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Pregnancy, pelvic pain & safely returning to running

Pregnancy, pelvic pain & safely returning to running

Pregnancy is an exciting and special time but it can also come with a lot of questions. Whilst Google gives us access to a wonderful world of information, it can lead to more questions and sometimes concerns. This article will discuss the effect of pregnancy on the mother in terms of pelvic pain and the pelvic floor and returning to running after pregnancy, backed up by evidence and research. It is important to remember that not any one pregnancy is exactly the same!

Pelvic Pain & Exercise during Pregnancy

Based on various studies, approximately 50% of women experience low back pain or pelvic girdle pain (pubic, buttock, tailbone, pelvic floor regions) during pregnancy and 25% continue to have this pain 12 months after delivery (Davenport MH, et. al., 2019).

A panel of experts looked at 32 studies, which included a total of 52,297 women without absolute or relative contraindications to exercise (Davenport MH, et. al., 2019). For the absolute and relative contraindications, please click here. From this, it was found that physical activity during pregnancy decreased the severity of low back, pelvic and lumbopelvic pain. (Davenport MH, et. al., 2019). This is both during the pregnancy and in the early postpartum period. The exercise components of these studies included yoga, aerobic exercise, general muscle strengthening and a combination of resistance and aerobic training (Davenport MH, et. al., 2019).

Another study by Owe et. Al (2016) looked at 39, 184 pregnant women who had not previously given birth. This study found that exercising up to five times weekly prior to pregnancy was protective against pelvic girdle pain and also those women who reported participating in high impact exercises prior to pregnancy had the lowest risk of pelvic girdle pain during pregnancy. (Owe KM, et. al, 2016).

The most current guidelines state that an accumulation of 150 minutes of moderate intensity exercise each week is recommended in order to achieve the health benefits and reduce risks of pregnancy complications (Mottola MF, et al., 2018).

Pregnancy & the Pelvic Floor

In relation to the pelvic floor, the main recommendation part of the most current guidelines state that pelvic floor muscle training is associated with a reduction in prenatal and postnatal urinary incontinence (Mottola MF, et al., 2018). These exercises can be performed daily HOWEVER, it is crucial that women seek instruction from a trained health professional (such as a women’s health physiotherapist) to ensure proper technique in order to obtain the best outcomes/benefits from performing these exercises. This is especially the case for women who have never trained these muscles.

Returning to Running after Pregnancy
More recently (March 2019), three highly experienced physiotherapists – Tom Goom, Gráinne Donnelly & Emma Brockwell combined their areas of expertise to release a paper on returning to running postnatal and the guidelines for this population. The main findings that were included in the paper were that women in the post-natal period benefit from an individualised assessment and guided pelvic floor rehabilitation in order to prevent and manage pelvic organ prolapse (bladder, bowel or uterus descending into the vagina) (Hagen, S et al., 2014), manage urinary continence (Bø, 2003) (Dumoulin, C et al., 2018) (Price, N et al., 2010) and improve sexual function.

Based on expert opinion only, the following suggestions were made:

• Return to running is NOT recommended at all prior to 3 months post-natal OR beyond this time point if any symptoms of pelvic floor dysfunction are identified before or after attempting return to running
• Pelvic health, load impact management and strength testing should be assessed in order to establish if a patient is ready to return to running in the post-natal period
• Additional factors that should be considered in the postnatal evaluation are weight, fitness, breathing, psychological wellbeing/status, abdominal separation, breast support and feeding, running with a buggy and relative energy deficiency in sport (RED-S)

How we can help you at Physiotec:

It is imperative to see your physiotherapist before commencing physical activity, especially if planning a pregnancy, already pregnant or in the post-natal period.

Here at Physiotec, your women’s health physiotherapist can:
1. assess your pelvic floor muscles to ensure you are using them correctly
2. assess and address other areas of concern such as low back pain or pelvic pain
3. advise you on the safest exercises during pregnancy as well as into the post-natal period
4. perform a physical assessment to determine whether you are ready to return to running or other exercise after pregnancy 
5. perform a running assessment to ensure that your technique places minimal loads on your pelvic floor and joints following pregnancy

You might also like to join one of our Pilates classes to stay strong or build strength and control before, during or after your pregnancy.

