Category Archives: postnatal

How you can help your pelvic floor

I was asked by someone this week about rehabbing the pelvic floor post birth, in preparation for getting back to running.  I was so pleased that she was aware of the importance of taking her time – things keep popping up in my timeline about postnatal classes where people are running with buggies, skipping and even doing jumping jacks! All of this can have a deleterious effect on the pelvic floor and continuing to overstress a weakened pelvic floor can lead to prolapse.

However taking your time, making a few lifestyle changes and building up core strength can mean that even if you’re currently experiencing pelvic floor dysfunction (any leaking, back pain, heaviness in the pelvis) you may be able to get back to your previous exercise routine.

I prolapsed after my first child and was given very little advice about it other than being told I would probably need a hysterectomy when I go through menopause.  Because of this experience I have spent my time learning more and applying it to my own life as well as in my work with others.

First thing I implemented was no impact.

As someone who wasn’t a runner, this wasn’t a big change.  But I did have to stop jumping around in my aerobics classes and also give my trampette a wide berth…!  I can now run for the bus without worrying and I played rounders in the summer where I was sprinting for quite a while with no effect.  So I could probably run now if I wanted to but I’m still choosing to stay low impact most of the time.

Second thing was no crunches

The downward pressure created by crunches/sit-ups will push on the pelvic floor.  Full planks and press-ups and exercises with both legs lifted also creates a lot of pressure and so I avoided them.  However there are alternatives – for example in press-ups performing them on an incline, plus incorporating crunchless core exercises – so there is no reason to stop exercising, just make a few changes.  Bear in mind that sitting straight up in bed is also a crunch (and how many times do you do that a night?) – I roll over to get out of bed instead.

It’s not all about what you shouldn’t do though. There are things that I needed to start doing:

  • alignment/posture

particularly the with respect to the pelvis.  Try tucking your tailbone under and bringing your hips towards your ribs.  Lift the pelvic floor now.  Then take your hips away from your ribs, allowing your lower back to arch more, then lift the pelvic floor.  Then bring yourself to a neutral pelvis where your level through the front and the back of the pelvis (think of it like a bowl) – the pelvic floor lift should feel easier in this position.  Pelvic floor works best when we are in alignment, with the head, shoulders, rib cage, pelvis and heels all stacked up in line

  • breathing

both looking at how you breathe during exercise and from day to day.  During exercises you need to breathe out on the effort and lift pelvic floor at the same time.  This also applies when you are lifting a weight – baby, shopping etc. – and also when you go from seated to standing (The knack – as you go from sit to stand but vice versa too).  The other aspect of breathing is to stop breath holding and sucking your stomach in.  When you breathe in your stomach should actually swell not suck in.  I see so many people who’s stomachs stay still when breathing and instead their shoulders lift.  Try lying on your back with your knees bent, feet flat on the floor.  Put one hand on your chest and one hand on your stomach.  As you breathe in you should feel your chest move first then your stomach.  Your stomach lowers as you breathe out and then your chest.

All these changes I’ve made have meant that my prolapse has improved and I’m hoping to avoid that hysterectomy!  I know that there’s still work to do and I’m currently learning more about another part of the puzzle:

  • relaxation

stress can affect the pelvic floor, there’s also some evidence that lower limb injuries and back injuries will impact the pelvic floor too, even years after healing or the pain has stopped. There may also be scar tissue from episiotomies or tears.  I’ve just learnt some trigger point release for that – sitting on one of the spiky balls!  It’s uncomfortable but definitely has an effect – I will let you know how that goes!  And it’s also helped to introduce deep breathing, mindfulness and relaxation practices into my daily life.

 

So when looking at rehabbing the pelvic floor, it’s not just about a list of exercises to do – we need to think of the body as a whole and the pelvis at the centre of that, and looking at improving in all these areas

Is postnatal exercise just for YOU?

I saw an advert for a postnatal exercise class the other day that had a line about how mums were deciding to be selfish and take time for themselves.  Now I’m all for me-time as an essential part of a mums postnatal recovery and don’t see that as being selfish at all – in fact, if anything, mums aren’t selfish enough and always seem to put themselves at the bottom of the to do list.

But in addition to mums deserving to do something that benefits them, I also see so much benefit to the babies coming along to exercise classes too.

