Advice from a Woman's Health Physiotherapist

Rebecca Bennett is a chartered women's health physiotherapist, with a post-graduate Master's in women's health physiotherapy and acupuncture, who has treated over 1000 pregnant and postnatal women in the past year alone.  She believes women can do a lot to look after themselves and restore health and fitness after childbirth, she endorses Ready Steady Mums as a great service to help you do so.

Today, Rebecca shares her insight on common health issues for mums, and options for treatment and prevention.

Q: Firstly, how does a Women's Health Physiotherapist treat mums?

Rebecca: Very simply, I locate causes of pain and then use manual therapy (hands on treatment), strengthening exercises, stretches and any other relevant modalities to treat the pain and prevent its return.

 
Q: What do you find are the most common pregnancy related problems you see in your patients?

Rebecca: Most commonly, but not exclusively, mums come to me with: (a) Back Pain, (b) Pelvic Pain (including pubic symphasis dysfunction; pelvic girdle pain and piriformis tightness) (c) Diastsis Recti (separation of the 6-pack muscles) and (d) various gynaecological problems (inlcuding stress incontinence, perineal tears and vaginal prolapse).

Q: What is your advice for mums about back pain?

Rebecca: This most common complaint during pregnancy has various possible causes, many of which can be avoided with simple changes to lifestyle. The hormone relaxin is released during pregnancy to soften your pelvic joints and allow expansion during delivery, but it is not clever enough to act in isolation and affects your whole body.

I see postnatal back pain less frequently than during pregnancy because, I believe, mums are too busy to think about themselves. The effects of the hormone relaxin take about 12 weeks to disappear, even though it leaves your system straight after birth.

A good starting point for back-pain sufferers is to increase your core strength to give your back and pelvis extra help to negate the hormone induced laxity. You need to work your 'Transverse Abdominus', which will take you to just 30% of your maximal abdominal contraction before other muscles kick in.  The 'Ready Steady Squeeze' is an exercise you'll learn in your Ready Steady Mums programme.  Activating it is like trying to squeeze into tight jeans.

It's also important to engage this muscle whenever you lift or bend, as the contraction will support your back and pelvis.  Remember to assess what you're lifting first (and if someone else can do it - ask them, especially if you're still pregnant!). When you do lift, bend from the knees, straight back, do the 'Ready Steady Squeeze' and breathe! If the object is very heavy place a chair next to it so you can lift in two sections.

Lastly, posture posture posture!

During pregnancy your centre of gravity moves due to extra weight around your abdomen and breasts and the curve in your lower spine increases, putting more pressure on your lower back. Look in a mirror and practice tilting your pelvis back and forth until it appears more neutral. Do not sit or stand in the same position too long. Have a pillow in the small of your back when sitting to avoid strain or going 'banana back' (hunched). Changes to your workstation can help, like tucking yourself into your desk so you don't lean forward for the keyboard, and regularly changing position. And all the time, stay aligned: stand with your weight evenly between your feet and don't lean on the arm of your sofa but sit upright.

After you become a mum you'll be lifting much more and posture is twice as important. Have your changing table at the right height for a straight back and good posture. Carry baby centrally or change hips often. When you're feeding, have a pillow in the small of your back and on under baby to maintain your spinal curves.

Q: What are the types and causes of pelvic pain and what is the best way to manage each?

Rebecca: There are 3 types of pelvic pain I will talk about -

1. SPD - Symphasis Pubis Dysfunction causes pain in the bone in front of the pelvis.  Movements that will irritate/squash the joint are: crossing legs (scissoring) in bed, standing on one leg, walking up and down hills and stairs, getting into the bath or car, turning over in bed. To manage, keep your legs together whilst getting in and out of the car and put a small pillow between your legs at night. If the pain persists you can benefit from a support belt or ice placed on joint to reduce inflammation (a sanitary towel dowsed in water and popped into a plastic bag in freezer).

2. Pelvic Gurdle Pain (PGP) is a generic term for pain in pelvis. Because it can be caused by a multitude of issues it’s best to get a referral from your GP to see a specialist. Management would always include good posture though so start now!

3. Piriformis Tightness is the term given to a muscle in the buttock tightening. Sometimes when getting up your bottom might seize up and is quite painful and difficult to walk. A deep massage in the buttock can help relieve pain, try sitting on a golf ball on a hard chair putting pressure on the sorest part for 10 seconds then off for 5.  If it doesn’t resolve the pain seek treatment.

Q: Because of Diastasis Recti Ready Steady Mums advises mums not to do any sit ups early on - can you explain why?

Rebecca: The separation of recti muscles - or “Deviarication of Recti(s)” - is when your 6 pack separates away from the linear alba

Q: What are the gynaecological problems you commonly see and what is your advice for mums?

Rebecca: I deal with any of the following problems - incontinence (many women leak a little when they sneeze or lift a heavy object), prolapse (where the bladder, uterus or bowel bulges into the vagina), and vaginal trauma from childbirth or vaginal pain.  I can not stress enough how important the pelvic floor exercises are.  I love the emphasis Ready Steady Mums programmes put on building strength in your pelvic floor.  First you need to learn to activate your pelvic floor muscles, and then you need to make a habit of exercising them...

Here’s how: Imagine you are trying to stop urine and wind. Squeeze and lift. Try tensing progressively from back to front. Try coming up in stages like floors in a lift. Try varying the speed from slow controlled activations, holding for 5-10s each time; to pulsing in quick sets of 10. You can not do this exercise too much or too often.  Do this at least 4 separate times a day, including slow (up to 10 second holds) and fast (quick pulsing) variations.

If you suffer from any problems with your bladder, bowl or vaginal pain or discomfort following childbirth then ask to see a specialist.  Allowing the hormones to leave your system (12 weeks postnatal) and carrying out your pelvic exercises can be beneficial. Avoid lifting heavy items and heavy impact exercise until you have been examined and the problem resolved.

Q: What should women do if they think they are suffering from any of these problems?

Rebecca: I hope my advice gives readers some ideas about how to prevent and manage common mums' health issues.  But remember that on-going pain should be assessed by a professional as soon as possible. Although pain is common in should never be thought of as 'normal' and there are generally things that can be done to help.

I'd also welcome any questions and you can email me at: natusphysio@yahoo.co.uk.