Bibliography

Bø, K. (2003). Is there still a place for physiotherapy in the treatment of female incontinence? EAU , 145-153.
Davenport MH, et. al. (2019). Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. British Journal of Sports Medicine, 53, 90-98.
Dumoulin, C., Cacciari, L. and Hay-Smith, EC. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews(10).
Hagen, S., Stark, D., Glazener, C., Dickson, S., Barry, S., Elders, A., Frawley, H, Galea, MP, Logan, J., McDonald, A., McPherson G., Moore KH, Norrie, J., Walker, A., Wilson, D. (2014). Individualised pelvic floor muscle training in women with pelvic organ prolapse: a multicenter randomised controlled trial. 282(9919), 796-806.
Mottola MF, et al. (2018). 2019 Canadian guideline for physical activity throughout pregnancy. British Journal of Sports Medicine, 52, 1339-1346.
Owe KM, et. al. (2016). Exercise level before pregnancy and engaging in high-impact sports reduce the risk of pelvic girdle pain: a population-based cohort study of 39 184 women. British Journal of Sports Medicine, 50, 817-822.
Price, N., Dawood, R. and Jackson SR. (2010). Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas, 67(4), 309-315.

Physical Activity & Pregnancy

Physical Activity & Pregnancy

Physical Activity & Pregnancy

The Facts, the Figures & the False Conceptions

If you are pregnant or planning a pregnancy and you are unsure about the current guidelines for physical activity and what is safe, this is a must read! An excellent team of experts have appraised over 27,000 manuscripts and abstracts (Davies G & Artal R., 2019) in order to bring us the most up to date information and guidelines on physical activity during pregnancy.

THE FACTS:

Physical activity during pregnancy:

  • DOES NOT increase the risks of structural or functional birth defects which stem from in the womb (Davenport MH, et al., 2019)
  • Has a significant effect on reducing the severity of low back pain, pelvic girdle pain and lumbopelvic pain. (Davenport MH, et al., 2019)
  • Decreases the chances of using instruments during delivery (Davenport MH, et al., 2019)
  • Reduces the chances of depression during pregnancy as well as the severity of symptoms. Unfortunately, this does not apply to the post-natal period. (Davenport MH, et al., 2018)
  • Reduces the risk of excessive weight gain during pregnancy as well as weight retention postpartum. (Ruchat S, et al., 2018)
  • Results in a small increase in the mother’s body temperature which is safe for the baby. (Davenport MH, et al, 2019)
  • Effectively reduces the risk of developing gestational diabetes mellitus, gestational hypertension and pre-eclampsia. (Davenport MH, et al., 2018)
  • Reduces the odds of having abnormally large babies (Davenport MH, et al., 2018)

Additionally…

  • There is no association between physical activity during pregnancy and increased risk of miscarriage or perinatal mortality (stillbirth or deaths in the first week of life) (Davenport MH, et al., 2019)
  • There is not enough evidence to inform us if lying on our back to exercise is safe or if it should be avoided altogether during pregnancy (Mottola MF, et al., 2019)
  • There was no association found between exercise during pregnancy and complications with the newborn baby or harmful childhood outcomes (Davenport MH, et al., 2018)

THE FIGURES & RECOMMENDATIONS

(Mottola MF, et al., 2018)

  • An accumulation of 150 minutes of moderate intensity exercise each week is recommended in order to achieve the health benefits and reduce risks of pregnancy complications
  • Exercise over a minimum of 3 days per week, however daily exercise is encouraged
  • Variety is key in order to achieve greater benefits
  • Pelvic floor muscle training can be performed daily in order to reduce risk of urinary incontinence
  • Exercising flat on the back should be modified if the pregnant women is experiencing light headedness, nausea or feeling unwell
  • TAKE HOME MESSAGE: All women WITHOUT contraindications should be participating in physical activity during pregnancy

THE FALSE CONCEPTIONS

  • Exercise will harm the baby. The evidence has shown that there are no increased risks of miscarriage or a small baby when undertaking physical activity during pregnancy
  • Heart rate should be below 140 beats per minute. This is an outdated guideline from the 80s and there was no evidence to even support this guideline, it was based on expert opinion.
  • Exercise needs to be at a gym or with group fitness. Lots of studies that were looked at were walking programmes. Additionally, moderate intensity physical activity can include gardening, mowing the lawns and some household chores.