The NHS states that babies should be encouraged to be active throughout the day and avoid being sedentary for long periods of time – in car seats, pushchairs, bouncers etc.  This is why in my buggy class we tend to exercise in one area so that the babies can be let out on to the floor whenever possible!  And in Pilates, unless they’re sleeping, babies can get over an hour of play on the mat – giving them loads of room to roll, rock or for tummy time.

Babies getting the chance to be active along with their mums is good for two reasons:  first, they’ll see exercise as a normal and fun thing to do and secondly, they learn by copying.  Being active also helps the brain to develop.

There is some degree of sensory play in class as well – the balls, bands, mats and dumbbells are all a source of fascination.  One baby’s first crawl was because she wanted to get to the dumbbells!!  Outdoors the leaves and grass give vital feedback about their surroundings – and help their immune system too.  The fresh air is good for them and as an added bonus may help them sleep better!

The social aspect of the classes is also key – I know my daughter first started walking because she clocked an older child doing so.  I watched her watching him and as soon as she got home she grabbed hold of the high chair and off she went!!  There is also a lot of enjoyment in just watching their mums – I’ve a few video clips of babies laughing at the exercise!  And in Pilates there is often a very chilled feeling to the start of the class as the babies watch the flowing movement – they sometimes seem mesmerised!!

There have been lots of developmental firsts in my classes, from first rolling and crawling to first standing unaided and first steps.  Given time and space and a great example from mum gives the babies lots of opportunity to develop – so turns out class is as good for them as it is for you!!

Click here for a great pdf on physical activity guidelines for under 5s from the NHS

Heal your diastasis with food!

I really enjoyed listening to a webinar from Jessica Drummond of the Integrative Women’s Health Institute last week.

One of the sections that I was particularly interested in was on postnatal soft tissue and wound recovery – applicable particularly for those with diastasis or a c-section and perineum wound.

My advice nutritionally has always been to use bone broth either in soups or gravies but her information will give you a few more tools to use!

Eating foods that are high in collagen can help to repair and build damaged tissues – this includes wounded and strained core and pelvic floor muscles.

Good sources of lysine and proline, the amino acids that build collagen, are meat, chicken, fish and egg whites. For vegetarians – peanuts and wheat germ.

But there are other nutrients necessary. Vitamin C is destroyed when collagen is made so your intake of citrus fruits, strawberries and dark leafy greens, for example, will need to increase.

Hyaluronic acid is needed to create bundles using collagen. It can be found in sweet potatoes, avocado, mango and bone soup – using bone broth or whole fish.

The final nutrient she mentioned is zinc. This can be found in sesame seeds, cashews, dates, linseed, cocoa, beef, blue cheese and eggs. The healthy treats we have after postnatal Pilates should take care of that!

Looking at the list, an all-encompassing recipe would be a Chinese style soup of bone broth, chicken pieces, kale or pak choy, sprinkled with sesame seeds or cashew nuts.

Perfect for the summer we’re having!!

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.

 

When can I run again?

If you search the internet for the answer to starting running again after baby you may well be confused by the information out there.  There are some people who are back to their normal regime way before 6 weeks postpartum, others who advocate avoiding all sorts of exercise.  So what’s right for you?

First up you shouldn’t return to formal exercise until 6 weeks postnatal (8-10 if you’ve had a caesarean) and you should be getting the all clear from your doctor, although I know some doctors wait to combine your check-up with babies 8 week check.  And some doctors don’t do them at all now.

However once you’ve had your check that doesn’t mean you can just start up where you left off.  At 6 weeks only the initial healing of your body has been completed – full healing could take a year or more!

Returning to impact exercise too early can reduce pelvic floor strength and lead to incontinence or prolapse so it is worth taking things slowly and building up gradually.

So once you’ve had your check, and assuming you have no pelvic floor issues or diastasis, it is fine to introduce low impact exercise and specific postnatal classes.  Body conditioning classes are also fine but need to be lower weights and avoid direct work on your stomach muscles (i.e. no sit-ups or crunches or planks).  Over the next few weeks you can gradually increase the intensity and the weights.

And then what, what’s the magic number of when you can start running/crunching/go to hardcore classes?

Unfortunately there is no definitive answer.  Some say 4 months, others 6, still others a year.  I thought I’d been conservative waiting 5 months after a C-section before then teaching a high impact aerobics class.  I wasn’t and I prolapsed because of it, despite having no warning signs so I do tend to err on the side of caution with mums who come along to classes.

