Category Archives: Pilates

5 tips for preventing back pain when caring for children

As I was walking home from class yesterday a father and his toddler walked past me.  The dad was taking tiny baby steps in time with his son, was crouching in a squat position to be at his son’s level and was leaning over to one side in order to hold his hand.  This reminded me of how Becky used to love to hold my finger as she walked – up until her hand was big enough to hold mine.  And how it hurt my back let alone nearly dislocated my finger!!!

The trouble with having bad posture when you’re caring for children is that you’re going to repeat that same position over and over again each day and this will take it’s toll on your body.  And because of the interconnectedness of our body parts, that pain could show up anywhere, with the back often being the prime suspect.

Here’s my 5 top positions to be aware of your posture:

  1. Bending over to change nappies and other jobs at waist height – stay in close, hinge from the hips and keep the upper back in alignment. You’re trying not to just round your shoulders and hang from your ribs.  If the task is lower down, bend at the knees into a squat or lunge
  2. Getting out of bed – roll over onto your side and push yourself up. Try not to just sit straight up – this causes pressure through your stomach and could prevent diastasis from improving as well affecting your pelvic floor and back.  I demonstrate this on video here
  3. Pushing the pushchair/shopping trolley – stand upright, not too far away, with your arms slightly bent and think of powering through your legs, it’s a great bum work out!  Don’t rest your weight on the pushchair and don’t think of it as pushing with your arms – your whole body is doing the job.  Applies even more so when going uphill!!
  4. Picking baby up from the floor – bend at the knees into a squat or lunge keeping your back in alignment, pull baby in close, exhale as stand up (using the knack).   The same with car seats – and it’s better if you can carry them close with both hands when baby is small.  Picking up from the cot you need to stay in close and again bend at the knees and hips
  5. Carrying baby – try not to lean back to rest baby on your chest.  Drop your ribs down and keep them in alignment with your hips – you will feel your core tire quicker but that will just remind you to change positions.  Try and keep baby high and in the centre.  If you carry to one side keep them high and let their head rest on your shoulder – try not to push your hip out and try to vary sides rather than always favouring one

Bear in mind that any continuing pregnancy conditions need to be assessed – pelvic girdle pain, piriformis/sciatica, diastasis, pelvic floor dysfunction.  These can all contribute to back pain as well.

 

A Pain in the Bum – Pelvic Girdle Pain

Pelvic girdle pain (PGP), sometimes known as Symphysis Pubis Dysfunction (SPD) or SI Joint Pain – can be felt in the back, bum, legs and front of pelvis.

It’s a common problem in pregnancy – 20% of pregnant women get it, although it can be as much as 50%.  But remember common does not mean normal – so you don’t have to just put up with it!

The good news is that it does tend to clear up after pregnancy – only 7-8% women still have a problem postnatally.  But how you deal with it in pregnancy will have a bearing on your recovery

There are various risk factors for the condition including:

  • pelvic girdle pain in previous pregnancy
  • gaining excessive weight during pregnancy
  • lack of core strength
  • poor posture
  • pelvic misalignment or history of trauma to the pelvis
  • hypermobility, connective tissue disorders or laxity in the joints
  • expecting a large baby or multiples
  • baby’s position

There is also a range in the severity of pain felt and different activities can affect differently – some movements may cause no pain in some women but be excruciating for others.  For instance, the classic going up stairs was not a problem for me but turning over in bed was always painful. The general rule of thumb is – if it hurts, don’t do it!  There is no benefit in pushing through the pain and you’re more likely to make it worse.

Here are a few ideas to try which may help out with day to day activities:

  • Walking – take smaller steps and go slower.  Be aware that if you have a small child or a dog pulling on you that will also exacerbate it.  Otherwise walking is a great exercise and should be continued as much as possible
  • Sitting – don’t cross your legs – either at the ankles or the knees.  Sit upright and with both feet on the floor – an upright chair or birthing ball is helpful rather than the sofa.  Click here to go to my YouTube channel where there are videos instructions on sitting, standing up and getting up from the floor or bed.  Using the Knack on movement will also help.
  • In bed – turning over is usually the issue.  Keep a pillow between your knees then squeeze your knees, perform the Knack and try to keep your hips stacked as you roll.  This can be aided by having a duvet under the bottom sheet.  Also reducing friction to turning can help – using silk sheets, a snoozle slide sheet or if you’re desperate, a bin bag!

For more information the best website to use is
www.pelvicpartnership.org.uk – loads of information there.

take a deep breath

I wanted to talk about breathing this week. For something that should happen automatically, it’s often the hardest thing to get right! Most beginners starting off with Pilates struggle with the breathing. It’s ok not to get it, as long as you breathe! But if you do get it, it is integral to proper form, pelvic floor health, core strength and general well being.

