post natal body Archives - Vanessa Barker Fitness

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fitness, postnatal exercise, Uncategorized

Is Swimming Bad For Diastasis Recti?

I get asked about swimming quite a bit, mainly whether it’s safe when you have diastasis recti, but I’m going to cover pregnancy as well as postnatal here, so I’ll start with that.

Swimming During Pregnancy

Swimming can provide relief from aches and pains often experienced during pregnancy, relieving the pressure of your bump by supporting it, and taking the strain off your back.

It’s also great for improving your circulation which is sometimes affected during pregnancy, because of all of the hormones running around your system. The pressure of the water on your veins and arteries actually stimulates blood flow and can reduce swelling you may be experiencing, say in the feet or ankles.

A workout and relaxation all in one!

A trip to the pool also gives your muscles a great workout! Water offers 12 times the resistance of air, and your deep abdominal muscles get in on the act too, as they help stabilise the pelvis in water.

The rhythmic action of the stroke can also be quite relaxing, as can the feeling of weightlessness. For baby, the soft muffled sounds created by the water induce a feeling of calm and tranquility for him/her too.

Which stroke is best?

If you are experiencing any pelvic pain during pregnancy, I’d suggest that you avoid breast stroke leg action. Even if you don’t suffer with SPD now, I’d be mindful of how you feel, and avoid kicking too hard/ agressively. Keep the kick narrow, and avoid a wide ‘froggy’ breast stroke kick.

I personally found freestyle/crawl a lot more comfrotable when pregnant, but I know not everyone is confident with this, and it can be quite tiring.

As a guide, on a scale of 1-10, you shouldn’t exert yourself above a 7 when pregnant. This means out of breath, but not uncomfortable: you should still be able to talk and hold a converstation (albeit a panting one)!

I’d also recommend buying a pair of goggles so you can swim with your head down, because this puts less pressure on your back. Swimming with your head out of the water causes the pelvis to drop and accentuates the increased curve in the lumbar spine.

Swimming With Diastasis Recti

Ok, postnatal now. The question isn’t so much “is it safe”, as unless you have pelvic pain or a back problem, the risk of injury is low. It’s more can it worsen your diastasis, or prevent it from healing?

Firstly, people worry that being horizontal could put a downwards pressure on the abdominal wall. However water creates a hydrostatic pressure, and when you’re horizontal in the water the pressure from the water below (which helps give you buoyancy) will apply some compression to the abdomen.

There’s more to consider though, and your alignment in the water (or your technique) is really important too. If you have your head out of the water the whole time, then you’re arching your back (which may be sore) and stretching your abs. It flares out the ribs, which I see a lot in postnatal mums and you’re better off avoiding.

Let’s look at the 2 most popular strokes.

Breast Stroke

So if you’re going to swim breast stroke, head down (as in looking at the swimming pool floor) and in the water with each stroke! I can’t really go into technique much here, but if you watch Michael Phelps here, he actually keeps his back fairly neutral. Most of us don’t manage quite such a neat stroke though!

Also- if you still have any pelvic pain, the points above apply and I’d avoid breast stroke.

Front Crawl

I still find there can still be a flaring of the ribs, as when I swim in busy lanes I have to look up to see if anyone is in front of me. This arches my back a little and flares my ribs. I have to be VERY mindful of my technique to avoid it- again keep your gaze on the pool floor. Let’s look at Phelps again (may as well learn from the best!) and see how flat his body and spine is.

Keeping your hips up and kicking from the hips, using the butt muscles (instead of kicking from the knees) helps too, with both speed and glute strength (important for a healthy pelvic floor).

I also have to focus to keep my shoulders relaxed, and not up around my ears! Tight neck/ shoulders is common with my clients, so you don’t want to make that worse.

Core Strength and Shoulder Mobility

You also need to consider your flexibility. Lie down and reach your arms in the air.

Then let them fall behind you.

Does your back arch and ribs flare out (as I nicely demonstrate and highlight with my snazzy editing skills)? If so then there’s a good chance that when you swim and reach in front, you’re doing this too.

If you engage your core can you lift your arms without arching your back (again demonstrated by me below- my ribs have dropped down and my back has a gentle curve,rather than a larger arch)?

You need to engage your core to do this. Be honest with yourself, can you do this while you’re swimming? You might be better off working on increasing your core control before you get back in the pool.

The other thing that might be in issue is shoulder mobility. If your arms won’t fully reach up or flop to the side, you may need to increase your flexibility in that area first too.

postnatal swimming watford personal trainer

Breathing

No breath holding (this applies to pregnancy too). When your head is under water exhale, then inhale when out. Holding your breath places pressure on the core and floor.