So the only real answer to “when?” has to be – listen to your body.  If you have any pelvis or lower back pain after exercise, a feeling of heaviness in the vagina, any bulging or straining or doming of the stomach or the pelvic floor or any leaking these are all a sign that that exercise is too much for you at this particular time.  As is shaking during an exercise or breath holding.  Doesn’t mean this will be for always – just at the moment your body isn’t ready and you need to modify the exercise until you are stronger.

This should apply whenever you’re exercising not just in the early postnatal period.  Your form is the most important thing to be mindful of when exercising and how your body is feeling.  There is always a way to make an exercise easier or to bring the intensity down.

Other things to bear in mind when exercising:

  • tiredness – fatigue can lead to injury as you push yourself through
  • sore breasts – if you can feed before exercise that can help.  A decent sports bra is important too.  There is such a thing as a feeding sports bra although they can be quite expensive.
  • loose joints – the effects of pregnancy hormones on your joints can last around 3 months post birth.  If you’re breastfeeding the effects are thought to last until 3 months after you finish feeding.

So bear these in mind when you want to start a particular exercise regime.  You can practice exhaling on exertion and lifting the pelvic floor before the 6 weeks (once any perineal damage is healed) – this way the core is protected and you will be rebuilding the body from inside out!

Pelvic floor first is a great website that’s worth visiting.  Their Returning to sport pdf gives a timeline of what’s recommended at various stages.

And remember, all my classes are pelvic floor and tummy safe!

advice from other mums to you

Words of advice for new mums

And your first piece of advice is – feel free to ignore this advice.  As a new mum you are likely to get a lot of advice in the next few weeks, most of it unasked for and much of it unwanted.  The biggest thing you can do is take courage, forge your own path and not worry what anyone else thinks.  If there was only one way of doing things then there would be only one parenting book…

The right way to parent

Having said that, here’s some things that helped my mums – many of the same things came up with everyone so hopefully it will be of some use to you as well:

  1.  Breastfeeding – oh this may well be a blog post in itself…  It is not necessarily easy and doesn’t always come naturally and it’s not always for everyone.  Like learning to dance, both partners need to know what they’re doing and sometimes baby just doesn’t get it!  Seek help early on – don’t wait until you’re struggling.  There is a telephone service at Stepping Hill, clinics at local children’s centres, national breastfeeding helpline, local breastfeeding groups.   I had an amazing midwife who helped me postnatally – I think without her I would have given up and that would’ve sent me over the edge. We tried loads of different positions – for me lying down helped the most until we got it.  But I also felt the difference between my two babies – they fed so differently at first, so it’s definitely a two-way thing!  Just know that it does stop hurting and becomes a lovely experience.  And in the meantime, there is always Lanisoh cream!
  2. Let go of the guilt!  There are many ways to raise a happy baby so be confident in your choices, do what works for you and don’t compare yourself to others.  Things often don’t go the way you plan, from your birth experience, through to your feeding and sleeping choices.  It’s all ok – whatever gets you through.
  3. It’s hard! I spent a lot of the early days in tears – lack of sleep, pain, struggling to feed, not knowing what I was doing, hormones, railing against the change in myself.  It wasn’t all loveliness by any means and that’s fine – no-one enjoys the feeling that they have no idea what they are doing.  It’s a new job and you wouldn’t expect to know everything on your first day.   I eventually accepted my new role, worked on the feeding and began to gain confidence.  I would say though I probably should have talked to someone – if you feel sad more often than you feel happy then it would be worth mentioning this to your doctor/midwife.
  4. Sleep deprivation is torture.  Do everything you can to sleep when you can.
  5. You have no life in the early days – you’re just a feeding machine. My baby didn’t feed well and seemed to stay latched on for an hour but also wanted to feed every hour. So I was rooted to the spot. Make sure you have plenty to amuse you and plenty of food/drink – use the time to relax and recover rather than feeling like its stopping you from doing what you want/need to.  Ask for help when needed – all those visitors need to earn their cuddles.  Farm out the washing, cooking and shopping to others.
  6. Everything changes! It’s such a steep learning curve in the early days and just when you think you’ve got it cracked along comes some new event in your babies life. But for every new challenge there is also new joy in your baby.  It’s hard being a mummy and knowing you’re responsible for how your kid turns out.  But I can honestly say it’s still the best thing you’ll do – so stay strong and trust yourself.  This too will pass.  So many difficult stages feel like they’ve lasted forever when it’s only been a few days and will last only a few more
  7. Get out of the house every day – it will make you feel better and it’s good for the baby.  Start with short walks and simple tasks – get milk, a treat etc. (chocolate was mentioned…)
  8. Always fill the change bag as soon as you get home, so it’s one less thing to worry about or delay you when you are trying to leave the house
  9. Don’t feel you need to entertain your baby all the time – sometimes they just need to sleep
  10. Try batch cooking so there are meals to hand when you have no energy.  I wish I had done this – we ate a lot of sandwiches in the early days…  Even better – get someone else to batch cook for you!

