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Is Swimming Bad For Diastasis Recti?

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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.

swimming postnatal exercise watford
Then let them fall behind you.
swimming postnatal diastasis watford

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)?

swimming postnatal engage core

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.

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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.

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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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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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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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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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No Housework And Regular Massage: Postnatal Traditions From Around The World.

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postnatal traditions recovery fitness

I have some vivid and precious memories from the first few months after my sons were born, despite being in a bit of a daze at the time. It’s such a special time, and one of enormous transition: physically there’s a lot of healing needs to take place, there are hormonal changes, bonding, learning to breastfeed, and relationships adjust.

And I can’t help but feel we don’t honour this time as we should. We’re pretty good about pregnancy, but once baby arrives, the mum doesn’t always get so much attention anymore. And with paediatrician appointments,  endless nappies to change, baby clothes to wash and visitors to see baby, self-care can take a back seat.

 postnatal recovery traditions

But is this good for our recovery?

In a word: no. Which made me wonder- do other cultures take better care of new mums than we do?

Confinement.

Many countries have confinement practices where the new mum stays at home, with no visitors except close family until the confinement period is over. For Malaysian women this usually lasts for 42 to 44 days, for an Indian mum, it’s about 40.

Wouldn’t it be wonderful if we could follow a similar practise in the UK, treating the postpartum period as a time to cherish and give mum extra care? Unfortunately it is just not practical for most of us: how many have family members who can tend to us for that long? There is the option of hiring a doula though, who often provide support beyond the birth itself and can advise on self-care and even help with household chores, or postnatal support from someone like Karen at Parents & Co, who can provide overnight care too.

No washing your hair!

This is a Chinese one, and linked to an overall practise of staying warm, because loss of blood and energy is thought to make mum ‘cold’: in Vietnam they practise nam lua (‘mother-roasting) where a fire keeps the mother warm for a month.

Other warming practises include bathing in warm, herb infused water- I don’t think any of us want cold baths or showers, so this one is pretty easy to follow!

postnatal traditions

Is this a valid concern though? Apparently so! One study found people who dipped their feet in icy water for 20 minutes were more likely to develop a cold than those who didn’t.

Given that new mums often experience increased sweating (getting rid of the extra water retained during pregnancy) these warming traditions do seem like a good idea!

No TV or reading!

Ok, I would have struggled with this one. I get the reasoning- strain on the eyes and potentially tiring- but I’m not sure I could stay in the house for that long without books. Unless I ran up a MAHOOSIVE bill at audible.com. Is it acceptable to ask for itunes vouchers instead of baby clothes as a gift?

Other activities considered to be stressful and avoided include shouting, crying, and too much conversation. I may have struggled with the crying (hormones!), however talking to fewer people may have helped…

No housework

Awesome. Also, no bending at the waist to prevent back injuries. In India new mums are sometimes helped by a dia (or even a maid) who will help with cooking, laundry, and bathing the baby.

In some cases, where the birth has been particularly difficult and there may be problems such as a prolapse, this is great advice. In others, it may feel impractical: bending over baby to play, for example.

Also, whilst I’m all for rest, some exercise, such as gentle walking, can be really beneficial in encouraging the core to repair. It will increase circulation which will increase the nutrients being delivered to mums muscles, aiding her at a cellular level.

However, there’s something else that aids circulation…

Massage.

postpartum traditions healing massage

Also awesome. In India the dia will do this too (maybe even daily), or in Malaysia a bidan massages the abdomen. Pregnancy and the strains of a new baby can leave mum with tight areas, and  a tight spot pulling you out of alignment can affect posture, and therefore abdominal healing (diastasis recti).

Release work doesn’t have to be done with massage, I give clients techniques they can use at home for this, but massage would be my method of choice!

Abdominal binding.

Many cultures practise some form of belly wrapping to aid with healing the core. In Malaysia they use a special postnatal corset (bengkung), and India a long cloth to bind it. They can give extra support to weakened abdominal muscles, reduce postnatal swelling, and encourage them to close back together.

In the UK Physiotherapists can recommend abdominal support for women who are having trouble healing. But whereas across the pond in France new mums see a Women’s Health Physio as standard, subsidised by the government, here you have to be referred by your GP if, or search for a private one. The difference this would make to recovery, and incidences of pelvic floor disorders such as incontinence and prolapse, is immense.

Diet: warming ginger, good; windy onion, bad.