Core Connection

If you’ve done some postnatal core training and can engage your deep core and breathe diaphragmatically, then that really will help. Personally I would work on that postnatally before getting in the pool. This way you’re controlling your core, controlling your spine and rib position, and minimising any pressure on your diastasis.

Swimming is a very repetitive movement, and you don’t want to be doing it in a way that repeatedly puts pressure on a tummy that needs to heal.

The Take Home

Swimming isn’t necessarily bad for diastasis, but it depends on your technique!

Ultimately, if you feel swimming makes you feel a bit human again, gives you some time out, and you feel better for it, then GO FOR IT!

BUT, if you have a large diastasis, or one that isn’t healing, maybe consider this could be a factor. Think about your technique, and it might be that you need to take a break for a bit whilst you work on restoring it.

September 27, 2017/4 Comments/by Vanessa

fitness, postnatal exercise

Speedy Postnatal and Pregnancy Circuits

While the sun was shining I got in the garden and filmed a couple of workouts to share on my Facebook page.

2 speedy circuits, postnatal and pregnancy friendly (bar one exercise when you’re final trimester, and provided no SPD), one for the lower body and one for the upper.

They’re time-lapse ones, to keep it quick for the sake of social media, BUT I’ve written up the circuits in this blog, with real time video demos of the exercises linked, so you can try them at home. All you need is a resistance band, but they are inexpensive and so versatile it’s worth getting one.

Here’s the type I use (I haven’t actually got this one as I buy long rolls and cut them out as I get through so many, but with most brands medium is an appropriate strength, and 1.2 metres is long enough.)

Postnatal and Pregnancy Lower Body Workout

Banded Side Steps x 20 Use a mini band as in link here or you can use a long resistance band as I did in the time-lapse video. Stick your bum out in a mini squat position and take 20 steps, 10 in each direction. Works the butt and outer thighs.

Banded Squats with Pulse x 10 Inhale as you lower, exhale as you pulse and rise. The band adds extra resistance, the pulse is HARD, but if newly postnatal or very pregnant a squat without the band and pulse is better, as in the video here.

Deadlift with Band x 10 Keep ribs over pelvis throughout, inhale and push your bum back, exhale and rise, driving the action with your glutes.

Reverse Lunges x 20 Alternating. Inhale and step back, dropping down so your knees are at 90 degrees. Exhale and return to start.

Banded Leg Extensions x 10 each side Hands under shoulders, knees under hips. Wrap the band more glutes! No need for the band if you’re pregnant or newly postnatal (and is too much strain for a larger diastasis), and final trimester this will start to get too hard even without the band, so you can do it sliding your leg back whilst keeping your toe on the floor, then skip it completely.

Repeat circuit as needed!

Postnatal and Pregnancy Upper Body Workout

Pulldowns x 10 Sorry no video for this one, but detailed instructions: hold resistance band overhead. Exhale and bring your arms down to the side of your body with a 90 degree bend at the elbows, with the band behind your back. Inhale and return. Engage core to keep ribs down (rather than let them flare out). Good for the back and shoulder and chest mobility.

Chest Press x 10 Exhale as you straighten the arms, inhale as you bend them. Aim to bend the elbows to 90 degrees, forearms parallel. Works chest, triceps and shoulders.

Open the Door x 10 Exhale as you open your arms up, inhale as you return. Works deep shoulder muscles and opens shoulders, good for posture.

Pull Aparts x 10 Keep ribs down as you exhale and pull the band apart. Keep shoulders relaxed, slide shoulder blades together. Great for the back, shoulders and posture.

Bent Over Row 10 Keep a neutral spine‐ this means not letting your back bend forwards. Bicep Curls 10 No video but very simple! Stand on the band with arms straight and exhale as you bend your arms.

Overhead Tricep Extension x 10 each side Keep your ribs over pelvis‐ there’s a temptation to let your back arch here! Exhale as you straighten your arm.

Repeat circuit as needed!

These are pregnancy and postnatal Safe, BUT Stop anything that causes pain, and book into see a Women’s Health Physio‐ many do packages with a pregnancy and postnatal appointment. All exercise carries a risk of injury, so consult your doctor before starting anything new

July 10, 2017/0 Comments/by Vanessa

postnatal exercise, Uncategorized

New mum with an aching back? Try this quick fix!

Have you got an aching upper back?

I seem to be seeing this quite a bit with clients at the moment, and a common cause is slouching, which granted most of us are guilty of, but feeding a baby seems to make it so much worse! I’m wondering if ‘baby-feeding back’ can become a thing, like ‘tennis-elbow’?

So a massage will help, right?