Other considerations for physical activity & pregnancy

There are other considerations specific to the mother during pregnancy and physical activity. These include, but are not limited to, the pelvic floor and risk of overload/prolapse as well as pelvic pain. If you are planning a pregnancy/already pregnant and have a history of pelvic pain or pelvic floor concerns, it is important to see your physiotherapist before commencing physical activity. Here at Physiotec, your women’s health physiotherapist can assess your pelvic floor muscles to ensure you are using them correctly, assess and address other areas of concern such as low back pain or pelvic pain and advise you on the safest exercises during pregnancy as well as into the post-natal period. You might also like to join one of our Pilates classes to stay strong or build strength and control before, during or after your pregnancy.

Download more information on Physical Activity during Pregnancy here

Try Torpedo Perturbation Training at PhysioTec

Try Torpedo Perturbation Training at PhysioTec

Perturbation Training

See one of our Physiotec staff, Colm Coakley, demonstrating some perturbation training using the CorMax Torpedo. Half filled with water, the Torpedo becomes an unstable load which your muscles need to figure out how to control. Consequently, it provides a great dynamic stability challenge! Also, due to the ever-changing stimulus, it keeps the nervous system guessing.  This requires the system to continually change the way muscles are stimulated to respond.

In response to pain, or sometimes due to excessive training in very rigid unvarying patterns eg like regularly holding a rigid plank for 2+minutes, the nervous system can begin to recruit muscles in very confined, ‘primitive’ patterns. This can lead to a loss of normal efficiency and load sharing-load sparing in muscle recruitment patterns. As a result, this can also potentially contribute to pain, injury and a loss of athletic performance. At Physiotec, we are always exploring and embracing strategies that can help our patients get the best out of their bodies and their lives. Come & join one of our highly qualified physio’s in an innovative and challenging workout.

6 Tips To Bulletproof Your Running This Summer

6 Tips To Bulletproof Your Running This Summer

It’s spring time and for many it’s a sign to start getting fit for summer. For those who had been hibernating during winter it is worth taking note of these following tips to bulletproof yourself for the months of running ahead.

 

  1. Remember you are exposing your body to increase stresses and strains that it may not be accustomed to. Many runners experience injury in their first 8 weeks by doing too much, too fast, too soon. Increase running volume by no more than 10% every 2 weeks.
  2. If you are taking up running for the first time, allow 48 hours between runs during the first four weeks. You can do other lower impact exercise on alternate days such as cycling, swimming and strength training.
  3. Break up your first few runs into run/walk intervals. For example 1 minute run/1 minute walk for 20-30 minutes. 
  4. Run with a shorter step and higher cadence. Pick the foot up as you swing the leg through and land with a verticals shin and bent knee joint in the front of the hip. Run tall with an upright posture. As you improve in fitness and strength your running technique will feel easier.
  5. Strength Training/Pilates will help your running performance and reduce the risk of injury. Runners need strong hips, trunk muscles and ankles to move well, maintain good posture and prevent injury. Two-three #strength training sessions is recommended per week focusing on whole body ground based exercises such as squats, lunges, deadlifts and step ups. Good movement and technique must be trained before adding resistance.
  6. Make sure you have the appropriate equipment/footwear. Nothing more likely to cause injury/discomfort than this. Find the runner that is most comfortable for you or a brand you trust and have used previously in the past with good results.

 

If you have pain running and you’re unsure about why, STOP! Go see your GP or Physiotherapist, find out why you have a problem and then deal with it. Many running related pains are easily dealt with, but some, if left untreated, can become chronic problems.

