Physiotherapy Now

Jerusalem physiotherapy by Tamara May

labour

Losing the baby weight

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After giving birth just over a week ago to my son, it might be appropriate to write about the extra baby weight and some realistic expectations and real medical facts. Although it may not be directly related to physiotherapy I still feel it is an important topic worth mentioning. 

Once the baby comes out, why o why does the tummy not go back to the way it was? Well first of all you have breast tissue, increased blood supply and for the first 6 weeks you still have an enlarged uterus. In fact, depending on the size of your baby you might not look that much skinnier than when the baby was inside you.
The most important thing to remember is slowly is the key to healthy weight loss, especially if you are breast feeding. Starving your self is not a responsible way to lose weight, especially as you are now responsible for not just your self but also your newborn, and your baby needs to grow (you don’t want to put your baby on a diet with you) The body needs to heal and it does this with the right nutrients. You need to be drinking plenty of water and eating from all the different food types in a
balanced diet.
Exercise is also another key way to lose weight, finding the sport that you like and enjoy is always a good start to keep you focused, but don’t over exert yourself. You need to listen to your body; rest post birth is important in your recovery. In fact the body takes 2 years to fully recover after birth, although most feel fine much much sooner than this time frame. Within the first 6 weeks post birth it is very important to listen to your body and go and take the mid-day nap when the baby is sleeping.
A healthy happy mummy is a healthy happy baby. But if your are suffering from any aches or pains 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.

Understanding Round Ligament Pain

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Round ligament pain is a sharp pain or jabbing feeling often felt in the lower tummy or groin area on either or both sides. This believe it or not is one of the most common complaints during pregnancy and is most common during the 2nd trimester.
There are several thick ligaments (ligaments are what joins two bones together) that surround and support your uterus. One of these ligaments is called the round ligament. This connects the front part of the uterus to the groin (hence that is where the pain is felt).
As your baby grows and your uterus and tummy therefore also grow the round ligament is therefore forced to stretch. If it becomes too stretched it starts to strain. If this happens then sudden movements can cause the ligament to tighten quickly (a bit like an elastic band snapping quickly). This is what causes a sudden and quick jabbing feeling. Ligaments are suppose to tighten and relax slowly when bones bend and straighten.
The symptoms of round ligament pain include a sharp sudden spasm in the belly. More often affecting the right side more than the left. The pain also only lasts a few seconds. Some exercises may cause the pain as well as rapid movements such as sneezing, coughing, laughing, rolling over in bed and standing up too quickly.
How can the pain be relieved?
If you feel it is necessary then you can take over the counter painkillers like paracetamol or acamol. Make sure you are not taking Nurofen (Ibuprofen).
Specific exercise is very good for this. Some exercises are counterproductive to round ligament pain but exercises that keep your stomach and core muscles strong are good. Stretching is also helpful. Often one of the more helpful exercises is putting your hands and knees on the floor, lowering your head and pushing your backside into the air.
Try to avoid sudden movements. Change positions slowly, especially standing up.
Bend and flex your hips before you cough, sneeze or laugh to avoid pulling on the painful ligaments. Heat can also help relieve the pain, but make sure not to put the heat directly over the baby.
Round ligament pain is often quick and not long lasting but you should be aware if anything changes and when to go to the doctor immediately; for instance, severe pain, pain that lasts more than a few minutes, fever, chills and pain on urination and if you are having difficulty while walking.
Stomach pain during pregnancy could have one of many different possible causes and it is important for your doctor to rule out serious conditions such as inguinal hernia, appendicitis, and stomach, liver and kidney problems. Pre-term labour pains can sometimes also be mistaken for round ligament pain.
Physiotherapy is not your first port of call on this one. The diagnosis should be made by the doctor first so that everything else can also be checked. Upon diagnosis and only after that is physiotherapy then appropriate to advise on correct exercises.
If you are suffering from round ligament 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.

Exercise After a C-Section

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Getting the right balance after a C-section is extremely important. Your body needs to recover and rest is very much needed. Rest whenever you get the opportunity in the first 4-6 weeks. Whenever the baby is sleeping, forget the housework and take a nap too (and anyone who knows me personally will know that me saying forget the house work is not something to be taken lightly.)
Eventually your body will start to feel like yours again and exercise can help the healing process along. A good form of general exercise is walking, starting with as little as 5-10 minutes daily and gradually building the time up to 30-40 minutes over the first 2 months.
Your lower trunk will also need to be strengthened and stabilised. This includes pelvic floor muscle exercises – which should not be forgotten by any women, not just those who are post c-section. Pelvic floor exercise should be carried out at least 3 times a day. Holding a contraction for 10 seconds and doing 10 reps of these, and also doing a quick contraction with a quick release also doing 10 reps of these.
Transversus abdominal exercises are another main area to focus on, (which includes pelvic tilts).

Lie on your back with your knees bent and feet flat on the bed. Pull in your tummy and tilt your pelvis up, flattening out the lower back. Hold this position for 2-3 seconds and then slowly relax half way. Continue tilting your pelvis up and relaxing to the half way position. Aim for the movement to be slow and smooth.


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.

