As well as exercises to strengthen specific areas of the body, raising your heartbeat and working up a sweat is also very important during pregnancy and highly recommended. It will help strengthen your heart and lungs as well as maintain muscle tone. Now most sports are suitable if you are pregnant (for those of you that were already doing a sport), but what about the couch potatoes? I do not advise couch potatoes to start training for a marathon while pregnant but on the other hand I would not advise to continue being a couch potato all through your pregnancy, as long as there are no complications and you have not been advised to be on bed rest. I am therefore going to mention each sport specifically, as to what the correct advice should be, as it is important to pick a sport that you enjoy.
Dance routines and aerobic exercise is safe to continue as normal if you are experienced, although you may want to tone down the intensity level and make sure you do not exert yourself to the point of exhaustion, which could deprive your body of oxygen. However if you are a beginner I would advise low impact dance or aerobics, or even water aerobics.
Swimming and exercise in water is great. In water you weigh just a tenth of what you are out of the water. It is gentle on your joints but also allows you to boost your strength and flexibility.
Gym machines such as step, rowing and treadmills are also great to use during pregnancy, including beginners. You can adjust speed, inclines and tensions to a level of comfort for you starting slowly if you are a beginner. Make sure you stretch beforehand and take it slowly. During the 3rd trimester it is best to avoid jumping and fast running and be very careful to avoid falling over.
Jogging for the experienced runner is also fine and during pregnancy you can stick to it but you may want to consider limiting your distances and sticking to a more level terrain (or use a treadmill). If you were not a runner before pregnancy I would suggest you stick to walking for now. Bear in mind that loose ligaments and joints during pregnancy can make running harder on the knees and also make you more prone to injury, so make sure you do not over do it.
Kick boxing during pregnancy, now it takes a great deal of grace and speed, 2 things that are reduced during pregnancy. You may find you are not able to kick as high or move as quickly but if you are still comfortable getting exercise from kickboxing and you are not a novice it is fine to continue. Be careful to avoid movements that you have difficulty in doing or that cause you to strain, and remember not to over do it.
Outdoor sports such as cycling, skating, hiking and skiing are not to be taken up as your new sport especially as they test your balance but again if you are experienced (except skiing) in this area and are comfortable to continue it is fine. However high altitudes, slippery conditions (skiing) and rock climbing are not advisable. Be careful about safety; don’t cycle in wet conditions, or windy and rocky paths and always wear a helmet. With skating as you get bigger your balance will become more challenging and then it is time to hang to your skates up for a while. Skiing is too dangerous as there is high risk of serious injuries, even if you are in the Olympics.
Last but definitely not least I will mention walking, which is great for everyone anywhere and everywhere. Start slow and build up to a brisk walk.
With all this exercise don’t forget to drink, drink and drink some more, especially in the hot weather.
If you are suffering from any pain and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you privately or through Leumit in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.
How should I get back into exercise a few months after having my baby?
Months have gone by, everything has healed nicely and you are in a good routine with your baby. Some of you might only get round to thinking of exercise at this point in your life, but where to start? You may be a few pounds heavier than before pregnancy and introducing exercise into your lifestyle is a really good idea.
I just have to mention it before I get into the nitty gritty but starting with your pelvic floor exercises is a good idea; it might not get you the flat tummy you’re after but it will give your body a good head start into avoiding incontinence.
Now for the tummy exercises, the pelvic tilt is a really good one to start with, it helps flatten the tummy even if there is a gap (RAD) above your belly button. You need to tilt your pelvis and hold for 3 seconds. Start with 10 a day and build the number up.
Another good exercise is the plank, again this is good for the tummy muscles and again it will not cause damage to those that do have a weaker pelvic floor. You need to hold yourself in press up position, tightening your abdominal and glutes. When you have mastered that and can hold for 10 seconds without too much wobbling then raise 1 hand in the air and let your body turn and follow through. Aim to hold this position to for 10 seconds. Start less and work your way up.
Now exercise can be incorporated into your lifestyle instead of setting time aside which can easily be pushed off and forgotten. On that note another one of my favourites is with your baby, and as your baby grows, so too the weight that you are using. Place your baby over your legs when you are in a lying position and raise your legs up and down, your baby might like this one too.
If you are suffering from any pain and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.
Tips for Lower Back Pain
During pregnancy as your bump gets bigger your tummy will naturally stick out leading to your bum also sticking out. This automatically leads to a change in posture. Therefore it is no surprise that lower back pain during pregnancy is common. Over the course of nine months, your body will go through a very quick posture change. This leads to shortening and lengthening of different muscles that have previously not been used as regularly.
This is the reason that exercise (even without pain) is very important during pregnancy. Exercises such as sticking your tummy and bum in are essential, and this also helps working out what I like to call your core muscles.
Wearing high heels only exacerbates this change in posture, so wearing flat shoes throughout the pregnancy is preferable. You could also wear a support belt. This helps support your back into a more desirable posture, although this still needs to be coupled with appropriate exercises.
Taking a rest and getting off your feet regularly is also helpful, as well as sleeping on your side, with pillows for support. Many find that sleeping on your back will increase the pain, due to the larger curve in your back from your change in posture, as well as it being better for the baby as well.
Instead of bending down to pick an item off the floor, squatting down with one leg is much more desirable. This is a preventive treatment, to avoid lower back pain.
