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The 4 Move Total Body Workout!

postnatal fitness workouts

I’m often short on time. My clients are often short on time. So being able to create a workout that makes the most of the little time we have is a basic requirement for me!

So I’m going to share with you the basic template I use to create most of my programmes. It’s simple, has the potential for loads of variety, and gives you ‘bang for your buck’ in terms of what you get out of each exercise. Basically, you’re maximising the little time you do have.

How?

Because the 4 moves cover your whole body. They use big movements, which means more muscles involved, more work done in a shorter space of time, and more calories burned.

It’s suitable for any goal.

The variety I said you can get from this means that you can tweak it to suit fat loss, improving strength, work up a sweat doing some cardio: all you need is some imagination! You can use it at the gym, or at home with no equipment.

And even when I’m creating a longer workout, these 4 exercises usually make the base of that workout, and I build from there, adding some extra moves in.

So what are the 4 moves?

  • Lower Body Push
  • Lower Body Pull
  • Upper Body Push
  • Upper Body Pull

What exactly does that mean?!

An exercise using either a pulling or a pushing action. (I’m hoping the upper/ lower body part makes sense!)

So an example that is suitable for postnatal clients (click the exercise name to see a video demo):

  • Squat (lower body push, pretty much always a squat variation, of which there are LOADS!)
  • Bridge (lower body pull- generally speaking if it makes your butt burn then it’s a lower body pull.)
  • Wall Press Up (upper body push- works your chest)
  • Wall Angel (upper body pull- works your back)

As you can see, the pushes and pulls work opposite sides of your body.

Do 10-12 reps (or 30-60 seconds for the wall angel) and complete it as a circuit, 3-4 times. That’s about 15 minutes, and for really time-pressed clients, they can do 1 circuit every time they get a spare 5 minutes (this one’s low intensity, so I don’t worry about a warm up like I would on harder workouts).

“I want to get a bit sweaty and feel like I’ve had a workout.”

Let’s take the same postnatal template, and tweak it.

All you do is head to the park, complete the circuit then add a power/ hill walk before the next circuit. If you have a baby in a buggy, trust me, this is hard.

This is suitable for when you’re postnatal or pregnant (even with diastasis recti, although then it would be unloaded and you’d need to be assessed to check you’re controlling the exercise ok) , but because these exercises are slightly harder technique-wise it’s not one I usually start clients on.  Because you’re adding resistance here it can be challenging for any level- just add or remove some weight! If you want some more postnatal core exercises you can read this blog though.

“I’m not postnatal and want to push myself even harder.”

Great. So many options for you! I’m going to throw some equipment in, but basic stuff you can buy to use at home.

The caveat here is that you do need to be taught to perform the swing. This is an ADVANCED option that I use, but I’ve included to show you just how hard this workout can get, especially if you have a little equipment (and all of these moves can be made harder still)!

For this one I quite like to break it down into a superset. I use these a lot with clients and on the Restore My Core programme. A superset is 2 exercises, and you go back and forth between them. So exercise 1a and 1b you go back and forth 3 times, then the same for 2a and 2b.

Obviously with the more intense workouts you need to throw in a suitable warm up and cool down before and after, but I really hope this gives you an idea of how easily you can create a workout, and how you don’t have to spend hours in the gym to improve your fitness.

Disclaimer: consult with a medical professional before making any changes to your exercise routine, especially if you haven’t done any restorative postnatal work- be sensible about what you attempt! See full disclaimer here.

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Scar Aversion: When you can’t bear to touch your scar, and what to do about it.

My last blog was about C-section scar massage: why it’s beneficial and how to do it.

And so many of you told me how useful it was, as there is so little information given to C-section mamas about their scars and how it can affect them.

But quite a few of you also commented that you can’t touch (or in one case even look at) your scar. When I did my postnatal massage course and we did scar massage this was discussed, but I have to admit it’s not something I’ve come across much, so it isn’t my area of expertise.

So I’ve called on 2 wonderful therapist friends to shed some light on this.

Rachel Weber of Time and Space Therapies is a massage therpist and ex-midwife who also runs Birth Story Workshops and 1:1 sessions, and Kate Codrington is also a massage therapist, and runs self-help Love Your Belly Workshops.

 

None of my massage clients have had this issue, but I’m aware of it from my training. How common do you find it?

 

Kate: I’ve come across it a handful of times in my work with pregnant women, all of those were emergency sections where there are unresolved feelings about the birth. Of course when a woman has been given time to prepare for a section it is much less common.

Rachel: I come across this fairly often, women who can’t look at or think about their scar even years after. Sometimes they have NEVER looked at their scar. They don’t think anything of it, they just think it’s normal not to.

This can be a very emotional issue can’t it, in relation to birth trauma?

 

Rachel: For a lot of women the scar is a constant reminder of the birth they didn’t want and of any trauma surrounding that. It is likely to be holding deeper issues as well that they are not necessarily aware of on a conscious level; feelings of having failed, of their body having failed them, even of being a ‘bad’ mum or of being weak, not speaking up for themselves, or deep hurt about how they had been treated or not listened to etc.

These feelings can be very hard to acknowledge and society/family often don’t know how to deal with them and expect us to be ‘grateful’ so we tend to cover them up to the point of not even knowing they are there.

Kate: Exactly! Then this hurt can be projected onto the mother’s body and in the case of scar aversion, the scar itself.

Once baby has arrived, our energy needs to come back in; our boundaries re-form into a new identity. A mum; we become mum-shaped! But women need a safe, nurturing environment for this to happen in. Expectations are set off kilter by media images of celebrity mums, which force women into diet and fitness regimes that are not nourishing for new mums and will actively delay recovery. We seem to have lost the practice of protecting and nourishing new mothers with massage and special food and practices in mainstream culture.

So do you find similar with women after vaginal births too?

Rachel: Women hold onto a lot of emotion around their births in general, and this can be for all different reasons. A lot of women have also never looked at their perineal scars/stitches, often because they are ‘scared’ of what they will find. Some even get their husbands to do it for them but have never looked themselves.

