There are many considerations before lacing up the shoes and heading out for your first runs. These include:

👉your birth outcomes

👉your leg and hip strength

👉your pelvic floor health, strength and endurance

👉your hormones ( are you still breastfeeding?)

👉your support of your pelvis and spine (integrity of your inner core strength)

👉your pre-natal and pregnancy exercise levels

👉your body and fitness type.

Moore et al (2021) published a study with tests as guidelines for strength required for running. Here are the tests for running specific tasks. You can try them at home if you think you’re near to these measures. Can you achieve these without pain, bladder leakage, pelvic floor heaviness or abdominal dragging?

✅can you walk for 30 minutes?

✅can you stand balanced on one leg for 10 seconds or more?

✅can you jog on the spot for 60 seconds or more?

✅can you bound or skip for 10 metres?

✅can you hop on the spot 10 times or more?

These tests are no means exhaustive. There are many other tests assessing strength, balance, running specific and pelvic floor muscles control.

Find a physiotherapist who can assess and help you return to any sport after have your baby. She will be the expert in safe and timely guidance back to what you love doing - no recipes, completely individualised just for you! The Fix Program’s Mums&Bubs classes and post natal physio are the perfect lead into your running return after pregnancy and birth!

#runningmums #returntorunning #postnatalexercise #postnatalrunning #postnatalpelvicfloor

If you are a new Mum and are super keen to lace up the joggers and head for a jog, take the time to ask whether your body is truly ready. You may be 6 weeks after labour, your OB may have given you the green light, but what about your leg strength, your pelvic floor health and your fitness? Are you really ready to go running?

There are many considerations before lacing up the shoes and heading out for your first runs. These include:

👉 your birth outcomes

👉 your leg and hip strength

👉 your pelvic floor health, strength and endurance

👉 your hormones ( are you still breastfeeding?)

👉 your support of your pelvis and spine (integrity of your inner core strength)

👉 your pre-natal and pregnancy exercise types and levels

👉 your body type.

Moore et al (2021) published a study with tests as guidelines for strength required for running. Here are the tests for your pelvic floor recovery and strength after pregnancy and birth. You can try them at home if you think you’re near to these measures.

✅can you achieve 10 quick on/off ( or lift up/drop down) contractions?

✅can you hold 10 maximum pelvic floor contractions for 6 seconds, each all being equal?

✅can you hold a gentle contraction for a full minute, continuing your breath? ( 30% contraction effort)

These tests are no means exhaustive. There are many other tests assessing strength, balance, running specific and pelvic floor muscle control.

See our other recent posts for more running preparation advice for new Mums.

#runningmums #returntorunning #postnatalexercise #postnatalrunning #postnatalpelvicfloor

Returning to running as a new Mum cannot be rushed.

There are many considerations before lacing up the shoes and heading out for your first runs. These include:

👉your birth outcomes

👉your leg and hip strength

👉your pelvic floor health, strength and endurance

👉your hormones (are you still breastfeeding?)

👉your support of your pelvis and spine (integrity of your inner core strength).

Moore et al (2021) published a study with tests as basic guidelines for leg strength as required for running. Here are the tests for hips and leg strength. You can try them at home if you think you’re near to these measures and to see if you are run ready as far as your strength goes:

✅can you achieve 20 single leg pelvic bridges?

✅can you achieve 20 single leg sit to stands?

✅can you achieve 20 single leg calf raises?

✅can you achieve 20 side lying leg lifts?

These tests are no means exhaustive. There are many other tests and considerations with your balance, running specific and pelvic floor muscle control. Moore et al (2021) also list these.

Check out our other posts abut the other aspects needed to start your jogging journey after pregnancy. And for further targeted and individualised advice and planning, our physios are here for you and your exact return to running.

#runningmums #returntorunning #postnatalexercise #postnatalrunning #postnatalpelvicfloor

Yes! The research shows that nearly all pregnancy related pelvic girdle pain resolves after labour. Every woman is different.

It may take a few weeks to months.

It may disappear immediately you walk out of the birthing rooms.

You may require the expert guidance of a physio to get everything well aligned in your hips and pelvic region after the pregnancy changes, and muscles working again in the appropriate way to support the pelvis.

You may need short term activity modification or taping around the pelvis as you return to gentle exercise.

You will need to start your exercise journey post bub by reconnecting with your deep abdominals, pelvic floor and breath.

You will need to find this inner strength before adding impact like running, jumping, or loads such as weight lifting.

But do know that your pelvis will be alright after the miracle of pregnancy and birth!

#pelvicgirldepain #pelvicpain #pregnancypain #pregnancypelvicpain #pregnancybackpain #sijpain #spd #psd #pubicsymphysis #postnatalbackpain #postnatalpelvicpain #thefixprogram #thefixprogramonline #pregnancyphysio

We love the way our compression shorts feel, but do they ease pregnancy back and pelvic pain?