Yes and no. Yes in that absolutely, when you have a collection of knots between your shoulder blades that could earn you a Scouts badge, a good massage feels glorious.

But this can be short term, because it hasn’t addressed the cause of your soreness.

What is the cause?

I’ve already mentioned poor posture when feeding, slouching or hunched over baby. And there’s a chance it’s not just when feeding. Next time you’re in a queue or waiting for the kettle to boil, pay attention to how you’re standing: have you let your shoulders slump forwards?

Do you find yourself standing like the figure on the left or the right?

If you spend too much time sitting or standing with rounded shoulders, your chest is in a shortened, tight position, and your back is stretched. This stretch on the back muscles mean they become tense, fighting this pull and developing sore knots.

Massaging these tights spots will help make you feel and move better in the short term, so keep doing that, but your chest needs releasing and lengthening to stop that strain on your back. Even better, strengthening your back will really help you to maintain better alignment and prevent the ache from returning. Here’s how.

1. Hand to Wall Chest Stretch

This is a lovely chest release, and targets down the arm and wrist too, which can get tight from all the lifting mums do! Do one arm, then before the second do some arms circles to compare how your arms feel. Does the side you’ve released feel a lot looser?

You may want to release your shoulders too, as I find a lot of cients have tension here. A stretch or some self-massage are fine, just keep the stretch gentle and hold it long enough that you feel the muscle has released (you can compare the stretched side to the other like above, to make sure it’s worked). No need to use your hand even, just tilt your head to one side.

2. Wall Angel.

A simple exercise you can do anywhere, the wall angel is great for strengthening your upper back.

Stand with your feet 3-4 inches from the wall, and there should be a gentle curve in your low back. When you raise your arms to the wall maintain that cureve- if you feel your back arch then gently engage your tummy muscles to maintain your posture.

Once your arms are up, try to relax your shoulders, rather than allowing them to hunch. For the vast majority of people just holding this position is enough, not need to slide your arms up yet. Start with 30 seconds.

While there try to keep your breathing sow and controlled, with your ribs opening up to the sides.

Doing the hand to wall stretch before the wall angel helps to make the wall angel easier. Both together only takes a couple of minutes so you can do them 2-3 times a day.

3. Remove the Cause!

Finally,you need to remove what’s causing your back to ache, in this case poor feeding habits! Try supporting your back and baby with cushions when feeding so you can sit more upright, and if you’re bottle feeding try changing which side you feed from too.

Of course there can be other reasons for an aching, including how you hold baby, previous injuries or conditions. Core strength can also play a big part, and I’d always recommend a restorative postnatal exercise programme. And remember, if you have any severe pain, especially in the spine itself (I’m just talking about musclular aches in this blog) then see a therapist.

If you have any questions about anything in this blog you can find me, along with other pregnancy and postnatal professionals, in this Facebook support group. We’ll be happy to answer any questions.

March 22, 2017/0 Comments/by Vanessa

fitness, postnatal exercise, Uncategorized

The 4 Move Total Body Workout!

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.

Squats.
Kneel-Ups.
Incline Press Up on the back of a park bench (or against a tree if this is too hard)
Wall Angel (against a building or if there isn’t one then a tree).
Hill/speed walk interval (if you’d like to include a run instead, check out my advice on returning to run after baby).

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.

Single Leg Deadlift (lower body pull)
Goblet Squat (lower body push)
Resistance Band Push (upper body push)
Resistance Band Pull (upper body pull)

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.

1a- Kettlebell Swings (lower body pull)
1b- Side Lunges (lower body push)
2a- Leg Assisted Chin Ups (upper body pull. Note- video uses a bar, I use Olympic Rings with clients as you can set them up nearly anywhere)
2b-1 Arm Shoulder Press (upper body push)

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.

November 9, 2016/0 Comments/by Vanessa

Blog Entries

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/].

October 23, 2016/2 Comments/by Vanessa

Blog Entries, Frontpage Article, postnatal exercise, Uncategorized

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

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.

October 7, 2016/12 Comments/by Vanessa

Blog Entries, postnatal exercise

Exercise After a C-Section

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

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.

July 23, 2016/0 Comments/by Vanessa

Blog Entries, postnatal exercise

Physiotherapy For Where?!

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!

June 10, 2016/2 Comments/by Vanessa

Blog Entries, fitness, postnatal exercise

What Your Doctor Doesn’t Tell You At Your 6 Week Check.

The 6 week postnatal check- that’s when you get the all clear and it’s back to business as usual, right?

That’s how I remember feeling anyway, and from my experience training new mums, I know I’m not alone.

I remember sitting there and asking, “So I’m ok to go back to exercise now?”

And I got lucky, because my GP said yes, but advised that giving birth means my body had been through some big changes, and 3 months would be better, to really have time to recover.

