Return to Running After Baby...part 2

What happens during a Return to Running screen?

To do a full assessment, pelvic floor examination is strongly recommended. I complete a full assessment including bladder and bowel function, sexual dysfunction, previous injuries, pregnancy and birth history followed by a pelvic floor examination (if consent is given) to check for signs of dysfunction, weak/over active muscles, tummy muscle separation and teach you all about your core and pelvic floor. If there are any issues, we will make a plan to tackle those first and get them under control. This does not mean you have to stop exercising – we might have to just modify what you are doing/how you are doing it.

If there are no issues, we can then progress to the strength and impact screen. The body has to be strong enough to cope with impact so checking muscle strength is the next step. If there are any weaknesses this will be your homework for a few weeks to build strength.

Next step is the impact screen. This is designed to check how your body and especially pelvic floor will respond to an increase in load and pressure going down through it. It will highlight if there are any loading issues for example pain, leaking, pressure/heaviness – do you need to relax the pelvic floor more? Change your landing technique? Strengthen your pelvic floor more? If there are any issues then we work on these too.

Emily (from EmPowerMe Fitness) and I are working on a 6-8 week Return to running course….stay tuned for more info!!

Once you are symptom free, strong enough and your body has shown you are ready for impact….lets go! You can gradually ease back into whatever you would like to train for. For example:

• Running – perhaps start a couch to 5km 8 week plan

• Netball – preseason like drills to ease back into impact

• Cross fit – low reps of jumping and landing (body weight only) and increase reps, speed, height, distance as you are able

Often return to impact will show up problems that women didn’t realise they had. I will often see them after 6-12 months when they have tried running but have developed issues. If this happens don’t panic – we just need to figure out what is going on and get a plan in place.

 If you are ready to get back into running and impact exercise…you know who to call!

Risk factors for potential issues returning to running

• Less than 3 months post natal

• Pre-existing hypermobility conditions

• Breastfeeding

• Pre-existing pelvic floor dysfunction or lumbopelvic dysfunction

• Psychological issues which may predispose a post-natal mother to inappropriate intensity and/or duration of running as a coping strategy

• Obesity

• Caesarian section or perineal scarring

• RED-S (Relative Energy Deficiency in Sport)

Signs and symptoms of pelvic floor and/or abdominal wall dysfunction

• Urinary and/or faecal incontinence

• Urinary and/or faecal urgency that is difficult to defer

• Heaviness/pressure/bulge/dragging in the pelvic area

• Pain with intercourse

• Obstructive defecation (e.g. constipation, staining to empty bowels)

• Pendular abdomen, separated abdominal muscles and/or decreased abdominal strength and function

• Lumbar/pelvic pain

Reference: Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population. Tom Goom, Gráinne Donnelly and Emma Brockwell Published – March 2019

Return to Running After Baby...part 1

It’s been 6 weeks since bubs arrived, and I’m ready for running and impact exercise right?

Em No.

When the clock strikes midnight on Week 6 post natal, the body tissues do not magically heal to allow you to go straight back to pre-pregnancy exercise (sigh…if only it were true though!!)

De Mattos Lorenco et al. 2018 completed a systematic review to look at all the research on urinary incontinence in female athletes. They concluded “High-impact activities showed a 1.9-fold prevalence over medium-impact activities and 4.59-fold prevalence over impact activities”

Running can create ground reaction forces between 1.6 and 2.5 times bodyweight and will increase intra-abdominal pressure, but just how much of this is absorbed by the legs and the pelvic floor? Have a look back at these blogs to understand about the core and pressure system .

The pelvic floor muscles therefore need to be strong enough to support this pressure, but also be able to adapt and move with the changes in pressure to stabilise the pressure in the abdomen.

Pregnancy puts a significant amount of pressure onto the pelvic floor. The pelvic floor has a “U” shaped space (see blue line on the picture to the left) for the urethral and vaginal openings.

The U shaped space actually widens during pregnancy and even more so during a vaginal delivery. After a C-section the space will decrease but it can take up 12 months for this space to return to a similar size after a vaginal delivery. But it will never return to prenatal size. Why is this important? Look from the side

You can see the vagina is in the middle of the pelvic organs and canals. If there is injury or laxity in the tissues that support the organs, the tissues becomes over stretched and the organs will descend into the vagina causing a pelvic organ prolapse. The vagina sits above the levator gap, therefore an increase in this width means less support for the organs.