One of the reasons people feel so relaxed in Pilates classes is because of the focus on thoracic (or rib cage) breathing. Day to day we tend to use our secondary muscles for breathing – our chest and neck muscles – which leads to shallow breathing and is linked to our fight or flight instinct so keeps us on edge. By breathing into the rib cage we can take deeper breaths which helps us de-stress and brings a sense of wellbeing.

If you’re not sure if you’re doing it right, resting your hands on the bottom of your ribs can help give you feedback, as can wrapping a scarf around and breathing into the scarf. We’ve also been using the imagery of an umbrella opening and closing – you can visualise this easier if you click the link to see this video. It is an amazing animation of rib cage movement when breathing properly. It also shows the movement of the diaphragm and the lungs and then the muscles.

The other focus I talk about is the lifting of the pelvic floor as you exhale. I filmed this video to show how the movement of the diaphragm controls the breath. The pelvic floor then mimics the movement of diaphragm – this way it keeps pressure in the abdomen constant.

By training pelvic floor with the breath out on exertion you can prevent downward pressure on the pelvic floor and so prevent continence issues and prolapse. It also aids recovery of abdominal muscles and teaches proper recruitment of the core rather than an over-reliance on the six pack muscles – this imbalance in muscular strength can lead to back pain.

So by focusing on thoracic breathing we can get so many benefits – from relaxation to reduced back/neck pain, improved core strength and less incidence of pelvic floor dysfunction and more! So, take a deep breath!

Pelvic Organ Prolapse

Pelvic Organ Prolapse (POP) is a secretive, not often talked about thing.  And yet last week every single day I ended up speaking with people about their prolapse so it just seemed destined that that is what I would write about today!

Prolapse is the descent of one or more internal organs that then push into the vaginal wall.  There are different stages – mild, moderate to extending outside the body.  There are many symptoms, many of which could be attributed to other ailments.

  • Urinary incontinence or urine retention – feeling of never fully emptying bladder
  • Constipation or faecal incontinence
  • Feeling of dragging, like your insides are falling out or heaviness/ache in rectum/vagina
  • Lump or bulge in vagina
  • Inability to hold a tampon in
  • Lower back or pelvis pain
  • Vaginal/rectal pain
  • Painful intercourse/lack of sensation
  • Leakage of urine/stool during sex

The earlier prolapse is discovered the better as there are preventative measures – surgery can be avoided or its severity lessened.  They will also help post-surgery.  Typically one prolapse can lead to another unless steps are taken to prevent this.  Understanding more about how it occurs can also help prevent it.

Causes of prolapse are many and varied

  • Childbirth – 50% of all women who have given birth will prolapse
  • Menopause and age related drop in oestrogen levels
  • Chronic constipation
  • Chronic coughing
  • Obesity
  • Genetics
  • Neuromuscular conditions
  • Heavy lifting
  • Diastasis recti
  • High impact aerobic activities – running, jogging, high impact aerobics

It’s worth noting though that POP doesn’t happen overnight – typically many factors over a number of years will build up to cause it.  What’s crucial is intra-abdominal pressure – the build up of this results in bearing down on the pelvic floor. It’s a necessary bodily phenomenon – without it we couldn’t poo – but if there’s a constant downward pressure it can be more than the pelvic floor can cope with.

And this is where the knack comes in.  By mindfully contracting the pelvic floor before we stand, lift, cough, sneeze etc. we prepare for the force to come.  Practicing the connection with your outbreath and your pelvic floor contraction can retrain the body and help it to do it’s job.

Other things to bear in mind

  • Weight control – particularly the amount of abdominal fat you’re carrying
  • Lifting technique – never hold your breath.  Always exhale on exertion and lift pelvic floor
  • Toilet technique – no straining.  Try to have feet on a stool (2 toilet rolls will do) to raise knees above hips.   Vocalising can also help!
  • Exercise – pelvic floor safe exercises for those with a weak pelvic floor, prolapse or have had gynaecological surgery. Gentle Pilates. Core strength and pelvic floor activation. Exercises to avoid – crunches, double leg lifts, full plank position, high impact sports. Ultimately you need to decide what to stop and what to continue with – you can get support for exercise, from supportive shorts to sea sponges and pessaries.

For more information and support see the APOPS website at www.pelvicorganprolapse.support.org.  They also have a private Facebook group – pelvic organ prolapse.  Also Pelvic Floor First at www.pelvicfloorfirst.org.au

Good books – Sherrie Palm, The Silent Epidemic and Sue Coult, Pelvic Floor Essentials.  I have copies if anyone would like to borrow them

Get a kegel app for your phone – lots of free ones but the one most recommended by women’s health physiotherapists is the NHS Squeezy app

And as they say on Channel 4 – “if you have been affected by this” please feel free to get in touch.  I would be glad to give any help and advice.