Late Cancellation Policy from March 2015

Cancellation Policy

At The Fix Program we aim to provide a professional service at a time that is most suitable to you. We also aim to have same day appointments available for urgent enquiries and all other appointments available within 1 week of your enquiry.

Unfortunately, we are experiencing a large number of last minute cancellations and clients not attending their allocated appointment times.  This is having a major impact on our waiting list and can negatively affect treatment progress.

What we are doing about it

Reminder emails 24 hours prior to appointments are a proactive approach on our behalf. This gives our patients the time to contact us via email or phone to cancel and shift appointment times.

So that we can continue to provide a timely service, Fix is now implementing a CANCELLATION AND FAILURE TO ATTEND POLICY.

If we receive advance notice that you are unable to attend it will provide an opportunity to offer the appointment to other clients from our waiting list or those requiring emergency physiotherapy.

We would like to avoid having to apply a cancellation fee - your co-operation would be greatly appreciated.

Learn to breathe well and relax

There are many reasons why we should learn how to breathe well. Appropriate breath can help our bodies in many ways and its importance is somewhat overlooked. Breathing can bring about relaxation, reduce stress levels, decrease pain, increase feelings of good health and wellbeing.

So, what makes me stressed?

We've all heard the expression 'fight or flight'. This is how the body has evolved to respond to any threatening situation. In times of stress the body uses a hormone called cortisol. Cortisol turns on processes we need for survival and switches off processes that are not needed for survival. This is great in an emergency, but if you are stressed all of the time, prolonged elevated cortisol levels have been found in blood streams. These chronically high levels are linked to depression, mood swings, memory changes, poor healing, pain, weight gain and immune problems.

On the flip side, when you're relaxed and feeling good, your body produces 'happy hormones' such as opioids and serotonin.

How do I de-stress?

• For a start, try to stop worrying. Pilates, Yoga, relaxation, meditation and breathing techniques have also been proven to reduce the level of circulating stress hormones and increase your level of happy hormones.
• Try going for a walk, listening to relaxing music, or just clearing your mind for twenty minutes every day.
• Try to set aside 'worry time'. Rather than worrying about things constantly (and keeping your cortisol levels elevated) make a specific time every week when you think about your worries. If a worry enters your head at another time, like when you're trying to fall asleep, set it aside for your 'worry time'.
• Try this relaxation technique when lying down or sitting comfortably. Close your eyes and focus on your deep breathing. Focus on the cool air as you breathe in through your nose and the warm air and you breathe out through your mouth. Focus on one body part at a time starting from your head all the way to your toes imagining all your muscles releasing and feeling heavy.
• Try to take time to practice mindfulness throughout your day. Even a minute here and there to become mindful of your breath, the comings and goings of your body sensations, tensions and your surroundings can help to de-clutter your brain and provide energy and calmness.

And there's even more to the importance of breathing well

We also know that learning to make your diaphragm stronger by breathing well has many a physical effect. This is the breath we strive for at your Fix Program classes. These can include:

• A more efficient delivery of oxygen to your body. Using your diaphragm allows for greater volumes of air into all corners of your lungs.
• The physical mobilising and stretching effect of breathing into your lower lungs will improve movement of your ribs and the stiff thoracic or middle spine.
• The prevention of extra work and tension of the chest and neck muscles which are often inappropriately used for daily breath. Most of us know how tired these muscles typically are anyway. Why add to that with your breathing style?
• A stronger deep postural 'corset' for our spine and pelvis. The diaphragm has connections to many organs and muscles in the trunk via fascia and via this connectivity has a crucial role in stability and movement control in the region.

Yes, the diaphragm is a muscle that too can be strengthened! And a stronger diaphragm will lead to a stronger deep abdominal corset, pelvic floor and spinal alignment.

The challenge

Try to become more aware of your breath as you go about your busy lives. This can happen anywhere – at work, rest or play. Slow down the rate of your breath, relax your neck and shoulders and visualise the breath into your lower ribs. Imagine breathing widely and sense the expansion and movement in your trunk.

