to create informed, mature and non-judgmental dialogue around all aspects of sexuality (a sex positive approach). She is consultant and advisor for clients attending Milltown Physiotherapy who may wish to follow up with more intensive therapy.
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
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.
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.
Our chartered physiotherapist and leader of our ante/post natal Pilates classes, Stephanie Crossland attended the prestigious APPI Pilates Conference in the UK last weekend.
At the conference Stephanie completed a workshop and met with Alan Herdman who is recognised as bringing Pilates to the UK in 1970, after he served an apprenticeship with 2 instructors who had trained with Joseph Pilates himself!
Some of the highlights included an antenatal based exercise class with Cherry Baker, gaining more knowledge and insight into using Pilates exercises safely with pregnant women. She loves to share the new information and research within the clinic.
Interestingly she also attended a post natal session with emphasis on return to sport with Biljana Kennaway (APPI Master). While there she got some great information on cutting edge research for use with her mother and baby Pilates class.
Stephanie has a huge knowledge base in Pilates and has conducted research on the use of Pilates-based exercise in ante and post-natal women with pelvic girdle pain gaining an Masters in the process! Stephanie has a special interest in the treatment of Pelvic Girdle Pain in Pregnancy. Additionally, she is an instructor in Pilates for this client population.