Our physio team are often asked about the benefits of external compression garments for pregnancy and post-natal wear. Usually a lovely bike-short or legging with compression panels  around the belly and perineum - easy to wear under your normal clothes, much like the ‘skins’ range of sportswear you see about.

As physios, we know the importance of a balanced strength of muscles about the pelvis and spine for optimal postural support. And this is the case even more so in pregnancy and in early post natal days. After all, your bodies are facing their greatest ever biomechanical challenge in movement and posture. These shorts offer a subtle compression about the pelvis, lower back and pelvic floor areas of our body, increasing the stability of your pelvic joints. They also are claimed to increase the activity of the all important muscles about the pelvic floor and abdomen

So what evidence is out there that they even work? I thought I would take a look to see what research there is out there, combined with the anecdotal evidence about how terrific and supportive these shorts are.

What is pelvic girdle pain?

Not all women will suffer from pelvic girdle pain (PGP) in pregnancy and early motherhood, but those that do, more than 70% will return to a pain-free lifestyle within a few months of delivery. Hormone changes to joint laxity, an inefficient network of supporting muscles and carrying heavier weight within the pelvis can create sensitive and painful pelvic joints. These pelvic joints are the pubic symphysis (PS) and the sacro-iliac joints (SIJs), at both the front and back of the pelvic ring.

Compression garments do work well for most women with mild to moderate PGP, but it is best to seek advice from your physiotherapist, because for some women, pelvic compression can actually make their pain worse.

A quick review of the research.

I reviewed a paper published 2008 in the European Journal of Spine* and found some interesting comments and conclusions on the diagnoses and management of PGP in both pregnant and non-pregnant populations. Here is what I found most interesting about the treatment of PGP in pregnancy:

• Individualised exercises in pregnancy are recommended, based on pelvic stabilising muscles – the pelvic floor, the deep abdominals and deep spinal muscles. These act like am internal compression belt, much like a corset to support your pelvic ring and the 3 joints involved.

• Specific focus on movement control and stability about the pelvis needs to be an integral part of a the management of PGP in pregnancy.

• There is no evidence to recommend the use of a pelvic belt as a single ‘stand alone’ treatment for PGP. A pelvic belt may be fitted to test for symptomatic relief, but should only be applied for short periods.

• It has been shown that transfer of weight through the pelvic joints ( often the source of pain here) is better by application of a pelvic belt (in most women).

• One pilot study showed a positive effect in pain scores and on daily activities after using a maternity support binder for relief of pregnancy-related back pain^

So, how does the compression of a belt or garment work?

Muscles in the body will work their best in a particular alignment or position. As muscles become over stretched (like your tummy muscles over your growing baby belly), or too tight, muscles can’t contract and activate optimally. They need to work harder and for all their extra effort, they still don’t support or move you as well. The optimal and most efficient contraction for a muscle is with the muscle somewhere in the middle of its stretch – not too tight or not too loose.

The compression garments offer a subtle compression force about the abdominal, back and pelvic floor muscles, bringing them into more of a ‘middle supportive range’ ( OK still not the best over your baby belly, but much better than when not wearing them). This ‘better position’ for the muscles means that they can contract better to support and hold your pelvic joints, thereby reducing your discomfort.

Anecdotally, wearing a compression garment around your belly is also a gentle reminder about posture, and I believe this is a further reason for their success in controlling pain. Other research shows that working gently on keeping your waists tall and your ribs stacked automatically keeps your ‘core ’ activated. And in doing so, your internal compression belt is humming away in there too to support your changing pelvis.

*Andry Vleeming, Hanne B. Albert, Hans Christian Östgaard, Bengt Sturesson, and Britt Stuge. European guidelines for the diagnosis and treatment of pelvic girdle pain (Eur Spine J. Jun 2008; 17(6): 794–819.)

^Carr CA. Use of a maternity support binder for relief of pregnancy-related back pain. J Obstet Gynecol Neonatal Nurs. 2003;32:495–502

Holding our posture up all day can be quite a tiring feat. Our bodies are so terribly good at adapting for the needs we place on it. Often these adaptations are great strategies, but often, they are not. We ‘cheat’ and often begin to use muscles and strategies not quite ideal and often a cause of tension, poor alignment and pain. 

Every single one of us has our little ‘strategies’ to cope and respond with the loads and stresses we put on our body all day, no matter how small. You would be lying if you didn’t fall into some non-ideal postures and habits in your day. Young children are possibly the only ones who can boast good posture. This is at least before long days sitting at school and carrying big backpacks begin to change things.