Labouring with SPD: The Birth Plan

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Making a birth plan is important in my opinion (even if you don’t stick to it) and this is even more true if you suffer from SPD. In a midwife’s ideal world there would be no pregnancy complications and everyone would deliver on their backs in stirrups, so that the midwife could maintain a good posture and control the baby easily. In many patients’ ideal world they would deliver in a more upright position so gravity could help the labour and delivery along. By making a birth plan, you can consider all the different options and factors and work our what your preferred labour would look like.
If you suffer from SPD it is important before labour begins to measure how far you can open your legs in a pain free range. If your are very prepared you can buy a long piece of rope and tie it around your knees so you have the measurements of how far you are going to allow your legs to be open during the delivery, on hand. This is even more vital if you plan on having an epidural. This is because you will not feel pain while the epidural is in but will feel the pain afterwards if you have opened your legs into your pain range. With this in mind, a position that should definitely be avoided is a delivery in stirrups.
In the first stage of labour, movement and gravity play an important role. Most commonly, at this stage you are still at home, and timing your contractions. If you suffer from SPD it is still good to be walking around but not to be constantly climbing the stairs, which can often speed things along. Using the gym ball can also be good, by sitting on it and rolling your pelvis, but do ensure that your legs are not straddled too far open.
It is important to support your body in positions that are comfortable for you but to avoid straddling your legs, for example do not straddle a chair, however you can lean onto a chair or any other equipment.
In the final pushing stages there are many good options for positions. Being on your side is very good because the midwife can have good control and you can too. You can also be in a squatting position (as long as you are in pain free range). Any position where your legs are in your control and cannot be pushed open by someone else is a good position.

If you are suffering from SPD 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 After a Caesarian Section

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Those of you that have been through or will be going through a C-section rather than a vaginal delivery might notice a difference in recovery after the birth. You might not go through the pains of labour, you might be unlucky enough to have to do both but you will definitely realise that your body will need to recover once the baby is out. Your body will be sore in many different places and recovery time will be longer in comparison to vaginal delivery.
Rest whenever you get the opportunity in the first 4-6 weeks. A good form of general exercise is walking, starting with as little as 5-10 minutes daily and gradually building the time up to 30-40 minutes over the first 2 months. It is also important to do specific exercises to strengthen and stabilise the lower trunk. This includes pelvic floor muscle exercises, transverse abdominal exercises and pelvic tilts. I will go into more detail on these specific exercises next week.
It is also important to move in and out of bed correctly. Pretend you are still pregnant (yay). Move slowly and try to avoid using the abdominal muscles in the first 4-6 weeks. To get in: sit on the edge of the bed, lean down onto your elbow towards the pillow, bend your knees and lift your legs onto the bed, then roll onto your back. Reverse this action to get up.
When coughing and sneezing support your lower abdominals by placing your hands or forearms over the caesarean wound. Contract the pelvic floor muscles before the cough or sneeze. To clear your chest take three slow deep breathes in and out, then huff (as if to steam up a mirror), then support your cough as above.
Avoid all unnecessary lifting (so lots of excuses can be made to the hubby about housework.) Avoid lifting heavy objects (anything bigger than the baby) for the first 4-6 weeks. To lift, keep your back flat, draw your tummy in, squeeze your pelvic floor muscles and bend your knees. Keep the object close to you as you lift it up. Use your legs to take the weight of the lift and not your back. So avoid strenuous housework – this definitely includes but is not limited to the laundry basket and the bucket of water to wash the floor.
Driving should be avoided for 6 weeks but you will need to contact your insurance company for individual policies. You must be able to do an emergency stop without hesitation or pain before you can drive again.
You must also speak to your own doctor about pain relief, especially if you are breast feeding.

If you are suffering from pain 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.

SPD After Labour

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Symphysis pubis dysfunction (SPD) is a common condition found during pregnancy, presenting as pain around the pubic joint area. It is a separation by this joint that leads to pain, caused by the hormone relaxin that is produced in your body during pregnancy. Once the baby is born, the level of the hormone decreases (but is mimicked if you are breast feeding), and the pain will start to go away.
Well this is the scenario in most cases, however for some people this pain can linger or even start after labour itself. Due to the hormone relaxin, your ligaments are more soft and stretchy to enable your baby to be born. Due to this, labour itself (especially if it is a traumatic birth or you delivered in stirrups) can cause a separation at the symphysis pubic joint.
SPD after labour will get better but in some cases it can take time. The good news is there are things that can be done to speed this healing process along, one of those being physiotherapy. After your physiotherapist has assessed you they will give you lots of advice on movement techniques such as keeping your legs closer together during activities that you need to carry on with your daily living. They will help you find comfortable positions to carry out tasks that are important to you. They may also decide to give you crutches if they feel you will benefit from them, along with a specially designed SPD belt (this is different from a back support belt). They will also guide you on specific exercises and design you a personal home program exercise session. Of course this program will also include pelvic floor exercises that every woman should include into her daily routine.
If you feel you need to, you can also take pain killers and over the counter anti-inflammatories. It is important to remember that you can only take anti- inflammatories after labour once the baby is out and NOT if you are still pregnant and suffering from SPD. This is true even if you are breast feeding. If you are pregnant and suffering from SPD, you can only take over the counter pain killers such as Acamol and must go to your doctor if you need something stronger.
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If you are suffering from SPD 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.