Enjoy your running! Every session you do doesn’t have to be better than the last one. Schedule easy runs for yourself where you don’t worry about pace and just enjoy a nice easy trot!

When is your child safe to begin resistance training?

When is your child safe to begin resistance training?

When is it safe to begin resistance training?

It is a common misconception that resistance training in children stunts growth. Many parents and coaches remain convinced that weight training will result in short stature, due to potential damage to the growths plates (epiphyseal plate).

In actual fact, The Australian Strength and Conditioning Association (ASCA) have developed a position stand on youth resistance training, which is in contrast to these beliefs.

At PhysioTec, we believe there is a place for strength and condition in children. We maintain that supervision is essential, and believe that this is an ideal time to condition young developing children and adolescents to a level where there body can not only withstand, but excel in their chosen field.

Are you still unsure?

Well, if a child is ready to participate in organised and structured sports, such as cricket, football, rugby and basketball then they are generally ready to perform a supervised resistance-training program. This will allow them to handle even the most intensive sporting schedules

 

September 2017

Physiotec’s 7 laws of Strength Training

Physiotec’s 7 laws of Strength Training

 

7 laws of Strength Training

1 Train Consistently

Consistency with training is vitally important. Those who train week in and week out will experience steady improvements in fundamental lifting skills, strength and muscularity over time. Assess your weekly routine and see when you can fit in at least 2-3 30-45 minute sessions per week into your schedule

2 Warm Ups are essential:

The “RAMP” system provides a method by which warm-up activities can be classified and constructed. This system identifies three key phases of effective warm-ups.

Activities included in the ‘Raise’ section can be used to increase body temperature and blood flow. The ‘Activate and Mobilise’ section can be used to optimise strength, control and dynamic flexibility around areas central to performance in the gym. The ‘Potentiation’ section provides an ideal time to carry out activities such as speed and plyometric training in order to prepare the body to work at maximal capacity.

3 Use Good Form:

You do need to be very strict with your exercise form, and you need to learn the right type of form for your body on various lifts. This is especially important for bigger exercises like squats and deadlifts where the risk of injury is inherently higher than, say, dumbbell curls. Developing competency in the major compound lifts such as the deadlift, squat and lunge will reduce the likelihood of injury in the gym and can ensure you train consistently throughout the year and reach your goals.

4: Stimulate the muscles of the entire body:

To make a muscle grow, it must be stimulated on a regular basis. Compound exercises are designed to stimulate a lot of muscles throughout the body. For example the deadlift stimulates the forearms, traps, lats, scapular retractors, spinal extensors, glutes and hamstrings, even the core and quad muscles This helps explain why deads are such a great exercise. However, if all you did was deadlift, your pecs, delts, and biceps wouldn’t come close to reaching their full hypertrophy potential. Make sure your programs regularly incorporate enough exercises that combine to thoroughly hit the entire body.

5; Basic Strength Must Improve:

 Progressive overload is the most important aspect in the strength game. If you embark on a strength training regimen and fail to get stronger, you won’t gain much muscle. You must use heavier loads and perform more reps over time.

As you get more experienced in the gym, you should see dramatic strength progress compared to your beginning level in a squat variation, a deadlift variation, some kind of upper body press, and an upper body pull. And if you want to be your absolute best at anything, be it squats, deadlifts, bench press, power cleans, or even Turkish get-ups, then you need to perform the lifts consistently to groove the neuromuscular patterns and maximize motor learning. Failing to do so will leave unachieved progress on the table.

6 Muscle is made in the gym and built in the kitchen.

 Nutrition is key when it comes to strength development. The best training program in the world is no match for a poor diet.

If you want to develop strength and perform optimally, then you must take nutrition seriously. You need to take in the right amount of calories and the right blend of macronutrients for your goals and physiology. You don’t have to be perfect 24/7, but eating a consistent amount of carboydrates, protein and fats can help with strength and hypertrophy gains.

7 Sleep.

Some folks need more sleep than others and some can perform well with less, but you should still care about your sleep (quantity and quality) and prioritize it. Make a genuine effort to be consistent with your sleep schedule if you’re serious about getting results. Failure to do so will hinder your pursuit of strength and hypertrophy.