Kate: Yes, I regard scar aversion as being on a spectrum of distress following a birth that was traumatic in some way; for one woman it might show up as the desire to ‘get rid of’ her baby belly, or in a more extreme version, may not want to be touched or seen or be able to leave the house at all.

And as Rachel has said, women are so often told ‘well your baby is alive and well, be grateful for that!’ which can leave them feeling angry and embittered for years if the birth story isn’t processed. This can also affect their sense of self and attitude to their body too, that it’s let her down or is inadequate.

 

How do you help your clients overcome these issues?

 

Kate: In general I encourage women to have their feelings; they have a right to feel OK about being angry or betrayed or whatever. It’s helpful if these feelings are expressed in a safe place;

  • Writing in out
  • Drawing it
  • Telling the story with safe people who will hear her without judgement. Rachel’s Birth Story Listening group is a wonderful place to start.

Yes, Rachel I imagine your role as a midwife as well as a therapist is valuable in helping women process their birth experiences? Where do you start?

 

Rachel: First I help her to acknowledge how she really feels about what happened. This can be more difficult and emotive than it sounds as she may never have admitted these feelings before. She can talk to someone or write it down. In relation to her scar she can write a letter entitled ‘Dear Scar.’ This is likely to reveal things she had never thought about before. It may bring up anger in which case it’s important to release it as suppressed anger can cause depression. She can yell in the car or under water, bash a pillow or do some vigorous exercise. In my sessions I would also help people explore the deeper beliefs they have formed about themselves; I am helpless, I am weak, I am a failure etc. and clear these using mind-body techniques.

And what about massage itself- obviously we don’t have to work directly on the scar, and won’t if the woman can’t touch it herself, but massage goes beyond muscular release.

 

Kate: I use a combination of visualisation and off-body work to help women heal scars. If they enjoy it I encourage them to do the same process at home. This can include;

  • Placing my hands above and below the scar, either on or off the body according to what feels most comforting for the woman, and visualising the energy as light passing from one hand to the other, through the scar.
  • Visualising the muscle and skin fibres knitting together.
  • Sending a river of love from the heart to the pelvic basin to sooth and heal the scar and the remaining trauma, washing it away into the ground.

The energetic focus of postnatal massage is to bring the energy back in so the woman can heal and ‘come back to herself’. To do this I use a focussed intention as I massage the aches and pains and also by wrapping with rebozo shawls to ‘close the bones’, which symbolises the completion of the cycle of pregnancy and birth. I usually combine it with belly massage that also encourages the womb and intestines back into their place, bringing more energy and vibrancy back and encouraging the rectus muscles to return to the midline.

How important a part of the recovery process/ self-love journey do you think this is?

 

Rachel: I think it’s very exhausting to have suppressed emotion, and the scar and being able to look at it or not forms part of this equation. At the same time it can take a lot of courage to face these issues and it may be years before someone is ready. People may also be in denial that it’s an issue. Having said that, most people are surprised how easy it can be to heal their emotions – often it can be as simple as expressing them – and wish they had done it sooner.

 

What changes do you see in clients who manage to overcome these issues/ this aversion?

 

Rachel: For me not wanting to look at one’s scar is part of a bigger picture of suppressed emotions. People say to me things like ‘this is the first time I’ve ever cried about this’ or ‘I didn’t realise I was holding so much.’ Obviously as you shed the emotions you free up space for more energy and more joy. In particular I find people become more present and more able to deal with stress without having emotional or angry outbursts (generally these outbursts are just stuff they have been carrying for a long time).

Kate: And touch helps us to reclaim and understand our bodies brining us back to ourselves so that we can feel gratitude for having created this amazing new being. After all, making a human is a neat trick!

Guest Post Bios

Kate Codrington

I wear 3 hats; I run online courses for therapists [http://www.katecodrington.co.uk/] who want to expand their practice, I am also a massage therapist [http://www.katecodringtonmassage.co.uk/] specialising in women’s health in my private practice in Watford and teach women self-help skills at Love Your Belly [http://www.loveyourbelly.org.uk/] workshops.

Rachel Weber

I help women heal emotionally from an upsetting, unexpected, confusing or traumatic birth so that they feel confident about life and childbirth again. I also do holistic and pregnancy massage and reiki. Based in Pitstone, healing sessions are also offered globally via Skype [http://www.timeandspacetherapies.co.uk/].

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What You Don’t Get Told About Your C-Section Scar

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I’ve written before about returning to exercise post C-section, but I didn’t touch on one important area of C-section recovery: the scar. Because I think this deserves a blog of its own.

I meet a lot of C-section mamas, and issues such as poor sensation/numbness, ongoing pain and a feeling of tightness in the area are common. Which is hardly surprising: even from a small cut I’ve felt tightness in the area as it’s healed.

But this rarely gets talked about- why not?! There’s been trauma to muscles, nerves, blood vessels, right in the hugely important area of the abdomen no less. Your core muscles (we want those functioning well, right?) and a number of organs are potentially affected by this. And massage can make a huge difference to the healing process.

So why aren’t all C-section mamas told to massage their scars as part of their recovery?

 

Advice is all about the appearance of the scar, such as looking for signs of infection, yet the effects of your C-section can go beyond what you feel in the scar itself.

This may sound severe, but remember the scar is far deeper than what we can see: if you think about how deep the incisions are, and how scar tissue is formed, this isn’t surprising.

After surgery scar tissue forms as part of the healing process, but the fibres go in all different directions, can feel tighter, and it can adhere to other tissues, such as skin, muscles and even organs. This is when problems can occur.

You can view a video here of what these adhesions look like.

So what issues can arise?

Low Back and Pelvic Pain

Adhesions in this area can affect the sacrum, which is where your spine meets your pelvis, so anything that interferes with its movement or function can have a knock on affect to your low back too.

Frequent urination

I think this one is self-explanatory! You should be urinating every 2-5 hours, but many women find themselves having to dash to the toilet far more often. Again adhesions in the area can affect the bladder’s expansion and sensitivity, interfering with normal function.

