Physiotherapy Now

Jerusalem physiotherapy by Tamara May

Exercise

Pelvic Floor: Key Questions to Ask Yourself

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Due to my short break from writing because of the chagim, I thought I would go back to the pelvic floor muscles before I move on to a host of different topics that some of you may not have heard of.
The onset of incontinence is gradual but never unnoticed. It is the body’s way of telling us that things are not quite as they should be. Leaking urine can bring on a downward spiral with loss of self respect as well as anxiety and depression. 
The initial leaking is called stress incontinence, caused by weakening of the muscles that keep urine stored inside the bladder. These muscles, called the pelvic floor muscles, fail to fight forces which push down from the abdomen when you laugh, sneeze, run or jump.
If left untreated, stress incontinence can lead to urgency and frequency. An example of this could be when running to the bank before closing time you suddenly feel dampness between your legs. You take a quick diversion to the toilet to check that this is not obvious to the outside world, you don’t really feel the need to go but as your mother probably told you better to be safe than sorry and you go to the toilet. Anxiety can begin to set in out of fear of a re-occurrence, causing you to take a trip to the toilet just in case, to really make sure your bladder is empty, thus establishing a pattern of frequency. 
Before you know it you are a confirmed toilet hopper, you know all the ladies toilets in town and which petrol stations along your driving route have conveniences too. You will then start to cut down your fluid intake (don’t ever do this) and before you know it you are laughing this situation off with all your friends, they are laughing in a supporting sympathetic way or are laughing because they have these same problems.
The three main symptoms are stress incontinence, urgency and frequency.  Stress is when leaking from a high impact movement. Urgency is the really strong need to pass urine that if ignored you feel you will probably end up with wet knickers. Finally frequency, which is how frequent you are going to the toilet. A combination of any of these three can be present.
Most people consider their toilet habits normal, however if the answer to any of the following questions is no, then your habits are not normal and it is time to really step up your exercises to your pelvic floor muscles to more than 3 times a day, which is the prescribed amount for people who do not suffer from this. It might also be the time to seek physiotherapy help as there are much higher success rates when treatment is started earlier on.

  • Do you go to the toilet 4 to 6 times each day only?

  • Do you sleep through or get up only once through the night?

  • Do you have dry knickers all the time?

  • Do you pass 300-400mls each time? 1 mug is approx 250mls

  • Do you pass water easily, without straining or stopping and starting?

  • Do you find urinating is painless and quite a comfortable thing to do?

If you suffer from any type of incontinence 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.  

Thoracic Pain and How to Avoid It

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The spine is split into different sections: cervical, thoracic and lumbar. This blog is going to focus on the thoracic spine, the middle bit of your spine but upper part of your back. Now technically thoracic pain can occur at any point during your pregnancy, but it tends to be more common during the third and final trimester. 
There can be many contributing factors to your pain. I have mentioned the hormone relaxin on this blog many times; the one that relaxes your ligaments and soft tissue. Unfortunately it is not a de-stress hormone. It can sometimes be the cause of muscle spasm, as it makes the muscles work harder. Other possible reasons for thoracic pain include:

  • As the size of the baby and uterus increase, your centre of gravity is shifted forward, placing more pressure on your back muscles
  • The extra weight gain can also put more stress on these muscles
  • The enlargement of breast tissue can alter your posture and place strain on the neck, shoulders and thoracic spine

There are ways to treat it once it has occurred, but as the saying goes, prevention is better then cure. Taking good care of your back is fundamental to hopefully preventing back pain ever occurring.
When looking after your back it is always important to keep it in a neutral position, when standing, sitting and even sleeping. When standing, stand straight and tall with shoulders back and relaxed, and don’t lock your knees. Use a wide stance and keep your weight evenly distributed between your sides. If you are standing still for a prolonged time rest one foot on a step stool and change feet regularly to change the weight distribution.
I often show my patients good sleeping positions. They can use a lot of pillows so I hope your partners don’t get too angry with you. It is recommended to sleep on your side especially in the second and third trimester. Place a pillow between your knees and another one under your bump to maintain a neutral spine. Also ensure you have a neutral neck or cervical spine position with an appropriate number of pillows under your head that is right and comfortable for you.
It is also important to wear a supportive bra and to ensure that it is not underwired. Make sure you wear comfortable shoes without a heel, to prevent and relieve back pain, by keeping the spine in a more neutral position.
Now the bit you probably won’t want me to say but I have written a lot about it the last two blogs, is exercise such as walking or swimming. This will keep your back muscles strong and help relieve discomfort. A few simple stretching and strengthening exercises can also make a big difference.
If you suffer from any type of back pain during pregnancy 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.  