Regarding stress, your goal shouldn’t be to eliminate it altogether, but rather to optimize it. It’s good to be challenged in life, but there’s a fine line between eustress (positive stress, like a good workout) and distress (negative stress, like 65 hours a week at a job surrounded by toxic co-workers). Aim to stay in eustress most of the time for maximum results. Step back and analyze your life choices and habits. This is an area in which many lifters can make adjustments that lead to immediate results.

 

Resistance training for persistent pain

Resistance training for persistent pain

Resistance Training for Persistent Pain

Resistance Training

At Physiotec, we see many people with persistent hip and lower back pain. A lot of them are fearful regarding resistance training or are unsure what types of exercises are appropriate for them. There is often a misconception surrounding resistance training regarding its potential to be harmful or unsure for patients with persistent pain. At Physiotec, we aim to create an environment, which promotes strengthening in a safe and graduated way.

Benefits of resistance training

There are many benefits of resistance training including improving muscle mass and bone density, injury and falls prevention and overall movement patterns. In our new strength and conditioning gym, you have a unique opportunity to be closely monitored by a physiotherapist who combines their excellent knowledge of pain science and resistance training in the overall management of your condition.

Assessment and management programs

All our assessment and management programs are 100% individualized to suit your specific needs. Whether you are young or old or are experienced or inexperienced with resistance training, our Gymstart program offers you a new and exciting approach to the management of your presentation.

 

Saturday Acute Injury Service

Saturday Acute Injury Service

Ever hurt yourself on a Friday night or Saturday and wished you could have your injury seen to? Did you know Physiotec now offers Injury Clinic every Saturday from 11:30am-1:30pm. One of our skilled Sports Injury & Performance Physiotherapists will be on staff every Saturday to cater for the acute injuries sustained during Friday night/Saturday. The right advice and early management makes all the difference. Get treatment/advice now. Don’t wait!!!

We also have a normal clinical service and pilates on Saturday morning, but reserve places with one of Sports Injury & Performance team specifically for acute injuries that require urgent assistance.

Why Gym Start?

Why Gym Start?

Welcome to the first blog post of our strength and conditioning series. Physiotec has recently recruited physiotherapists with specific experience in strength and conditioning. We recognise the need to give people access to strength training, especially coming back from injury. However, uninjured people will also benefit from the service.

In our clinic, we see more and more people who are engaging in gym based training and this ranges from young adolescents to elderly people.  The goals for strength training for the individual may be different but the fundamentals are the same: good form and appropriate loading. It is our goal to provide this service for our clients to enjoy strength training in a safe and effective manner.

We aim to update our blog regularly and provide some easy to digest content on all things strength training. In the meantime, keep up to date with our clinic via social media:

Facebook:  https://www.facebook.com/PhysioTec

Twitter: @PhysiotecAUS

Physiotec Updates

Physiotec Updates

END OF YEAR ROUNDUP!

2015 in Review

2015 was a year of exciting change and growth for Physiotec. The clinic expanded physically, new staff came on board, our technology advanced, our physiotherapists further expanded their already high level of knowledge and we reached out to the community with involvement in sporting events, teaching locally and abroad and with social media.

The clinic expanded upstairs this year providing another large gym space, two more treatment rooms, a second waiting area, a meeting/teaching space for our staff and a second office. We have also taken on board a Patient Liaison Coordinator, Toni Corta. You may have heard from Toni who is responsible for helping track the progress of our patients with the aim of providing the best quality service possible. We pride ourselves on providing treatment that is up to date and informed by cutting edge scientific evidence. The information Toni collects will further help us determine which treatments provide the best outcomes in our patient population. Better outcomes achieved more rapidly for our clients continues to be our primary focus.