Pain with intercourse

This comes back to adhesions around the organs again: if it limits their movement, then they can’t get out of the way during intercourse, which can be very painful.

Obviously not every woman who’s had a C-section will experience these symptoms. But it’s worth knowing about because sometimes it can be years before any issues occur, as adhesions continue to form. And while massage won’t prevent all of this, it can definitely reduce the risk and severity of symptoms should they occur. So you’ve got nothing to lose from trying it!

So how do I massage my scar?

When to start:

Ideally as soon as it’s fully healed to prevent the formation of deeper adhesions. But it’s never too late to start, even years later!

How often:

More regularly to start, when the tissues might not be moving very freely, but once they are it’s still a good idea to revisit it once every so often, in case it’s getting tight again.

If you have difficulties doing this or notice your tissues don’t seem to be responding to your efforts, then you should see a Women’s Health Physiotherapist for treatment.

How?

This is the best video I’ve seen of how to massage your scar, by Lynne Schulte at Intuitive Hands PT.

However there are also therapists who specialises in scar tissue massage. Emma Holly from ScarWork at Restore Therapy told me about a recent client and how scar massage helped her:

After a long labour she ended up with an emergency c-section. After a few months she started to try some exercise videos and found she had bladder weakness and sought out an amazing women’s health physiotherapist and has started a course of exercise to strengthen her pelvic floor.

Her c-section scar had left her with little feeling and a disconnect with the pelvic area. She came to me for treatment where I worked along the scar tissue, using ScarWork therapy to stimulate further healing. Deep stretches loosened some adhesions caused by surgery and using massage to release the pelvis and hips post pregnancy.

After one 45 minute session she walked out of the appointment and said “oh, my hips feel different” in the days that followed she noticed her feeling of the pelvic floor improved so she could be more aware when drawing up the muscles and is now finding her exercises from the physiotherapist and in restorative pilates much easier.”

In addition, if you are having any issues with pelvic pain, or that might be associated with adhesions to your organs (including bowel problems) many Women’s Health Physios are trained in visceral manipulation, so can assess you and work deeper than you might be comfortable doing yourself.

WH Physio Becky Aston explains how this can affect breathing patterns (read this blog for more on the breath and core strength) and result in pain elsewhere:

 

An amazing fact about the diapraghm (muscle below the lungs) is it moves up and down 20,000 times a day. We think of the ovaries, kidneys, liver, pancreas etc just existing in our pelvic and abdominal cavity but they move in a synchronised fashion with the diaphragm.

Now imagine that you have something restricting this movement i.e. adhesions from a scar. However small, they will limit this movement and other structures will have to accommodate. This can cause pain or dysfunction anywhere else in the body.

Releasing abdominal adhesions can relieve IBS symptoms, menstrual pain, back pain, help the pelvic floor muscle and deep core work more effectively and many more things.

Visceral release work is a gentle therapy with mobilises visceral and myofascial structures which can release those adhesions and allow the body to be synchronised again.

And finally…

A note on numbness and loss of sensation in scars, as this is what I most commonly get asked about.

Nerve damage can be permanent, but nerves do regenerate. The speed of this is slow though, about a mm a day (it depends a bit on the size of the nerve in question) so it can take months and even years to regain feeling. The same goes for feeling such as tingling or itchiness.

I find that the impact of a scar can reach far beyond its immediate area. Tight quad muscles (on the front of the thighs) for example can pull on the scar, so massage and release work here can be beneficial to the C-section mama. And any scar can have a huge impact on muscle function too.

If you’re interested in booking a postnatal massage with me to help with your recovery, and with your scar massage, you can find out more about what it involves here.

And if you’re one of the many women who finds the thought of touching your scar makes you feel ill, you’re not alone. The comments I received after first writing this blog prompted me to write a second about scar aversion. You can read it here.

 

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Learn This Simple Step to a Stronger Core

I think every client who comes to me wants a stronger core, and this is where we start. It really is a simple step. Or at least it sounds simple. In reality, it can be pretty hard to master, at least when you’ve just grown a baby!

I’m talking about breathing correctly.

Correct breathing technique is one of the tips in my guide to kick-starting your postnatal fitness, and it’s one of the first things I look at with postnatal clients, before starting any exercises even.

It might seem silly, and you’re thinking “but I feel so weak- I need to get working, feel my muscles again!”

And I get that. But if you don’t get the breath right, you won’t be getting the most out of your exercises.

Let’s start with the core itself.

I’ve explained it in this video, and if you look at the image below, you can see how the muscles of the abdominal wall and the back form a cylinder, with the diaphragm (that’s the main muscle used for breathing) at the top, and the pelvic floor at the bottom.

postnatal fitness

These four elements work together, and when one isn’t functioning properly, it affects the rest of the team.

Before you read any further, try something for me: place one hand on your ribs, thumb to the back and fingers to the front, and the other hand on your tummy. Take a few breaths- what can you feel moving, what’s happening?

Here’s how they should be working together.

postnatal core fitness

As you inhale, the diaphragm moves down, the pelvic floor lengthens, and the abdominal wall (and trunk in general, the low back opens up as well, which isn’t shown here) expands. The rib cage opens up in a 360 degree action too.

Here are the ribs in action:

You should hopefully feel a softening of the tummy and pelvic floor as this happens.

As you exhale the diaphragm rises, and the pelvic floor and abdominal wall naturally tension. You may even feel your low back joining in on a more forceful long exhalation.

How is this relevant to getting a flatter/ stronger tummy?

 

Because so many people have poor breathing technique. Especially new mums. Having your tummy muscles stretched and a baby’s butt pushing into your diaphragm for months will do that. Here are a few of the problems that I come across.

Mistake Number 1- Belly Breathing and Diastasis.

 

Diastasis Recti is when your abdominal muscles stretch apart during pregnancy. Once the baby is gone and the pressure stretching them removed, they should move back together again over the next few months.

But sometimes the pressure isn’t removed. If you’re a belly breather (think BIG expansion of your tummy every time you inhale) then that’s pushing on your diastasis every time you take a breath. Which is about 20,000 times a day. Not good.