After a caesarian section, the uterine scar will still be thickened and healing at 6 weeks post natal (which is one reason C-section recover takes longer) . But studies have also shown that abdominal fascial has only 51-59 % of its original strength at 6 weeks, and 73-93% of its original strength at 6-7 months ( Ceydeli et al. 2005, taken from Return to Running Guidelines see reference below)

Looking at the anatomy and statistics above, you can see why these guidelines were needed.

The guidelines state:

“a low impact exercise timeline is followed within the first 3 months of the postnatal period, followed by a return to running between 3-6 months post-natal at the earliest. In addition to this every post natal mother, regardless of delivery mode, should be offered the opportunity o receive a pelvic health assessment (from 6-weeks postnatal) with a specialist physiotherapist to comprehensively assess the abdominal wall and pelvic floor including vaginal exam as indicated”

We also know that:

“The evidence supporting individualised pelvic floor rehabilitation for the management of urinary incontinence (Bo, 2003; Dumoulin et al.2018; Price et al. 2010), POP (Hagen et al. 2013), sexual dysfunction (Braekken et al. 2015) and the prevention of POP (Hagen et al. 2013) is well established. (RTR gudelines).

Although the guidelines recommend 3- 6months, again this does not mean at bang on 3 months you are ready for a 5 km run. If you have any signs and symptoms of abdominal wall or pelvic floor dysfunction, or risk factors then allowing the body as much time to heal AND be symptom free AND reduce your risk factors will give you the safest return to running/impact experience. A pelvic floor assessment is strongly recommended too, there could be a prolapse that is not giving you any symptoms, or you may have risk factors for developing pelvic floor dysfunction later on in life. Simply not having symptoms of dysfunction is not a good enough reason to commence running.

Reference: Reference: Returning to running postnatal – guidelines for medical, health and fitness professionals managing this population. Tom Goom, Gráinne Donnelly and Emma Brockwell Published – March 2019

Piston Science by Julie Wiebe

My addiction to learning started here. This was a life changing moment in my pelvic health career.

For years I’ve known there was more to the “core" than the Transverse abdominis (lower abs) contraction we have all been taught. I’ve read the research but I just couldn’t put it all together and make sense of it. Then came along Julie Wiebb’s Piston Science.

Finally it all made sense. I remember standing in my kitchen emptying the dishwasher watching the videos and having a genuine light bulb moment. My understanding of how the core and pelvic floor worked together was explained in a way I completely understood AND it was all evidence based! SCORE!!

But the awesomeness didn’t stop there. The biggest part of this was my realisation that everything, like everything comes down to breathing. All body functions need it, and as I write these blogs you will see it pops up everywhere. If you cant breathe well it affects everything (even pooping!) This course taught me how to take my pelvic rehab off the treatment table, and away from basic exercises (like leg lifts, bridges and clams etc) and into the gym using functional movements. Finally all my woman’s health training, musculoskeletal and sports physio learning to date blended together and made perfect sense.

What I took to practice?

This education gave me the “bean lift” analogy that I now use with all my patients and cue in my fitness classes – MamaFit, Pilates, Yoga and even Pole Fitness.

“Exhale and lift your beans” should be my catchphrase!

Julie’s courses bridged the massive gap between treatment and exercise. They gave me the theory and confidence to take treatment to the next level incorporating exercise and real life movements. I go back through this course regularly to refresh my skills and remember hidden gems of treatment.

You can check out Julie Wiebe’s information and courses on her website…definitely worth the read!

How to contract your Pelvic Floor & Core

The number one question I get asked from patients in the clinic/email/message is:

“Can you just teach me how to do pelvic floor exercises?”

Of course I can…but just learning how to do a pelvic floor contraction is not going to fix your problems. But it is the starting point. Relaxing is just as important and contracting these muscles.

I teach core and pelvic floor in lying - but from the video you will see this isn’t a function position. It is for training purposes only

 Remember: an individual assessment is a must to get the best cue for you, and also to check you are doing it right!

The images are used with kind permission from myPFM.com