Awareness is half the battle here when it comes to posture cheats. When you begin to recognise your daily postures more, it is easy to then make small changes to ‘unlearn’ or to find other ways to hold your posture all day. Butt gripping is a very common one of these. Perhaps these below are you?

😮 Can you sense your self holding your buttocks clenched?

😮 Do you sit on clenched buttocks when you are at work all day?

😮 Do you butt ‘wink’ or tuck when you squat, or go to sit down on a chair?

😮 Do you clench your buttocks actively on squat to stand?

😮 Do you often ‘lose’ or dig out your knickers or pants that have found their way up your bottom?

Butt gripping as a long term ‘strategy’ that can cause your hip joint to be more compressed in the pelvis, preventing freedom of movement in the hip socket. Hip pain can develop. Butt gripping can also cause pelvic pain, a tight pelvic floor, and even back pain. Hips and butts are often a part of a well rounded back pain rehab program of exercises. 

Are you a ‘butt gripper’? Begin by determining if you are and see if you can soften across your buttocks whenever you feel the tension.

Visit a physio (at The Fix Program even) who can use manual techniques and awareness exercises to help you learn to let that butt gripping go!

 Did you know that there are other posture cheats? Perhaps you tend to back grip or chest grip too? Intrigued? Check out our other posts and make a healthy change to your posture habits.

#posture #posturalawareness #buttgripping #buttwink #squatting #hippain #backpain #pelvicpain #dianeleephysio #thefixprogram #thefixprogramonline #thefixprogramsydney

by Samah Elomari,  Women’s health physiotherapist 

We women, with our moods and energy levels will often find ourselves blaming our menstrual cycle for most things! At the same time, driving our housemates or partners mad!

Ladies, let’s turn it all around and use our changing hormone levels every month for the better! Here are women’s health physiotherapist Samah’s top 6 tips for exercising and training throughout your month.

Tip 1. At the end of your period and the week after, you are building more and faster muscle mass. This is due to the rise in oestrogen. Use these weeks to work on your strength training and lifting.

Tip 2. Around ovulation, your testosterone levels go up. Testosterone makes you feel competitive, powerful and energetic. This is perfect for competition day and running. At this time, you also have better coordination and faster reaction times – great for if you’re trying to learn dance or gymnastics routines. Book those dance classes and attend  Zumba classes at this time i the middle of your cycle. Find your feet if you are usually tripping over them!

**Tip 3.**If looking to lose fat, you’ll burn up to 30% more fat during aerobic exercise in those 7 days after ovulation. This is due to the rising combination of estrogen and progesterone, which fires up your body’s ability to burn fat.

Tip 4. If you exercise according to heart rate zones, expect higher heart rates to be more of a challenge to reach during your period. Try shorter workouts or shorter runs and swims during this time too, because you’re more likely to experience a drop in endurance. Leave you endurance workouts alone during your period.

 **Tip 5.**When training at higher intensities, you might experience more of a challenge during those 7-10 days after ovulation. Your heart is working slightly harder than normal, especially if you’re training in hotter climates…so you’ll reach a higher heart rate more quickly. Go back to those  dance and Zumba classes perhaps!

Tip 6. Here is comes, the most important tip.  Listen to your body and please  be kind to yourself. Only you know how your body is feeling. If you’re experiencing premenstrual syndrome (PMS) – that irritability, fatigue and a down mood – maybe what you need is some R&R, meditation and Yoga. Leave that big weights session or run to another day.

How true is the beloved old myth that when you are pregnant, you can eat for 2?

Jennifer May, Nutritionist and owner of Sydney City Nutritionist cannot disagree more. While pregnancy may make you feel that hungry, you cannot double your food intake each day. You may, however, may wish to double your nutrient intake with healthy eating habits.

If you put on too much weight during pregnancy, you increase your risk of gestational diabetes, backache, higher blood pressures, and C-section birth. Conversely, gaining too little weight during pregnancy can lead to low birth weight, premature delivery, and, later, developmental delays, or chronic health problems in your baby.

Here’s Jennifer’s guide throughout pregnancy when it comes to calorie intake:

• During the first trimester of pregnancy no additional calories are needed, however you may feel hungrier due to the high requirement of nutrients.
• In the second trimester an extra 334 calories on average are needed.
• In the third trimester an extra 475 calories are needed per day.
• It is important to meet those needs with foods that are highly nutritious and which promote optimum health and balanced blood sugar such as healthy protein, healthy fats and high fibre carbohydrates.

If you need further guidance on healthy eating habits and menus for pregnancy, contact Jennifer She would love to help and can consult with you through telehealth or face to face!

by Samah Elomari, women’s health physiotherapist

Abdominal separation or DRAM (diastasis of rectus abdominis muscle) is such as hot topic at the moment! It’s so exciting seeing so much more awareness both online and within the health community. Unfortunately though, with that comes a whole lot of misinformation…especially when it comes to what we define as a ‘normal’ separation.