Mistake Number 2- Sucking It In.

Holding in the abs. How many of us are guilty of that? In a world where we’re continually informed that a flat tummy and six pack= sexy, it’s tempting to do!

But if your tummy’s sucked in, where’s that pressure going? Down on your pelvic floor, or up on your diaphragm. The whole mechanics of your core is altered.

Strong abs do NOT = functional. You need them to be able to move with the breath. Permanent tension is not practical, and can result in back ache as your low back muscles over work too.

So let it go!

Had to be done!

Mistake Number 3- Shallow Or Chest Breathing.

 

Booby breaths as I like to call them. Think heaving bosoms in corsets. This often goes hand in hand with the sucking in, but many take heavy chest breaths, where the ribs go up as you breath, rather than out. It’s usually a tense and shallow breath, which means the core will not be effectively loading and unloading, so not making the most of your exercises. And think how relaxing a good deep breath is- you’re not getting that release if you’re stuck shallow breathing! If you’re shoulders rise when you breathe in- you’re doing it wrong! Remember- 360 expansion.

Now let’s try connecting to your deep core as you breathe.

 

With one hand on your tummy, one on your ribs, inhale, and try and feel a 360 degree softening in your belly and your ribs open up to the sides. Feel your pelvic floor soften and lengthen.

Now exhale for an 8 count, like blowing bubbles (I get the Restore My Core mums to actually do this!)- can you feel a tensioning in your tummy and hopefully pelvic floor?

personal training core

You might only feel your chest at first. After giving birth, regardless of the type of delivery, nerves can be affected, so this, plus the load carrying a baby placed on you, means this connection to the breath can be lost.

Bring your attention to your tummy and pelvic floor, and take your time.

Here’s a live facebook video I did on this, exaplining how you can practise correct breathing technique (it’s live so forgve me for forgetting to mention- as you inhale try to feel your pelvic floor lengthen, and rise as you exhale):

It takes practise, and there are also certain releases (such as massage, or some self applied techniques that I teach on Restore My Core) that I find very effective in helping to release and open up the rib cage and low back.

Hopefully you can see that even if you do the best exercises in the world to heal a diastasis, if your breath is putting pressure on your abdominal wall all day long, they won’t be effective.

To get a strong core you HAVE to start with the deep muscles. Once they are well co-ordinated, THEN you can start working on your abs.

But only when the inner unit is stabilised! Which means the diaphragm, pelvic floor and deep core working together on every breath.

Once you’ve got the hang of this head to this blog for some postnatal core exercises to get started on, and you can also download my 10 Tips for getting back in shape after having a baby.

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Is Balance Bullshit?

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When we talk about reducing stress, we often talk about balance. Because we’re all trying to juggle everything- family, running a house, seeing friends, work, exercise, eating well.

And that’s not even including the little things like painting your nails, reading a good book (right now it’s The One I Was by Eliza Graham) and getting a haircut. The list goes on right?

postnatal fitness

See how stressful it is juggling everything? And the state of that worktop! The strain I’m under here.

When training clients, whether it’s postnatal mums on Restore My Core or 1-2-1 sessions working on weight loss, I always ask about stress. It’s important to consider the effect stress could be having on your recovery or fat loss goals. Because increased stress (and therefore increased cortisol) does affect these things.

And most of us try to juggle too much. Inevitably something gives. We let some balls drop (snort). Which then feels like failure because we haven’t lived up to our unreasonable expectations of ourselves.

postnatal exercise

See how sad I am at my juggling failure?

But is it really possible to achieve balance?

Because I feel like balance is bullshit.

Has anyone REALLY ever attained a state of perfection where all these things run in harmony? Getting their fair share of your attention?

Because I fucking haven’t.

But do we need to? I think part of the problem is that we think we should be able to do it, and put too much pressure on ourselves. Probably because there’s always some other mum who looks like she does. I guarantee she doesn’t. I would bet good money she’s either a screaming mess behind closed doors, hyper-controlling with her children, or drinking a lot more wine than you.

So what’s the answer?

I don’t know. It’s a Friday night and I’m writing this, that’s how good my work-life balance is. And I haven’t even had any wine yet. Surely you don’t expect answers to life’s problems from a fitness blog? But since you’re here I’ll tell you the best I’ve come up with.

Prioritise.

Or rotate. Rotate your priorities, that’s better.

You can’t fit it all in. But you can concentrate on what’s important, at least for a while, then something else will need your attention, so you focus your energies there for a bit.

Let me explain. For me, my biggest priorities are family, work, and taking care of my health. I struggle to do all 3 as best I’d like, at once.

So when I feel particularly productive and motivated, I’ll have a period where I focus on my business. I’ll study, write blogs, develop the content I give to clients (videos, education) and generally try and move it forwards.

And I can just about manage this around childcare. But it means late nights, which means exercise is scaled back. I need the extra hour in bed so can’t get up for the gym. I don’t have as much ‘me time’.

Parenthetically I cringe a bit whenever I use that term, mainly because of Man Who Has It All. But while I know its clichéd I’ve yet to come up with a better term that everyone knows- suggestions below please.

So I start to feel a bit crappy, lose motivation and decide to focus on myself for a bit. Which means work takes a back seat. I’m still doing everything I can for clients, but webinars and business plans? Not so much.

But now I can get some early nights, train a bit more, spend a bit longer cooking. And then maybe I’ll use some of my pre-school hours to see some friends.

The idea that you can divide your attention equally to every aspect of your life, every day, is bullshit.

So stop trying to.

Because the more I try to do or balance everything, the more stressful it is.

Ask for help. Let some balls drop (still chortling). You don’t have to juggle them all.

So what if this mean sometimes I forget to order food and we need take away? Or I skip the gym (I make sure I have enough activity with the kids to stay healthy though, or fit in home mini workouts- this is when the fitness knowledge comes in handy!)

Basically stop worrying so much about balance.

postnatal fitness

Look how much happier I am now zero fucks are given. The kitchen’s still a mess, a small child has materialised and will probably start to whine soon, but I’m zen and can handle it all. (Note- I am not suggesting wine solves everything. If that’s what you choose to take away from this then that’s all on you.)

