Wednesday, 24 April 2019

Kegels Are Medicine

Kegel are Medicine

As a healthcare provider I am always learning from leading physiotherapists in women’s health. I was watching a Facebook video by Isa Herrera, a physiotherapist form the United States and she was answering a question about Kegels and she something that really got me thinking, “Kegels are Medicine.”

Kegels are medicine. They work, when you do them as prescribed. Did you know there are over 20 different types of kegel exercises? Just doing one type of Kegel may not be right for you. It’s about finding the right Kegel and then prioritizing to do them.

Just like when the doctor prescribes you antibiotics for an infection and says to take it 3 times a day with food. Most people make it a priority to remember to take them as prescribed and they work.
Exercise is medicine, but perhaps we don’t view it that way because it’s not a pill that we take. We all live busy lives and it can be very challenging to change and re-prioritize ourselves. I have found that the client’s who get better are the ones that make a commitment to their health and well-being. You cannot expect to do a Kegel here and there and get better.

Exercise requires a connection of mind and body. The therapist is the guide, but you have to become the Master through practice. If you are just going through the motions to say, I did it. You may be missing out on some important information your body is trying to tell you and you can risk injuring yourself when you are not closely paying attention.

Practicing your Kegels is also about patience, you don’t just take one antibiotic and you’re done. You have to take many before it starts to work. Sometimes, an antibiotic that works for one person doesn’t work for the other and modifications need to be made to the exercise program. How will you know if it’s working, if you haven’t given the exercise a dedicated effort? There is no cookie cutter approach and the same is true for doctors. It’s an interaction between you, the therapist and tools/techniques.
In her latest book, Female Pelvic Alchemy, Isa the author actually has a page where you sign to make the commitment and she outlines the 10 factors that are needed for optimizing treatment.

A lot of what she lists is mindset. If we begin to view exercise as medicine and do it as prescribed, make it a priority, then massive positive benefits are possible. You can take back your life, take back control of your bladder, get back to activities you love, super-charge your sex life and love yourself more than you did before. Caring for your self is an act of self-love.

So my challenge to you is, if you have been prescribed Kegels by a trained professional, make the commitment and try to take your “medicine” and let’s see what type of magic can happen.

The Pelvic Health Lady

Wednesday, 20 February 2019

3 Exercises for Tailbone Pain

3 Exercises to help with Tailbone pain.

The tailbone, also known as the coccyx bone is a small triangular shaped bone that is attached to your sacrum, the bone between your pelvis and below your lower back.

People develop tailbone pain for a number of different reasons such as, falling on the tailbone, injuring the tailbone during birth, losing mobility in the tailbone or developing muscle tension that pulls on the tailbone.
Knowing what specifically is happening with your tailbone it is always advised to a tailored plan. So make sure to get an assessment with a trained professional, such as a pelvic floor physiotherapist.
Here are 3 exercises you may find helpful for relieving discomfort in your tailbone.

1.  Sacral Ligament stretch exercise

In this first exercise you will be laying down on your back. Legs straight out. Start with your right leg by pulling your knee inward towards your chest and lining up your knee with your right shoulder. Holding there for 30 seconds and taking nice long deep breaths into the stretch. Then you will bring your right knee over towards the left so that your knee lines up with the middle of your chest. Hold 30 seconds and breathe deeply into the stretch. Then finally bringing your right knee over to line up as closely as comfortable with your left shoulder. Holding 30 seconds and breathing deeply. Then straighten out your right leg and repeat with your left leg.

2.  Cat/Dog

In this second exercise you will be on your hands and knees, preferably on a yoga mat or something cushioned. You will move your spine into a hammock like position where you arch your back, stick your buttock out and look up with your head. This is the dog position. Then you will gently move into the cat position where you will round your back, look down with your head and tuck your buttock under. You will move back and forth gentle between these 2 positions, 3 sets of 10 repetitions. Once you are more familiar with the movement we can add breathing into the exercise, where you inhale going into the dog position and exhale going into the cat position.