A physiotherapist will also ensure that your spine and joints are aligned properly; this can be quickly fixed sometimes, relieving the pain of your lower back straight away.
If you are suffering from lower back pain and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.
Pelvic Floor: Practice Makes Perfect
There are many contributing factors to the downfall of your pelvic floor, many of which I have discussed in previous blog posts. Another reason your pelvic floor can be weakened is the neurological factor. It is important to remember that your pelvic floor contracts reflexively before you cough or sneeze.
For those of you who have already given birth, you may or may not remember the soreness down below post-birth. It may have been so sore that you simply ignored the medical advice to pull up the area between your legs. Opening your bowels was a nightmare, getting your stitches to heal nicely and keeping your self dry and clean may have been your limit. Plus looking after your newborn (and your husband and anyone else in the house.) Squeeze tight, that male doctor who will never know what child birth is like had to be kidding but this is called the reflex inhibition.
Reflex inhibition is the brain’s way of protecting part of the body that is damaged. Unless these reflexes are re-established, chronic (long term) injury can be a result.You may be more familiar with an ankle sprain, you may be aware that if the ankle is sprained badly there is a tendency for that ankle to twist and give way again.
When treating sports injuries the physio concentrates on retraining the protective reflex action of the muscles around the ankle. There is no point in treating the joint without retraining the reflex. So too with your pelvic floor after childbirth. The protective reflex contraction of the pelvic floor when you cough or sneeze is lost, however the protective reflex can be re-learnt by teaching your self to actively squeeze and lift before each cough and sneeze.
The bottom line is it is important to re-train your body’s lost reflex by actively being aware before coughing and sneezing and doing your pelvic floor exercises. In this way, when a sneaky sneeze comes your way your body knows what to do without you having to take any proactive action, resulting in dry underwear all day long.
If you are suffering from incontinence or not sure if you are doing your pelvic floor exercises correctly and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.
The Pelvic Floor Questionnaire
I have written a number of blogs now on the pelvic floor area. Many of you might be asking yourselves whether it is this really that important, or thinking “this may apply to others but I am fine now and therefore I do not need to do my pelvic floor exercises”. However, yes this does apply to you; even if you suffer no problems at the moment, it can prevent future problems, so start exercising today. I have made a pelvic floor questionnaire that will help you determine whether you are a high risk or lower risk for future problems developing. If you find yourself in the higher risk category, which applies if you answer yes to any of the following questions, then you might find it worthwhile spending a session with a physio to ensure you are doing the exercises correctly. So here we go.
1. Do you suffer with your waterworks i.e. do you leak urine when you cough, sneeze or do exercise (stress urinary incontinence) or get a desperate urge to go and not make it to the toilet in time (urge incontinence)?
Facts
Up to 1 in 3 women will leak urine during their lifetime. Women under the age of 50-55 tend to suffer from stress urinary incontinence while post menopausal women tend to suffer from urge incontinence. However you can suffer from both regardless of your age.
2. Do you have a pelvic organ prolapse? (a bladder prolapse, cystocele, uterine prolapse, the womb, or bowel, rectocele, or a combination of any of these.)
Facts
1 in 2 women will develop a pelvic organ prolapse and women with a prolapse are 3 times more likely to suffer from urinary incontinence.
3. Have you had a normal vaginal delivery?
Facts
10% of women will have damage to their pelvic floor muscles after a vaginal delivery. After a normal vaginal delivery you are at double the risk of developing a prolapse. The risk increase if you have a big baby (over 4kg) or twins.
4. Did you have an instrumental delivery, either ventouse or forceps?
Facts
25% of women whose babies are delivered by ventouse will sustain pelvic floor damage, 65% for forceps.
5. Did you have a prolonged second stage of labour?
Facts
This is associated with neuromuscular damage to the pelvic floor.
If you are suffering from incontinence or not sure if you are doing your pelvic floor exercises correctly and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women’s Comprehensive Medical Centrein Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.
Prolapse: Don’t Let It Be Your Downfall
One in two women will develop a prolapse, but again this is one of those secrets that is never spoken about and therefore often never dealt with. Strengthening your pelvic floor muscles and making some lifestyle changes can reduce or resolve symptoms of a pelvic organ prolapse.
A pelvic organ prolapse is when either the bladder, bowel or womb bulges into the walls of the vagina which have often been weakened through various stages of life, such as pregnancy, birth and menopause, as well as chronic constipation and jobs involving heavy lifting. This may or may not be accompanied by symptoms. However, if you feel a lump, or a bulge in the vagina, or as if something is there or something has come down, or you get an aching, dragging feeling if you have been on your feet all day, then it can really affect the quality of your life. It can also cause urinary and bowel symptoms or make you feel uncomfortable during sex.
The pelvic floor muscle has two roles. One is to help with toileting and the other is to support your bladder, bowel and uterus. With a prolapse, the muscle fibres that need to be strengthened are the endurance ones. Therefore they are constantly working. If you brace your pelvic floor muscles every time you are lifting this can help strengthen them. Ideally if you have been diagnosed with a prolapse then you should avoid lifting heavy objects.
One way of dealing with a prolapse is surgery, but it is not always the best option and you should always first try a more conservative approach – which often produce very good results and avoid the need for surgery entirely. Your women’s health physiotherapist can show you suitable exercises and other treatments, and suggest appropriate lifestyle changes.
If you have a prolapse and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women’s Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.