Self-care really is important though

I find litte things can help when everything is getting too much. Again, you don’t have to be too ambitious here. Whilst I love a good Epsom Salt bath, new mums might find that aiming to get dressed and have a shower is enough to feel a bit more human. Maybe go crazy and brush your teeth before midday.

Carving out even a small amount of time for yourself each day can make a difference. Ideally you can do this without having to lock yourself in the bathroom, but if it comes to it, my money says that your OH gets away with the odd 30 minute session in there. If that’s the case then so can you. Just make sure he’s at home to deal with the fallout when you do it.

And on the exercise front, if you want to find out more about how to make the most of your time with your postnatal training, get my 10 tips to getting back to exercise after baby here.

 

 

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Exercise After a C-Section

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With c-section rates in the UK at around 26%, as you can imagine I meet a lot of mums who have had one! So I thought a blog covering some of the common questions and misconceptions I come across would be useful…

What is a c-section?

So, what is a c-section?  Well, it’s an incision usually made horizontally, just above your pubic hair line, first through the skin, then the fat is moved out of the way, then a fibrous layer of fascia is cut, again horizontally. The rectus abdominis muscles are not cut as as they can be pulled apart along the cling film type structure (called the linea alba) in between the 6-pack muscles.  Then the uterus can be opened, usually cut horizontally.
Skin, nerves, blood vessels and connective tissue is all cut, and clambs are used to hold them  open so the uterus can be safely accessed.
The uterus and the outside incision are both sutured back together, but the muscles are not. This means abdominal seperation, or diastasis recti is very common after a c-section, and can take longer to heal than it can after a vaginal delivery.

I know I’m having a c-section, so I don’t need to do pelvic floor exercises, right?

If you elect to have a section, there’s a misconception that your pelvic floor will be fine.  You might think that because your body won’t be going through the stages of labour, your pelvic floor won’t be affected.  This is where you’re WRONG!
Pregnancy itself puts tremendous pressure on your pelvic floor, as the weight of your developing baby gets bigger and bigger, and therefore weakens these muscles. In addition, the nerves that innervate those muscles have been cut, so there is sometimes a loss of ‘connection’. It’s still very important that you strengthen your pelvic floor during and after pregnancy, even if you elected to have a section.
And if you’ve gone through the stages of labour, attempted to deliver naturally, and then had a C-section, think about what muscles have been stressed throughout this ordeal?  That’s right – the abdominals and the pelvic floor!  You may have been at it for hours, pushing and pushing and putting a immense amount of pressure on these areas.
Image found at https://www.flickr.com/photos/tammra/283538056

Image found at https://www.flickr.com/photos/tammra/283538056

What is recovery like after a c-section?

After a c-section, your recovery time is longer than a natural birth. You may have a loss of sensation, a numbness, in your abdominals especially around the scar area, and the scar tissue itself may reduce your ability to do certain movements completely pain-free. The nerves that have been cut do regrow, but it can take well over a year for full sensation to return, and sometimes it never does.
Your pelvic floor may take a little while to activate consciously too, but keep sending the signal from your brain to these muscles, and eventually, it will switch back on, I promise.

When can you return to exercise following a c-section?

You will need to have had your Doctor’s check up before your return to exercise after a c-section, which, depending on your Doctor could be 8 weeks, 10 weeks or even 12 weeks, so give them a call to see what their guidelines are.
I ask mums wait a minimum of 10 weeks before they see me, however gentle deep core connection work and pelvic floor exercises can be done much sooner.
Just remember this is major surgery, and your body will need time to heal. Everyone’s recovery is different, so listen to how you feel.

What exercise is safe after a c-section?

Release work is hugely important- I find areas where the muscles are linked to the abdominal wall, such as the front of the thighs, can be very tight after c-section. So one of the first steps I’d recommend is getting a postnatal massage! I build in hands on release work to exercise sessions too though, and make sure clients have techniques they can use at home.
In addition scar massage is hugely beneficial- so much so I’ve written a whole blog on it here! (If the thought of touching your scar makes you feel ill, you’re not alone: read about scar aversion and the reasons behind it here.)
And postnatal-specific core exercise is probably THE best form of exercise for any new mum to be doing, regardless of the type delivery.
When I train a client who’s had a section, I start by asking them what sensation they have in the abdominals, bearing in mind that they may have next to no sensation, and still feel very sore and numb.
Next I ask how different areas of their pelvic floor feel.  After this, I check for abdominal separation, and basic re-activation and re-education exercises to either the pelvic floor or abdominals to help the muscles return to their original strength and fire properly.
Unfortunately, there is no quick-fix cure for strengthening the abdominals following a section.  It can take months of training, careful instruction and lots of homework.  If your abdominals aren’t assessed and addressed early following the correct procedures and using the correct techniques, then they may stay in a weakened state, which can lead to poor posture, pelvic discomfort and lower back pain.  The good news though, with the right assessment, instruction and homework, it is fixable.
I hope this helps- if you have any questions leave them in the comments below and for more advice you can download my 10 Tips for getting back in shape after having a baby.
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Family Fitness- 10 Ways To Exercise With Your Kids This Summer

We all know we should make fitness and healthy eating a priority, but in real life preparing nutritious meals that children will actually eat, and finding time for exercise, is easier said than done!

Balancing everything is not easy, so to help you get more active as a family this summer, I’ve compiled my top 10 ways to exercise with your kids.

There are many activities you can choose from, so you can try them and find what that your family might want to continue doing.

Depending on the ages of your children you might be more restricted as to what activities you can do, however most of the ones we have selected and be enjoyed by most ages.

1. Post Meal Walks

This is a simple and effective way to spend time together as a family and is very easy to complete! You don’t have to be very coordinated or require any special equipment. The reason I have suggested ‘post meal’ walk is this is great time to walk off your meal and reenergise yourself. It’s a great way to connect as a family and feel more refreshed.