3.  Child pose

Kneel down on a yoga mat and open the knees slightly to create a V shape. Place both your hands in front of your body and gently slide your hands forward so that your back begins to bend as your chest comes closer to the floor. Once in the child pose position I want you take a nice slow inhale through your nose and imagine you are pulling the air all the way down to the pelvic floor and relaxing the muscles around the tailbone. Then exhale slowly through the mouth as your try to stretch further into the position. Repeat for 10 breaths.

Video Link to these exercises: 

The Pelvic Health Lady

Monday, 28 January 2019

To belly band or not to belly band. That is the question

In the pregnancy and physiotherapy services it was believed that using a belly band in the first 8 weeks post partum would be helpful for “healing” a rectus diastasis. I am the first to admit that I too was recommending this for a period of time. I’ve learned some new information and ever since I have stopped recommending it proactively, but that is not say that in certain circumstances it is not helpful. So I want to share what I have learned.

Firstly using the word healing may be a bit deceiving in the case of a rectus diastasis. Yes we heal postpartum from tears or actual tissue trauma but when it comes to the ab muscles and fascia there is no inflammatory process happening that signals “healing,” like in the case of healing from a wound. Since there is no actual “healing” taking place, a band cannot heal a diastasis. The abdominal wall is actually recovering from a sustained stretch, which is why it is important to rest and allow the body to adjust to the new environment, I.e no baby inside.

One of the leading physiotherapists/educators Diane Lee suggests that using a band can actually prevent the abdominal wall tissues from tightening up. This is because the band puts the muscles/fascia on slack and tension is needed for collagen growth which is what helps muscles and fascia to develop.

We don’t really know why some moms get a smaller separation while others get a large separation. We also don’t really know why some moms regain function and tension in the abdominal wall faster while others don’t. What we do know is that the tissues need to be loaded to rebuild strength and tension.

As I mentioned above, there are some circumstances where using a belly band can be helpful, for example a mom who is experiencing back pain who has a newborn and/or additional kids and needs to get work done around the house or go out for groceries. If the band helps support her in those activities so she can get them done, this is an appropriate time to use it. However, as soon as that activity is done, the band should come off.

I have similar conversations when clients ask about back braces. Braces do the work that the muscles should be doing. There are going to be circumstances when they are needed to get through an activity but I never recommend for constant or permanent use. If the muscles don’t have to work they get weak, often times adding to the problem and creating a reliance on the brace.

Now its important to clarify that if using the band helps with the back pain in the postpartum period it is not because it’s changing the rectus diastasis, it is more because the band provides an increase in intra-abdominal pressure and a wall of support for activity. The same can be true for spanx. It can provide additional support to the back, pelvic and hips with activity but it won’t impact the connective tissue and muscles. So if you are using these to get through some activities by all means, momma’s gotta get work done, but make sure to take it off for most of the time.

Really the only way to address a rectus diastasis is through committed, consistent, hard work. If you read my previous blog on rectus diastasis I was mentioning that we don’t consider a separation a problem in the first 13 weeks post partum. After that if it persists, here are some timelines.

If the ab separation is due to a mechanical issue (meaning a muscle is not activating well or in coordination with other muscles) you can expect to see results from exercise in about 6-8 weeks. However if the fascia/connective tissues needs to re-build, meaning laying down new collagen it could take anywhere between 12-18 months with exercise.

One thing to consider in the time frame is that connective tissue will be impacted by breastfeeding so it can take 4 months after you stopped breastfeeding for the tissue to tighten, hence why it can take 12-18 months.

So the answer.. To band or not to band? Band if you have pain and it helps you get things done, spanx for an evening out but don’t be using this every day, all day as a solution. Make sure to see a physiotherapist.

Information for parts of the blog comes from a presentation done by Diane Lee PT from the Spring/Summer Birth Healing Summit 2018.

The Pelvic Health Lady