Part II: Exercise after Birth

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Last week I wrote about the importance of exercise during pregnancy. But what about exercise after giving birth? Don’t lots of people from all walks of life say and keep reminding you mothers how important it is to rest? (Rest – wouldn’t that be nice with a new born around the house…).
Indeed, rest is extremely important after giving birth. I don’t need to tell you that birth is a major trauma on you body; you probably already know that. (There is a reason why men don’t give birth). However, exercise is also important. Pelvic floor exercises can start and should start within 24 hours of giving birth. Without even seeing your faces I can see some of you shouting at the screen, the tears, the stitches, the soreness; yes, I know. But in fact, exercise to this area will increase blood flow to this area and increase healing times.  
How about other forms of exercise? You have to let your body be your guide. You can exercise as soon as your body feels ready. (If you had a caesarean-section, recovery time will be longer and should wait until your check up with the doctor).
Your lower back and core abdominal muscles will be weaker then they used to be. Your ligaments and joints are also more supple and pliable, so it is easier to injure yourself from over-stretching and twisting too much. So make sure you include some strengthening exercises as well as an aerobic workout, such as a run.
If you are doing too much your body will let you know, and you should listen and slow down. You will experience extreme fatigue, feel run down and take longer to recover from exercise sessions. If your bleeding becomes heavier or changes colour to more pink or red this is also another sign.  
If you suffered with any musculoskeletal conditions such as SPD then your approach to exercise needs to be a little different. You should still exercise, but stick to specific exercises which are beyond the scope of this blog. 
If you suffer from any type of pain during or after pregnancy and are not sure if it’s safe to exercise 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.  

Exercise During Pregnancy: The Correct Formula

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You may have heard the saying from your doctor or midwife that it is fine to carry on with exercise during pregnancy but don’t take on any new activities. You may have also heard the advice that pregnancy exercise classes are great and that general exercise and keeping fit is a great way to prepare your body for labour. So what happens when these two pieces of advice contradict each other?  
As a general rule, exercise that you were doing before pregnancy is usually safe during pregnancy – except of course for extreme sports and other dangerous activities such as horse riding. 
The benefits of exercise during pregnancy
Exercise is important during pregnancy, and has a number of benefits for you and your body:

  • It increases your energy levels  
  • It can help you sleep better (very important before the baby comes)
  • It reduces those pregnancy discomforts: As your bump gets bigger it pulls your body into a different posture, meaning that you are relying on different muscles from normal while carrying out your daily activities. Exercise helps stretch and strengthen your muscles, making them easier to use and therefore helping you cope better with the aches and pains.
  • Exercise helps prepare your body for labour; the better shape you’re in, the stronger your body will be when it comes to labour and delivery. Giving birth requires stamina, determination and focus, all skills used and practised while exercising.
  • There are medical articles that say that exercise makes for an easier labour and a shorter one too
  • Exercise can improve stress levels by increasing levels of serotonin, a chemical linked to mood; stress levels can often increase during pregnancy for many reasons
  • It can also improve your self-image and make it easier to get your body back into shape after giving birth  

Striking the right balance
Even if you don’t exercise regularly pre-pregnancy, taking on new classes specific to pregnancy or low impact exercises (e.g. regular walking or swimming) are not only going to do you no harm, but will do you the world of good, provided that you are not suffering with any specific pain and are having no complications. Pregnancy exercise classes are normally very good because they focus on core stability exercises related to the muscles that are put under extra stress with the change of posture that takes place during pregnancy. Walking and swimming also have many benefits, such as help your aerobic activity and stretching and strengthening your muscles. However, it is not advisable to take on high-impact or over-strenuous exercise, such as training for a marathon.
 If you are suffering from any type of pain during pregnancy and are not sure if it’s safe to exercise 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.