We also invest in technologies that can help us achieve this goal. Physiotec invested in an additional real time ultrasound machine used for muscle and tendon assessment, rehabilitation and biofeedback. Our ViMove system (wireless accelerometers for assessing movement) has undergone considerable advances with new programmes to assess and improve ‘core control’ and neck movement as well as advances in the knee and running modules. Our second gym has been equipped with a new reformer with a tower attachment and we also added a ladder barrel allowing a host of new exercise challenges. A spine corrector, two TWS sliders, a ballet bar, balance equipment, band stations, a weights station and much more can also be found in our new exercise area.

pilates gym new

Our physiotherapists are passionate about continually increasing their expertise. Our staff have been involved as treating physiotherapists in university research trials and have attended national Physiotherapy and Sports Medicine conferences and many workshops and lectures on topics such as Hip Pain, Hamstring Injuries, Bone Health, Women’s & Men’s Health (pelvic pain and pelvic floor function), Hypermobility, Dance Medicine, Running Injuries & Rehabilitation and Tendon Pain & Rehabilitation.

Our principal physiotherapist, Dr Alison Grimaldi has also contributed to the knowledge of other physiotherapists and health professionals in Australia and overseas through multiple presentations at the recent Australian Physiotherapy Association Biennial Conference at the Gold Coast and lectures and workshops presented at Pure Sports Medicine(London), PhysioUK (London), Centre for Sports and Exercise Medicine, William Harvey Research Institute (London), Neath Port Talbot Hospital (Wales, UK), the Sports Surgery Clinic (Dublin, UK) and the Australian Institute of Sport (Canberra).

Dublin lecture 2

Sports Surgery Clinic, Dublin

Alison also presented weekend courses for physiotherapists in Brisbane, Sydney, Melbourne and Canberra. She has continued her research involvement into management of gluteal tendon pain and hip joint pain through the University of Queensland and University of Melbourne and has co-authored three papers in peer reviewed scientific journals such as Journal of Orthopaedic & Sports Physical TherapyMedicine and Science in Sports and Exercise and Sports Medicine Journal.

Physiotec has been more connected to the world in 2015, with increased activity on Twitter and Facebook. We aim to help keep our followers up to date with the latest research in physiotherapy by providing information on useful links, blogs and tips on injury prevention.  Not only are we active on social media, but we also launched a new and easy to navigate website where you can browse our services, get to know the staff, and read more news in physiotherapy. Here is link to our new website: Physiotec

As part of our goal to get our clients more fit and active throughout their recovery, Physiotec staff and patients participated in the International Women’s Day Fun Run which raises money for Breast Cancer.

international women's day

We have also worked hard to help our patients to achieve their own activity and work related goals. Staff physiotherapist, Eric Huang, who is the founder of Brisbane-based cycling group M.I.A, helped some of our clients earn cycling medals while managing to gain podium placings himself.

MIA

mia podium eric

We have helped clients achieve lifelong goals of overseas travel and returning to work after years of disability, but it is often the everyday things that have the most impact – walking upstairs painfree for the first time in months, being able to attend family or social gatherings, achieving a good night’s sleep. We always love to see our clients overcome their difficulties and reach their personal goals.

What’s up in 2016?

In this coming year, our physiotherapists will be attending conferences and courses around the world. Alison will be attending the Low Back & Pelvic Pain Congress in Singapore and lecturing and presenting at the International Federation of Orthopaedic Manipulative Physical Therapists in Glasgow, UK. She will also be teaching in London, Wales, Ireland, Paris, Hong Kong, Singapore and New Zealand, as well as her regular Australian courses. Sharon will be attending the First International Ehler-Dhanlos and Hypermobility symposium in the USA. Kirsty, will once again be working with elite tennis players at the Australian Open in Melbourne. Eric will be continuing to further his knowledge and performance in all things cycling. Megan will be furthering her expertise in Women’s Health and Tony & Louise will be sharing their knowledge with some part time tutoring at the University of Queensland.

We will also be joined by visiting psychologist, Carolyn Uhlmann, who has a focus on providing support for patients coping with acute and chronic pain, chronic illness or caring for a loved one with health problems. She can also assist those who are learning to adjust and cope with changes in health, medical events, mobility and independence.

With the new staff members, new gym, new Pilates programs, running assessments and spinal assessments, you can expect that we will be offering more at Physiotec as we continue to grow.