The keeping warm theme continues here, as in many countries (including China, India and Malaysia) some foods, such as ginger, are believed to promote better blood circulation and strengthen the joints, while other cooling foods are avoided. Cucumber, cabbage, young coconut and pineapple fall into this catagory, the ‘cooling’ elements thought to cause rheumatism, arthritis and weak joints in a mother.

I’m not at all convinced by this, and would have recommended pineapple myself, as the enzyme bromelain in it is thought to aid digestion! However other advise I came across, such avoiding ‘windy’ foods like as onions and jackfruit, seems pretty wise! And bone broth/ soup is a staple of the postpartum diet in many cultures, which is great for recovery.

nutrition postpartum tradition soup

Not all these practises are followed rigidly; even for the confinement, some mums will end early if they feel they need to. I don’t think I would: the prospect of a month of massage and having my meals cooked is almost enough to make me want another baby!

If you’re struggling with your diastasis recti find out about my postnatal personal training packages here.

References

http://www.hyphenmagazine.com/magazine/issue-23-bittersweet/motherhood-rooted

http://www.babycenter.com.my/a1021145/confinement-practices-an-overview
http://www.babycenter.com.my/a1042118/indian-confinement-practices#ixzz3ZlkB5GUy

http://www.babycenter.com/0_postpartum-sweating_11720.bc

 

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Phenomenal Woman: In Celebration of the Post Natal Body

 Earlier in the year the fitness and lifestyle coach Jessie Mundell shared this meme:
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And as the anniversary of the passing of Maya Angelou approaches, I find my mind wondering back to it as I read one of my favourite of her poems.

We are so quick to celebrate the pregnant body in all its glory, but what about the post natal body? If anything our society is quick to remind us that we should feel shame at this new and unfamiliar shape, hiding behind a blanket, shrinking into ourselves as we perform the natural and beautiful act of breastfeeding our baby.

And all the diet and exercise tips are to banish that unsightly ‘mummy tummy’, or creams to get rid of those stretch marks.

If you want to change, that’s fine. In fact it’s normal: obviously we all want to get back in shape. But that doesn’t mean you need to look (or even not look) down at yourself with horror at the stretched skin and the extra lumps and bumps. Because every contour, every line, is a mark that shows you’ve created life.

This body is the one that has just endured hours of pain, even complications, and withstood more than the old you ever did. It has pushed through every challenge thrown at it. Celebrate that power, because for many who convince themselves ‘when I reach this weight/ size I’ll be happy’, the goalposts then shift to a new target.

Sure, you want to lose the extra weight and tone the belly. But enjoy the journey and celebrate every inch of your body and what it can do. Because if you hate yourself now losing weight alone is unlikely to be enough to make you love yourself. Start from a place of self-love and gratitude for what your body can do.

And stop worrying about what other women look like. Surround yourself with positive images: is your newsfeed filled with unrealistic pictures of fitness models with bodies that most of us will never achieve? Unfollow that page. I don’t find it motivational, and I doubt you do either. I don’t want to be thinking about my appearance all day, and all these pictures do is reinforce the idea that women are for public consumption, broken down into mere physical attributes to be analysed, rather than complex multifaceted personalities.

Besides, most  women look don’t look like that- head over to look at the Real Girl Belly Project for some more realisic photos.

It isn’t all about appearance.

Easy to say, harder to believe, and even harder to carry yourself with confidence in that belief. But Maya Angelou did: “Pretty women wonder where my secret lies. I’m not cute or built to suit a fashion model’s size.”

Be the person you want your baby to see, confident, embracing life, not holding back, waiting until you look right, one day. Let your baby see the joy in your feet and the sun of your smile; make sure your “head’s not bowed”.

I’ll leave you with the poem in all its glory.

Phenomenal Woman

Pretty women wonder where my secret lies.

I’m not cute or built to suit a fashion model’s size

But when I start to tell them,

They think I’m telling lies.

I say,

It’s in the reach of my arms,

The span of my hips,

The stride of my step,

The curl of my lips.

I’m a woman

Phenomenally.

Phenomenal woman,

That’s me.

 

I walk into a room

Just as cool as you please,

And to a man,

The fellows stand or

Fall down on their knees.

Then they swarm around me,

A hive of honey bees.

I say,

It’s the fire in my eyes,

And the flash of my teeth,

The swing in my waist,

And the joy in my feet.

I’m a woman

Phenomenally.

 

Phenomenal woman,

That’s me.

 

Men themselves have wondered

What they see in me.