2. Bike Rides

family fitness cycling

This can be enjoyed by all ages. It doesn’t have to be a 10-mile ride anywhere extravagant; a simple ride around your neighbourhood would be ideal. A great way to increase your fitness and tone up your legs too!

3. Roller Blading

This might seem a little odd however it is a great way to get fit and have some fun at the same time. I would suggest finding an appropriate location, as you want it to be fairly flat with as little traffic as possible. There are indoor places you can do this too – however as its summer it would be great to get outside.

4. Old school games, stuck in the mud, tag etc.

These games are classics and you can never get too old for them. They are still fun whether you are ‘it’ or you are being chased down. Great for fitness and dynamic movements, which keep you on your toes.

5. Bootcamp/Obstacle courses

If there isn’t one of these in your local area for you can enjoy, you can make your own! You won’t need a lot and it will be part of the fun (and exercise) to put it together! Old tyres, logs, things to climb, and running between objects will give you plenty to be getting on with! I’d suggest Aldenham Country Park play area for anyone local.

6. Canoeing

family fitness rowing

This might be something to do with your older children or if your kids are strong swimmers. A very strenuous and exhilarating sport to try. This is something that will require planning and will cost more than a bike ride or playing in the garden. This could be more for a special day out to enjoy as family to mark the day.

There are lots of water sports available at Rickmansworth Aquadrome, or head to Hyde Park and get to work on a row boat or pedalo!

7. Colour Run

colour run

Watford Colour Run at Aldenham Country Park

This is a great way to have fun and do something good. Entering a fun run together means you have a reason to train and a date to aim for. You can raise money for charity and get fit at the same time – win win!

And Park Run at Cassiobury Park is every Saturday, so you can get in some practise together too!

8. Rock Climbing

family fitness climbingIf you head outdoors for this then it’s probably another special day out to have as a family, which is quite vigorous. This would be for older kids as it can be quite dangerous and you would need to have some lessons or at least have some guidance before going out alone as a family.

However The XC in Hemel Hempstead is amazing, and do groups from ages 3 up. I’m about to get trained to become rope competent so I can take my eldest and we can climb together!

9. Ball games

Rounders, tennis, badminton and cricket are all traditional games you can enjoy as a family. Ideal for BBQ events to get everyone involved in too. Great for coordination and fitness, lots of fun as well as team building.

10. Gardening

Something that can be done without getting out of breath. Don’t let that fool you into thinking it’s easy! Crouching down planting flowers or digging up weeds is hard work and you will definitely feel in the next day. The best thing about gardening is you can see what your hard work has achieved! Children can be given their own area to grow food, which will also help with healthy eating!

Whatever you do try to make it part of the family routine- a 2013 study in the Journal of Physical Activity & Health showed that children were physically fit when they perceived at least one of their parents to be physically active. So walk instead of using car, and make visiting the park or going for a bike ride the norm in your household.

There are plenty of suggestions here to choose from and I would love to see pictures of you and your family getting active this summer.

Are there any other activities you think would be great?

Is getting active as a family important to you?

Comment below with your thoughts, as we would love to hear them.

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Physiotherapy For Where?!

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I sometimes describe pregnancy exercise to clients as training for their Olympic event. Because that’s kind of what it is- a life changing event where huge physiological changes occur in a woman’s body.

So we prepare for it. My clients stay as mobile, fit and strong as they can. We work on opening the pelvis for labour, on keeping the pelvic floor strong but not tight- we need it to relax and stretch for baby, and on making sure mum is in the best position she can be to recover afterwards.

 

But as with any sporting event, injuries occur.

 

And who do you see when you get an injury? Back pain, tennis elbow, knee pain? A physio, right? Or at least I hope you do- masking the symptoms with painkillers won’t do much good long term!

And the particular physio you need in this case is called a Women’s Health Physio. Some women will  see one in hospital, for example after a bad perineal tear. But most of us don’t. We should, but we don’t.

Giving birth is probably the only physical trauma that we don’t get help for!

 

It can be major surgery to abdominal wall that interferes with the core and whole body function, a cut or tear to perineum; it’s pushing a baby through your vagina!

How many times have you heard women complain “I’ve had pain around my pelvis/ incontinence since giving birth…” YEARS later?

Because there are ‘injuries’ from giving birth that we simply don’t recognise as such. Incontinence for example. Common but NOT normal, we treat the symptoms with pads, instead of the cause.

And the best way to determine the cause is to see a WH Physio, because it isn’t necessarily a weak pelvic floor.

The pelvic floor could be too tight, not used in the correct way or have other muscles compensating for it.

Emma Tailby, Women’s Health Physio at Ashlyns Physiotherapy in Berkhamsted says “We use an holistic approach in treating pelvic floor disorders.

“From treating incontinence to prolapse, pelvic pain or constipation, there is growing evidence that WH physiotherapy can alleviate, and in many cases cure these symptoms. Most women don’t know that help is available and it can be an embarrassing topic.

By doing correct pelvic floor muscle exercises 7 in 10 women avoid surgical intervention. You need this strong core foundation to start to rebuild your postnatal body.”

So what exactly does pelvic floor physio involve?

 

The initial assessment will include plenty of questions about your delivery, how your muscles feel, have you had any incontinence, your bladder and bowel health, diet, posture. You’ll be checked for abdominal separation and how well your deep core muscles are functioning, and there’s a thorough internal assessment.

This internal examination is explained and consented to. “Every woman’s body and post birth recovery is different so it is key to examine you to ensure the strength and function of your pelvic floor as an individual,” Emma explains.

However for anyone uncomfortable with this an external assessment can be done too.

“Can’t I just do my kegels?”

You can, and I work through kegel progressions with clients and on Restore My Core, with the aim of integrating the pelvic floor in to whole body movements, working it as part of a global system rather than in isolation.

BUT- you need to start in isolation. And you need to get it right. And I can’t know for sure if you are or not. As one client told me, “it wasn’t until the physio had her fingers up there that I really got the full lift through my pelvic floor!”

