Physiotherapy Now

Jerusalem physiotherapy by Tamara May

Exercise

Pelvic floor tips

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I have written many blogs about the importance of doing pelvic floor exercises but now here are some tips to help you do them every day. Pelvic floor muscles are functional, which means they need to get used with other muscles. Now it is true that often in sessions I get patients to isolate the muscles but it is important to do the exercise when lifting something heavy and incorporate the exercise in all heavy lifting activities.
Now it has to be said but breathing is very important. When holding your breathe during exertion means bearing down on your pelvic floor. So it is very important to breath through all exercise.
When exercising it is important to remember that high impact exercise can weaken the pelvic floor so if you are having problems choose a sport with little impact such as cycling and avoid things like your star jumps and wide leg stances. If the muscles are overstretched during exercise it is harder to contract properly.
Now just as important as it is to get a good strong contraction during exercise to the pelvic floor so it is it to be able to relax properly. That means in between each exercise make sure you are fully relaxed before continuing your exercise routine.  
When trying to get you pre-pregnancy body shape back the term core is often thrown around. Core exercises are really important and will help get your body back into shape. However what is often forgotten is that correct pelvic floor exercise can also strengthen core muscles too, so incorporate them into you regular exercise regime.
Often when leaking one starts to cut back on the water that they drink. Especially in this hot weather I do not advise this. Lots of water and fibre are important in maintaining a healthy pelvic floor. Straining and constipation only weakens the pelvic floor (remember the pelvic floor holds up your bowels as well as bladder and uterus). A healthy diet of lots of fresh fruit and veg with lots of water is great for the pelvic floor as well as the benefits it gives the rest of your body.

If you are suffering from pelvic floor problems 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.

When Not To Exercise

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In many of my previous blogs I have written about the importance of exercise. Specific exercise can help alleviate many of the common pregnancy aches and pain. However it is also important to be aware of when exercise is not going to be helpful and in some cases detrimental.
If there is ever vaginal bleeding one must stop exercising and go straight to the doctor, do not pass go and do not collect 200 [insert preferred currency]. There could be many reasons for the bleeding, some more serious than others, but either way it always needs to be checked out.
If you have dyspnoea before exertion, dizziness, headaches, chest pain or muscle weakness these are all more reasons to go to the doctor straight away. Do not wait for your next appointment but rather go straight away.
If you have calf pain (back of the leg) or swelling then it is best to rule out thrombophlebitis. This again is something that should not wait till the next appointment.
The more familiar reasons to take your self straight off to the doctor are preterm labour, decreased fetal movements and amniotic fluid leakage.
Treatment is often much more useful when started sooner rather than later, therefore do not push off going to the doctor, even if you think it is not serious. Doctors expect patients to come in with these symptoms and it is their job so they will not look down on you for going.
Pregnant women with uncomplicated pregnancies should be highly encouraged to continue and even start (gently) with exercise. There are many benefits to exercise, but just as important as it is to exercise, so too are the signs of when not to exercise and when to take your self off to the doctor.

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?

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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

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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

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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

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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.