That, plus having a baby who didn’t sleep well, plus geting mastitis at 3 months postpartum, meant that I didn’t get back to training as quickly as I had planned. Which probably saved me from doing myself some harm.

Because although I’d been a personal trainer for 7 years, I didn’t have any postnatal qualifications at that point, and the general message I’d absorbed from the media is that if you’re in good shape you should ‘bounce back’.

And I was fit, so I should be fine. In fact, because I worked in the fitness industry I felt I should be seen to recover and get my fitness back quickly, and I was very fortunate to have a doctor who gave me some good advice (and to be too exhausted to argue with it)!

Because The 6 Week Postnatal Check Does Not Mean You’re Ready To Exercise!

However, this hinges upon what your definition of ‘exercise’ is. Because I could also say you don’t need to wait 6 weeks before you exercise.

The problem I come across is that many doctors aren’t specific about what they mean by exercise. So while they’re thinking a few walks and pelvic floor exercises would be good, I know a lot of women will be thinking ‘back to my old workout routine.”

What Happens If You Do Too Much Too Soon.

Even though you might feel ok at your 6 week check, it takes so much longer than we realise to recover from childbirth. Then there’s the pregnancy hormones, lack of sleep and breastfeeding to consider. I’ve written here about postnatal recovery already, and the potential consequences of too much exercise too soon, and this blog is a must-read example of what happened to one mum when she returned to exercise too quickly.

Your Pelvic Floor

The pelvic floor is the area that often pays the price if you overdo it, and unfortunately this is one of the things your doctor probably doesn’t tell you.

Pelvic Organ Prolapse is when 1 or more of your pelvic organs (bladder, rectum, uterus, intestines even) move out of place, and prolapse down into the wall of the vagina. I had 2 children, did my ante and post natal exercise qualification, and still hadn’t heard of this. (I’ve since studied both pregnancy and postnatal exercise to a higher level to rectify the gaps in the fitness industry’s basic training!)

And I really wish GPs, or even the hospital/ homebirth team, would give new mums some information on this AS STANDARD! Because prolapse can have such a huge impact on your life, I’m sure a little information would lead to a lot of mums making far more sensible decisions.

Diastasis Recti

This is something else that I really wish GPs would check, but generally they don’t. I can count on 1 hand the number of mums I’ve met (out of 100s) who have had their diastasis checked at their 6 week appointment. For more information about what exactly diastasis recti is, read this blog, but it’s another biggie in that if it isn’t healed, you’re at a higher risk of injury or pelvic floor problems if you do too much too soon.

In fact, I don’t know about you, but my 6 week checks have been a quick blood pressure check and then asking what contraception I was using. In case the 6 week baby wasn’t enough!

In many cases the check up is more about the baby than the mum, and even though one of mine was a seperate appointment than the baby check, it still didn’t go anywhere near as deep as it should. The only way to know for sure what’s happening with your pelvic floor is too see a Women’s Health Physio (if you’re local to me I recommend some here).

So What Can I Do?

I said before that you don’t have to wait for 6 weeks until you exercise, and you don’t. But I’m talking about exercise so gentle you may not even think of it as exercise.

You’re advised to start your pelvic floor exercises (kegels) as soon as you’ve had baby, and you can start doing some gentle deep core connection work after a few days. Even with a c-section, you can do these from around 7-14 days. I do this with clients and mums doing Restore My Core, as there can be a loss of responsiveness in those muscles, which needs to be restored.

Following on from this, progressing to glute exercises to promote pelvis and hip stability is also beneficial. This, plus some gentle walking when you feel up to it (and I’d advise a few weeks rather than a few days for that) can help in a number of ways:

Faster Recovery Post Birth

The pelvic floor exercises will increase circulation to the area, helping to heal any tears, and both the core and floor work will help your nervous system to re-connect to these muscles.

Healing Diastasis and Preventing Incontinence

The right exercises, especially those that involve the deep transversus abdominis and pelvic floor, will help to heal diastasis recti. And pelvic floor exercises will help you regain control if you’re suffering from any leaking post-birth.

Reduced Pain

Having a stronger core will help take the pressure off your back muscles, which have to pick up the slack when the rest of the core isn’t functioning properly. Some gentle stretching and release work can help with this too.

The best course of action is to follow a specific post natal restorative programme, such as Restore My Core, but to learn more now you can download my 10 Tips for getting into shape after baby. And remember- the most important thing in the early postnatal period is rest, and when you do start exercising it should make you feel better, not worse. If you feel fatigued after you may have over done it. Listen to your body, and take it slowly.

March 27, 2016/0 Comments/by Vanessa