Becky Aston from Becky Aston Physiotherapy in Chesham says “Only 50% of women will do their pelvic floor exercises correctly when taught without an examination (or with verbal instruction). Some will have pelvic floor muscles that need help to contract and a WH Physio will be able to help with that. Some women have restrictions from scars even ones that are years old and without these released activating the pelvic floor muscles is difficult.”

You’ll be asked to perform a variety of contractions as your pelvic floor is thoroughly assessed. Full contraction, part contraction, a long squeeze, a series of shorter ones. Squeeze and hold then try and squeeze more. That kind of thing.

And you’ll get given exercises specific to you.

 

Let’s face it, you’re out of hospital as quickly as they can manage, and the 6 week postnatal check leaves a bit to be desired. If you’re lucky you’re told to do your pelvic floor exercises and pretend you’re stopping the flow of urine.

However Erica Lewis from Hertfordshire Women’s Health tells me this is far from ideal:

“Every woman has different needs and desires regarding what they want to achieve from their treatment and this, along with findings from the examination, determines what is appropriate and what should be avoided.

“Variations in pelvic floor exercises include the number of repetitions, effort of contraction, length of hold and exercise position, and for some women we have to focus on releasing and relaxing the pelvic floor before we even begin exercising it.”

I wish every client would see a Women’s Health Physio before coming to me.

 

This way I KNOW you’ve connected to your pelvic floor. I know, from the physio, EXACTLY where you are strength-wise. I know how well you’re connecting with your deep core muscles. I coach through this, but a personal trainer will not be able to do this as effectively as a WH Physio if you’re having problems here.

And then I can focus on what I’m there for: exercise programming.

(Although I like to be clear- exercises are the last piece of the puzzle when it comes to restoring your core after baby! Correct breathing technique, alignment, releasing tight spots and nutrition are all essential to the postnatal journey. Without getting all this right the best exercises in the world won’t make a difference.)

“But I feel fine!”

That’s great! I still think it’s worth having a postnatal check-up though. I want to KNOW everything’s ok, and even if you don’t have signs of incontinence, bulging at your stomach or pelvic floor/ low back pain/ pelvic pain, sometimes the problems don’t happen straight away.

Pelvic floor exercises and correct abdominal recruitment is not easy, and Becky Aston says “many women come and see me saying that they have been doing kegels for years and yet they still have a problem. On examination they are holding their breath or bearing down or recruiting every other muscle other than their pelvic floor muscles- how great would it be to get it working correctly before problems arise?”

When we start the menopause, the hormonal changes mean that connective tissue begins to lose elasticity. So if there is a weakness somewhere in your core or pelvic floor, this is when it will show itself. And it’s thought over 50% of women suffer a prolapse at some point.

Pelvic Organ Prolapse (POP) is when one or more of the pelvic organs (bladder, uterus, rectum) prolapses into the vagina.

 

There are varying degrees of this, and it can be managed, but in some cases it will require surgery. And in every case it is upsetting for the woman experiencing it.

You can get false teeth if you don’t care for them properly, but you can’t replace your pelvic floor, and that’s what’s holding your pelvic organs in place. It really is one of those things you don’t appreciate until something goes wrong.

And whilst the menopause is a high risk time for POP, it happens to plenty of young women too. Some exercises put more pressure on your pelvic floor than others, so if you’re thinking of going to bootcamp then you 100% need to see a WH Physio and find out if your pelvic floor can cope with it.

Even if you’re years postnatal, it’s never too late- book an appointment with your local WH Physio.

 

And if you know a new mum and are wondering what you can get her, instead of baby gifts how about a Mummy MOT? Along with cleaning, cooking, and help looking after siblings, I think that should be up there on the list of best things you can do for a new mum.

For more advice download my 10 Tips for getting back in shape after having a baby, and head to this closed pregnancy and postnatal support group, where I can be found to answer any pregnancy and postnatal related exercise questions, along with a whole team of experts, invluding 3 Women’s Health Physios!

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Improve Your Strut For A Better Butt!

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I’ll cut to the chase: most of us suck at walking.

In her book Move Your DNA Katy Bowman describes walking as “controlled falling”, in that most of us simply fall from one foot to the next, rather than focusing on using our butt muscles to drive us forwards.

I’ve written about the benefits of walking, and more importantly how much we should be aiming to do, but now it’s time to make sure you get maximum ‘bang for your buck’ from your walks.

Here are some simple stretches, exercises and changes you can make to your walking technique to ensure you’re actually using your glutes when you’re out and about!

Release Tight Hips

Too much time sitting means tight hips. When we sit our legs are lifted in front of us, and these muscles at the front of the hips can get tight. This means when we walk and we want our legs pushing off behind us, the tightness at the front can restrict that.

Here’s a simple test to see if you have enough mobility for your bum to effectively pull your leg back.

Lie face down on the floor. When your pelvis is neutral (which is where it should be) then your pubic bone and the two most prominent, forward boney points on the side of each pelvis should all be level. So when you lie down you should feel an equal pressure on all 3 points.

You should feel your pubic bone pressing into the floor, and if you look down from where it's labelled 'iliac crest' to where it ends, you should feel the 2 bony points on either side there too.

You should feel your pubic bone pressing into the floor, and if you look down from where it’s labelled ‘iliac crest’ to where it ends, you should feel the 2 bony points on either side there too.

Keep your head down, and lift one leg off the floor, using your glute muscles. How high can you lift your leg? Does the pressure on these 3 boney points remain the same or does your pubic bone lift up? Do you have to work your stomach muscles to keep it down?

Ideally you want to be able to lift your leg behind your body without having to work to keep your pelvis level. If you do, then when you walk you’re likely to compensate for this tightness by arching the lower back instead.

Stretch your hip as in the video below. Make sure you keep a neutral pelvis- squeeze your glute to almost tuck your bum under, and make sure you stay upright, rather than leaning forward. Raising your arm to bend slightly takes the stretch a little deeper. Hold for 30 seconds, or until the stretch eases off.

Strengthen Your Glutes

Follow this with some exercises to strengthen your glutes. This blog includes some simple exercises to help build strength for running, and they are equally useful for walking.