And my final bit of advice came from Lucy…

“After your 6 week check, get out to Mums, Tums & Buggies/Pilates with Sarah ;)”

I’ll see you then!

Incontinence Part 2

November was national incontinence and bladder health awareness month in the U.S. As lots of the training resources I use come from there it seemed an ideal time for me to bang on about my favourite subject again!

I’ve already covered stress incontinence, which is the most prevalent

http://sarahparkerfitness.com/stress-incontinence/

But there are other types as well. And bear in mind incontinence isn’t just urine, it can also be faecal

  • Stress – leaking due to a change in pressure on the bladder eg jumping, running, sneezing, laughing
  • Urge – a sudden and overwhelming urge to go. Leaking before have chance to get to the loo
  • Overflow/dribble – bladder doesn’t empty fully so leaking occurs without necessarily having had an urge to wee

Incontinence is not an unavoidable consequence of ageing and childbirth. Things can be done to prevent it and/or improve it. It’s always worth seeing a doctor and getting a referral to a women’s health physiotherapist. Instead of masking the problem with pads etc – you need to find the reason and make a lifestyle change!

Things that can affect the pressure within the pelvis:

  • Posture – try to keep your ribs stacked up over your pelvis when standing and sitting
  • Clothing – too tight clothing can compress and move your organs. High heels will make you tilt your pelvis in order to be able to stand upright
  • Diet – avoid foods/drinks that irritate the bladder or cause gas
  • Exercise – move more, sit less

Exercise needs to be functional, so that you’re using movements you need in everyday life – squats, lunges in all directions, hip hinges. Exercise can also have a negative effect if the exercise you’re doing is too much for the pelvic floor to withstand. Any exercise that makes you hold your breath, bear down, shake, really clench, lose postural cues or leak needs to be avoided for now.

Another useful part of your life to look at is your toilet habits as straining can cause huge problems.

  • Wee every 3-4 hours – try to avoid going ‘just in case’. You just need to relax to wee so don’t hover above the seat. Rocking the hips a little at the end can help if you feel like you haven’t emptied fully.
  • Poo when you feel the urge – don’t hold it in as this can cause compaction. Knees should be higher than your hips – feet up on a kids stool or just use 2 loo rolls. Don’t strain. If the pelvic floor won’t relax you can help by vocalising – try a grrr or ssss now and see which one makes you feel like your pelvic floor relaxes. Then use that sound when on the loo.

And finally – keep practising the knack

http://sarahparkerfitness.com/knack-pelvic-floor-health/

What’s with the six week rule?

There’s been a few people in my classes recovering from injuries and minor operations recently.  Then of course there’s the mums who are recovering from childbirth – considered a trauma whatever experience they have had!  But despite the range of severity and site of injuries, there seems to be a six week rule – no returning to exercise until after six weeks .  What’s so special about six weeks?

Stages of Wound Healing

The answer lies in the four stages of wound healing.  Tissue is the same no matter who you are or what has happened and it will go through the same process every time.

  1. Haemostasis – this is all about stopping the bleeding and forming a clot.  It happens immediately
  2. Inflammation – this is the stage of fighting infection and keeping the wound clean.  There is increased blood flow to the wound – resulting in redness and heat.  There is likely to be pain, swelling and possibly pus.  This lasts for 4-6 days.
  3. Proliferation – new skin is formed over the surface, whilst tissue is rebuilding underneath. This pulls the wound closer. This starts after 3-5 days and can last for 2-3 weeks
  4. Remodelling – changes to the tissue strength and number of blood vessels serving it.  This is when a scar starts to go paler and flatter.  The process starts 2-3 weeks after injury, once the wound has closed, and can last up to 2 years!

These stages are not distinct but  instead overlap, so there is some variation in healing times.  6 weeks means that all the early stages have completed and the remodelling phase is well under way.