Slow your breath and the mind will follow. Healthy mind, healthy and strong body.

Don't feel the pressure!

Are you feeling that your body isn't the same as is it used to be. Maybe you've just had a baby. Maybe you're recovering from an injury to your lower back or pelvis – yes men, this includes YOU! Maybe you're going through menopause. Effects of these events on the body's muscles are great and sometimes may be overlooked. This is particularly so about the pelvis and the pelvic floor muscles, where pain, injury, or cessation of regular activity and exercise can cause weakness and poor control.

You may wonder:

• Which exercises can I do?
• Which exercises should I be avoiding?
• Which exercises are high risk?
• Which exercises are low risk?
• Can my pelvic floor cope with the exercise I used to be able to do?

What is the big fuss about pressures on the pelvic floor muscle system?

Forces generated by activities of exercise and daily living on the pelvic floor may be too great if you have little strength or control. Repetitive jogging or exercise may be too much for these muscles to take and the risks associated include loss of bladder or bowel control, pelvic organ prolapse( falling down of the organs within your pelvis – bladder, bowel and uterus for the women) and chronic back and pelvic pain.

What is 'risky exercise?'

First, let's decide what makes an exercise more risky for the pelvic floor. The table below shows the different pressure transmissions in the pelvis and in the abdomen during different exercises. The lower the pressure values, the less "risky" the exercise is to the pelvic floor. This means that, the further you go down the table, the more likely the exercise is going to cause bladder or bowel issues. For example, you are more likely to leak a bit of urine with jogging or coughing than you are with crunching or walking.

For you guys out there who have bothered to read down this far, intra-vaginal pressure could be swapped for intra-rectal pressure. Remember we all have the same functioning pelvic floor -give or take- whether we are male or female.

So what are the take home points?

• Always breathe through the exercise – holding your breath can double the pressure in your pelvis.
• There's no real difference between sitting weights training and standing weights training in terms of the effects on the pelvic floor.
• Crunches and sit-ups are always given a bad rap with regards to pressures on the body and the pelvic floor. They actually produce less pressure than any other seated or standing exercise, and even less pressure than just standing upright! They might not be the best exercise if you have a neck or back injury or an abdominal separation though.
• You need to invest more in managing hayfever or asthma to prevent bladder or bowel accidents than avoiding exercise.
• You need to really build the strength, endurance and coordination of your pelvic floor if you're struggling with control during any exercise, especially aerobic exercises such as jogging or jumping. A women's or men's health physiotherapist can guide you to ensure you do these exercises correctly and she can prescribe an individualized pelvic floor program just for you.

So now you know the risks of exercises on the pelvic floor. But this doesn't apply as a blanket rule for every woman or man. Another important thing to consider before you return to exercise is your individual risk. Whether you are high risk or low risk depends on your body and your individual circumstances and experiences.

Your individual risk comes down to six things:

1. How strong are your pelvic floor muscles?
2. What is the size of your levator hiatus (the space between the two sides of the pelvic floor muscles) at rest?
3. How distensible are your connective tissue in your pelvic floor i.e. how much do they stretch?
4. Do you have pelvic organ prolapse?
5. Do you have levator avulsion (tearing of the pelvic floor muscles)?
6. What is the state of your hormones?

What can I do to be sure my choice of exercise is the right one for me at this time of my life?

For you women, your women's health physiotherapist at The Fix Program is able to assess these six factors to determine your individual risk; and combining your risk with the risk of exercise, she will be able to tell you which exercises are suitable and which exercises you may need to build up to with time, as well as which exercises you may need to avoid.

In addition to this, your women's health physiotherapist can help you strengthen your pelvic floor muscles including the muscles that may have some tearing, manage your prolapse (perhaps with the fitting of a pessary to support your connective tissue), as well as guide you with nutrition and lifestyle advice to promote hormonal health.

For you men out there, there are men's health physiotherapists who can also assess your risk factors, pelvic floor weaknesses and help you to train these all important multi functional muscles. Ask us for details if you need them!