They try so much

But they can’t touch

My inner mystery.

When I try to show them,

They say they still can’t see.

I say,

It’s in the arch of my back,

The sun of my smile,

The ride of my breasts,

The grace of my style.

I’m a woman

Phenomenally.

Phenomenal woman,

That’s me.

 

Now you understand

Just why my head’s not bowed.

I don’t shout or jump about

Or have to talk real loud.

When you see me passing,

It ought to make you proud.

I say,

It’s in the click of my heels,

The bend of my hair,

the palm of my hand,

The need for my care.

’Cause I’m a woman

Phenomenally.

Phenomenal woman,

That’s me.

By Maya Angelou

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I have #noexcuse. Because I don’t fucking need one.

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This is old news. I did a post about it on Facebook a while ago after I saw this photo on Instagram:

e56a76_9566c3186c1d489d84322aae3bfc7950

But despite the fact that a lot of fitness professionals spoke out against it, I still see it happening.

I’m talking about #noexcuses.

I’ve just seen this picture being used to promote a local gym to mums:

e56a76_416388a09e064b36b1662f739f432af8

And that’s why I’m writing this blog.

In all honesty I think (hope) they were just using it because of their creche, to say ‘that’s one barrier to your gym attendance that we’ve removed.’ But that’s not what the picture says. The picture takes her body, and says ‘what’s your excuse?’ Are we seriously going to pretend none of us has a valid ‘excuse’ for not looking like that?

Well here are what I think are 6 perfectly good reasons for not having visible abs.

1. Not wanting visible abs.

This may come as a shock to some, but not everyone wants a six pack.

Having goals is great. But having abs is HER goal, and there’s no need to judge others because they don’t live up to it. They’re not the be all and end all. They will not bring you happiness. They are not necessary in order to look attractive.

2. Not being a fitness model.

These women get paid to look like this. Well done to them for all the hard work, but for the rest of us, who don’t get paid, and may even have other jobs that take up our time, it’s not such a priority.

Also, the fact that they were fit before they had children makes things a lot easier. Are we really going to turn around to the mum who hasn’t done a workout in years and say, ‘hey, this mum who has 10 years training experience got her figure back in 6 months, what’s your excuse?’

3. Having a life.

Yes, I could exercise more and eat less, but having body fat low enough to show your abs has trade offs. Those trade offs for me include less time with my children and feeling more stressed when I am with them as I struggle to squeeze in a workout around running a house and a business.

This doesn’t mean I don’t exercise. I train, I stay fit, but my goals at the moment are health related, I’d rather not waste time and energy worrying about a few pounds or inches here and there.

4. Not having obsessive/ disordered eating habits.

Otherwise known as having a healthy relationship with food.

This means when you have to consume food outside your own home it comes on a plate in a restaurant/ cafe, not in a Tupperware box filled with chicken and broccoli from the steaming marathon you had on Sunday evening.

And you don’t feel guilty afterwards.

See here and here for a couple of examples of the damage competitive fitness can do to your relationship with food.

5. Genetics.

People come in different shapes and sizes. Some people are naturally slim and can quite easily get visible abs. For others it just isn’t going to happen. So let’s stop this message that certain physical attributes or body types are better than others. Let’s stop comparing ourselves to others.

6. You don’t need a fucking excuse.

You’re an adult. Not a child turning up late for class. You do not answer to the gym police about your appearance.

Are you healthy? Happy? Then good for you.

Stop worrying about the rest.

e56a76_238011450bc645f98ae0043796750d2f

As a trainer, I feel it would be irresponsible of me to post these ‘no excuses’ pictures. I don’t want to tell women they should look a certain way and I don’t want to play on their insecurities to get clients. I want them to learn to be happy with their bodies and to stop comparing themselves to others. To train to feel good physically and mentally, because a happy mum means a happy family!

I started writing this blog because I felt annoyed about the message the fitness industry send out sometimes. Hopefully I’m finishing it on a more positive note.

But even when I’m being body positive, I still feel a bit sad. Because it’s still about bodies.

How we look.

And we’re more than that. If you really want to feel better about yourself, step away from the scales/ mirror. Learn a new skill. Laugh with friends. Develop yourself inside as well as out.

Because your children don’t love you for your dress size or well applied mascara. They love you for the comfort in your hugs and words, the fun you have playing games, the safety of knowing you’re there when they need you, putting them first.

Because you’re a mum. And you don’t need an excuse.

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