First, you need to know a little about your rectus abdominis, otherwise known as the ‘six pack’ or ‘abs muscle’. Your abs (yes, they’re there even if they’re not visible yet!) extend from the rib cage and travel vertically to attach into your pubic bone. The two strips of the rectus abdominis muscle are connected via the linea alba, a thick structure of connective tissue. This connective tissue is like bands of elastic fibres running down the midline of the entire abdomen.

**The linea alba stretches in every woman during pregnancy! This is a normal phenomenon and in fact why the linea alba exists!
**

The linea alba is a firm structure. During pregnancy however, its fibres relax and soften. That means that as your baby grows, the uterus pushes against the abdominal wall and cause the linea alba to stretch. New mums will often ask about the distance between the abdominal muscles where this stretching has taken place. It is still common practice to have a physio in hospital come around, measure this and exclaim “wow, your separation is only 3 cm wide ( or insert any other number)”. This can invoke fear or that something has gone wrong throughout the pregnancy, but really it has not. Remember, the linea alba has served its purpose here to give your growing baby room to grow.   

So how wide is the linea alba normally?

A study was carried out on 150 women between the ages of 20 to 45 years who’d never been pregnant. They found that the normal width of the linea alba in this population was:

• up to a 1.5cm at the breast bone
• up to 2.2cm at 3 cm above the belly button and
• up to 1.6cm at 2cm below the belly button

The linea alba has a width to it for everybody, even women who are not pregnant, and men too. Which means that even if there is a small separation postnatally, the softening of its fibres means you will feel that separation on assessment. With all the misinformation out there, it can be scary to think something _ab_normal is going on.

If you’re concerned about an abdominal separation during pregnancy or after having your baby, come in for a postnatal check-up with one of our women’s health physiotherapists. We can help to train all of your belly layers, and talk through the correct strategies with breath and postural muscle control to assist with healing of the linea alba and your belly separation! This is an important step early on before jumping in on back to your regular exercise routines.

Reference: Beer, G. M., Schuster, A., Seifert, B., Manestar, M., Mihic‐Probst, D. and Weber, S. A. (2009), The normal width of the linea alba in nulliparous women. Clin. Anat., 22: 706-711. doi:10.1002/ca.20836

What effect on pelvic floor health does early return to exercise have after having a baby?

There has been a lack of research and evidence backed information about the safe return to exercise after having a baby.  A recent research paper hot off the press this month (May 4, 2020) studied the long term impacts of returning to exercise in the first 6 weeks after birth. The physiotherapy researchers looked at the impacts of early exercise on urinary incontinence and prolapse in new mums 12 months after.

So, does return to exercise in the first 6 weeks of labour have any negative impacts on the pelvic floor 12 months on?

Here were the study’s findings:

• The exercising group undertook low impact exercise 3 times per week for 30 minutes (such as walking and swimming)
• The non-exercising group did just that!
• The strength and endurance of the pelvic floor muscles was no different in the 2 groups of women when tested at 12 months.
• The reported symptoms of urinary incontinence and prolapse were the same between the 2 groups at 12 months. So, this very early return to low impact exercise did not increase the incidence of incontinence or prolapse at all. 
• The mums who did report issues with incontinence and prolapse at 12 months were overweight or were workers in physically strenuous occupations involving lifting and manual labour.  

So, what tips can we take home from this study?  

Tip 1. New mums should be encouraged to start general exercise within 6 weeks of giving birth. The importance in the physical and mental wellbeing benefits for new mothers of regular exercise at this time cannot be underestimated.

Tip 2. Exercise in the first 6 weeks should be low impact to not overload the pelvis and pelvic floor muscles after labour. This would include walking and swimming, or gentle mat based exercise.

Tip 3. There is no magical return to exercise guide for a new mum after this first 6 weeks. Each woman is different. Pelvic floor assessment for pelvic floor muscle strength, endurance and prolapse is encouraged for each woman. This, with added consideration of her labour, baby’s weight, her pre-natal fitness, hormonal situation, body type will allow for a safe and pelvic floor appropriate return to exercise of higher impact or load.

Tip 4. If a new mum is overweight or has had a strenuous occupation or activity level in the past, she has a higher chance of urinary incontinence or prolapse. Return to exercise after the initial 6 weeks may need to be adapted and risk factors modified. Again, this is unique to each new mum and a women’s health physiotherapist is the best health professional to guide these mums back to their exercise goals.

So new mums, start your gentle walks, or mat based exercise when you feel ready. But don’t feel the pressure, go when you are ready! Finally, do make sure your women’s health physio has assessed your pelvis and pelvic floor after this 6 weeks to safely guide you to through the next phases of exercise.