Go Minimal!

Your choice of footwear has a huge impact on how you walk. As this picture shows even a small heel can alter your whole body’s alignment. This means joints getting more wear and tear and muscles not working at their best.

heels walking alignment

So a flat shoe is advisable, with a flexible sole because reduced foot movement will also affect how your muscles are loaded. However if you’re used to wearing more supportive shoes please transition slowly, to give your muscles time to adapt; the book Whole Body Barefoot is all about transitioning to minimalist footwear. And if you wear orthotics or have any joint problems please consult your physio/ osteopath/ chiropractor for advice.

Vary Your Terrain

So much of our walking is on flat artificial surfaces. Including a variety of gradients in your walk challenges your muscles in different ways. For example walking uphill requires more flexibility in your calf muscles, and works your glutes more, and the variety means less repetitive strain on your body.

Uneven terrain is good too, especially if you’re in minimal shoes. Walking over lumps and bumps is good for the feet and more challenging to the body than a flat surface, meaning a better workout!

barefoot walking

Uneven terrain and barefoot- mega workout for her legs here!

Get off the treadmill

When you’re on a treadmill the belt carries your foot back for you, reducing the work for your butt muscles and increasing the work for the muscles at the front of your hip, which have to pull your leg forwards. This is the opposite of what we want, especially if you’ve spent too much time sitting at a desk or in a car!

If you do have to use a treadmill, make sure it is on an incline of at least 1%, to force you to push off a little and challenge the glutes.

And regardless of where you are, try to walk through the whole foot with a smooth rolling movement. Keep your head over your shoulders, rather than projecting it forwards (or looking down at a phone), and your arms should have a smooth swing, pushing back more than forwards.

For more specific exercises to help improve your flexibility, strength and posture, find out more about personal training.

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Are You Getting Enough?

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Probably not. Most of us don’t. Cars, the convenience of online shopping, the weather, it all means we don’t get as much time walking as we should.

Yes, walking. What did you think I was talking about? Ok I’m sorry, but it’s not easy making a blog on walking sound exciting.

walking benefits for the pelvic floor and postnatal

Because most people don’t think of walking as exciting.

It’s not a sexy form of exercise. You don’t see people boasting about their walking personal best like a runner does, or the killer spin/ Insanity/ whatever class is on trend and torturing you right now. (Sorry, I shouldn’t say that, I used to teach indoor cycling and don’t really consider it torture. Not once you’ve got used to the seats at least.)

But walking is the most underrated form of exercise.

And we really don’t get enough. One study found 80% of adults didn’t even manage to take moderate exercise 3 times a week, and just 25 minutes of brisk walking a day can add up to seven years to your life.  (ok, this is getting a bit boring now; no more health stats).

Walking is a fundamental movement of the human body.

As well as not doing enough of it, a lot of what we do is poor quality walking (I’ll talk more about this in my next blog), and it has so many benefits. I cannot emphasise enough how awesome walking is.

Walking works your pelvic floor

The pelvic floor loves movement; a sedentary lifestyle is one of the worst things for it. Watch this to see how regular walking engages your pelvic floor:

It gets those glutes working!

Too much sitting results in weak, ineffective butt muscles. Walking is a great way to strengthen them. Walk, and walk often, making sure they’re engaging properly. Make sure you’re pushing back with them, not just flopping forward from one leg to another. Have a feel- place your hands on your buttocks and see if you can feel them tense up as you land on each leg (don’t worry, this won’t look weird at all), then try and drive your eg back and use them to push yourself forwards.

Walk your way to more vitamin D

Not all walking is created equal, and walking on a treadmill is NOT the same as getting outdoors (more on this in the next blog). And when you’re outside, you get your daily dose of vitamin D. A LOT of adults are deficient in this, and interestingly it’s been linked to pelvic floor dysfunction, so yet another benefit to your pelvic floor!

Walking is fantastic postnatal exercise

It has none of the risks that some exercises (such as running) carry for vulnerable joints and pelvic floor muscles, when done properly uses a huge number of muscles, and it is one of the few exercises that is easily done with baby. In fact it’s great for babies to get outside, and increased sunlight has been linked to better night time sleep for them!

Add to that reduced stress, especially in natural settings, the chance to think (or not think if you need a bit of mindfulness), the benefits to the glutes and pelvic floor- this is why daily walking is part of the homework for mums on Restore My Core.

It’s easy to fit in

It’s so easy to spend your day rushing around and busy, but never really moving. A lot of people struggle to find the time to go to the gym or follow a more structured exercise routine, but it’s so easy to fit in some walks. Because walking serves a purpose: getting from A to B. Even if it’s just parking a bit further from your destination, start to build a bit more ambulation into your day.

How much do you need?

This depends on a bit on how much you’re getting now (I feel like I should be able to slip some puns in here). As with any exercise, build up slowly. But looking at how much our ancestors walked is a good guide to what we should be capable of.

In her book Move Your DNA, Katy Bowman says anthropolgists estimate hunter-gatherers walked about 1,000 miles a year. That’s 2.75 miles a day. BUT, this mileage wouldn’t have been broken down that neatly. There would be short walks spread throughout the day, along with days of very little walking and days with much longer walks.

The odd longer (10 mile) walk means you develop the strength and endurance in your muscles. The regular short walks mean you benefit from regular boosted circulation (‘feeding’ your cells and removing waste products) and regular breaks from too much sitting and all the negative adaptations that can bring.

10 miles might seem intimidating.

But how about signing up to an event like our local Starlight Walk? It’s 13 miles, but you’re raising money for a good cause, and there’s plenty of motivation and entertainment on the night. Something fun to aim for is the perfect excue to get started!

Next time I’m going to tell you how to pimp your walk (yep, still trying to make it sexy) and get the most from your daily amble. Because a lot of people are doing it wrong.

Not all walking is created equal, but with a few tweaks to your route, and the right stretches and exercises, you can make sure you maximise the benefits next time you head out for a stroll. Sign up for updates here to make sure you don’t miss it (and grab a couple of freebies while you’re at it).

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