However, it will take up to a year and possibly longer to return to full strength and function.  And scar tissue is only 80% as strong as the original tissue.  This is worth bearing in  mind when you are returning to exercise after an injury and after childbirth.  At 6 weeks healing is not completed, so you need to begin gradually and listen to your body – don’t try to get back to your previous level straight away!

C-Section Recovery

There is more to successful c-section recovery than just stopping driving and no hovering!  Do try to get as much help as possible in the early days – I know we always want to do everything but you have just had major abdominal surgery.  So even if you feel ok you still need to take it easy otherwise recovery can take much longer.  A general rule of thumb is to not lift or push anything heavier than your baby for the first 6 weeks – this includes the pushchair.

Other considerations are:

  • Continue to roll over to get out of bed – and reverse the action to lie down.  Check out my video here.  Some people find gently pressing a pillow on to their incision helps when rolling over and when standing up.
  • Remember to lift the pelvic floor and breathe out as you stand up – read about it here.  You need to use the same technique when lifting baby and during any exertion.
  • Be aware of your posture, especially when lifting holding your baby.
  • Make sure you are well hydrated and try to eat nutritious food instead of junk – more about healing nutrition here
  • After doctor’s clearance at 6 weeks, introduce scar massage to prevent adhesions.

Adhesions are tiny ropes of tissue (collagen) that bind together to help with healing after surgery and also after infection, inflammation, radiation therapy and trauma.  It is an important and necessary part of the healing process but unfortunately there seems to be no stop button.  This means the adhesions can remain and continue to grow for life – so even if you are way postnatal this may still be something that could help.

Something else to consider, especially for those of you who are way post surgery, is that NeuroKinetic Therapy proposes that other pain can also come from a stuck scar.  Scars are neutrally dense which means they receive all the messages from the brain instead of other parts of the body e.g. the abdominal muscles.  This could lead to pain and a lack of strength in other muscles – which may mean you don’t get the results from strengthening exercises that you think you should.  Deactivating the scar could make a huge difference – think I’m going to have to start practising what I preach!

Although you need to rest in the early days, movement is an important part of your recovery.  It improves the blood circulation helping to nourish your body, keep muscles healthy and prevent stiffness and constipation – gentle walks are perfect!

When you do consider a return to exercise after a C-section (at least 8-12 weeks later) you need to be aware of any pain/tenderness you experience.  A painful scar is a good indication that you need to ease off a little.  And it goes without saying – NO CRUNCHES!

Crunches are a waste of time

I’m always being asked about exercises to flatten the abs so I should explain why I don’t do crunches in my classes.
One of the main things to bear in mind is the saying that abs are made in the kitchen – it’s more about nutrition than anything else.  You cannot choose an exercise to reduce fat in a certain area and according to Men’s Health Magazine it would take over 22,000 crunches to burn 1lb of fat.  And for us women, the stomach is where we mostly accumulate fat.  So watching what you eat is going to be the main way to get your desired result.
Back to those crunches…  Most people know you have to stop doing them when you’re pregnant.  But it’s one of the first exercises women think of returning to once they’ve had their baby in a bid to get rid of the mummy tummy.  In fact they’re a huge no-no as the pressure they create in the abdomen will push out on the stomach muscles and may prevent any diastasis from healing.
But it’s not just pre and post natal women that need to avoid this exercise.  And here’s why:
1.  They don’t work –  most people’s stomachs push up as they do the exercise, training the muscle to be domed, not flat.
2.  They put pressure on the spine – the spine is loaded more than is healthy and the discs are compressed. This could lead to back problems and will exacerbate any existing back pain.
3.  They reinforce an unhealthy posture – due to our daily habits most of us have rounded shoulders, a chin that pokes forward and tucked under pelvises.  When you do a crunch you mimic these same movements.  In fact, one sure fire way to achieve a flatter stomach is to improve your posture.
4.  They put a huge amount of pressure on your pelvic floor – I saw a graphic video showing this and wanted to post it.  But either it’s been removed or my parental filters are too strong!  Either way, every crunch forces pressure down on the pelvic floor.  With 50% of all women who’ve given birth going on to prolapse and 1 in 3 women have urinary incontinence, I think it’s worth protecting our pelvic floors!   So what’s the best thing for a flatter stomach?

  • improve your posture – Pilates is ideal for this.  Also sit less and walk more
  • nutrition – eat real food, and try to avoid sugar and alcohol particularly
  • functional whole body exercises – I’m a great fan of all fours work and squats and lunges and include them in all my classes!