The silent epidemic.

I don’t normally watch terestial TV, but whilst away I flicked it on to be greeted by an advert about incontinence pants. There wasn’t much of this advert I agreed with, it was normalising incontinence, specifically after having a baby.

Incontinence affects 1 in 3 women at some time. Childbirth, menopause, impact sports and getting older all affect our pelvic floor but that doesn’t mean we have to put up with it or pretend incontinence pads are glamorous. Let’s face it, it should not be normal to wee in your pants unless you are unwell or in a nursing home! Yet so often on social media it is made to seem normal.

At points in life your pelvic floor will be weaker. Hormones play a large role as does the affect of carrying a baby and pushing it out. If you had an assisted delivery using forceps that will also cause further damage. As you get older muscle mass can decline so it becomes even more important to keep those muscles working properly. We can of course adapt by drinking less, going for a wee before you leave a safe environment (the “just in case” wee), avoiding certain moves like star jumps and wearing pants/a pad. However that is pretty restrictive and isn’t living as full a life as you could.

Urinary Stress Incontinence = poor function of the pelvic floor muscles. These are the muscles that need to relax for us to toilet, so they also need to contract to stop leaks. They can be too weak, too tight, poorly co-ordinated and working more one side than the other. So it isn’t as simple as a squeeze and release.

Now think about it, if other muscles are not doing their job what do we do? You may see a physiotherapist, take time to work on working the muscles correctly, resting them when needed, having some sports massage and work with the muscles around the injured area. It is no different with the pelvic floor! We need to focus on a whole pile of muscles around that area, plus the contraction and relaxation. You may need to downtrain the pelvic floor and you may need to change some of your day to day habits to help.

Ladies, let’s not think incontinence is normal. If you need help then seen a womans health physiotherapist and find your local Holistic Core Restore ® Coach (I’m the one for Southampton) for 1-1 work or the EVERYWOMAN course.

How your core keeps you strong in pregnancy.

Pregnancy is a time of real excitement but also anxiety and change in your body. Things that aren’t usually a problem can suddenly become one. One way to ensure you keep your body strong and functional is to include regular exercise with a specially trained teacher advising you. Why? As the body changes your normal exercise routine will almost definitely need to be adapted. It is also a good idea to add in movements that will build movement patterns for motherhood. The ideal time to prepare for postural changes, lifting, feeding and moving about with a baby is in pregnancy. It may not feel like it, but you have more time and head space when pregnant than after baby comes!

Top areas to focus on:

  1. Your core. This includes your pelvic floor, lower back, lower abdominals, waist muscles. Now you don’t need to be doing hard-core ab workouts (stay away from those) but you do want to strengthen these muscles in a kinder way. They need to be strong enough to support the growing bump, your posture changes and to support your pelvis. They also need to be able to relax for labour.
  2. Shoulders are the number 1 complaint I see in classes. Whether it is from desk working or carrying another child, now is the time to tackle it. Get some release work or massage in to complement the strengthening work. Start to work out where normal should be for your shoulders so you can listen to your body. Move within it’s range to prevent further issues. The moves we use in pilates are all about working within your normal range but also strengthening and improving it.
  3. Supporting your pelvis. Yes working on your core will help with this, but there is more to it. Your gluts and inner thighs are also key. So make sure you have some exercises to target these areas.
  4. Getting up and down to the floor. This is something you will need to do a lot with a baby so it is time to get practicing. Bending over is going to hurt your back. So instead lunging, hinging and squatting are your friends.
  5. Breathing. It destresses you, it helps your pelvic floor heal, it strengthens you. There are so many benefits, getting someone to watch you breath and correct you, could be the best thing you do!

Here are some simple core strengthening and shoulder focused moves you can do on a stability ball, chair or stood.

 

Do I have Diastasis Recti?

Diastasis Recti is also known as abdominal separation. Sounds pretty scary but it is actually very common and some research suggests it happens in all pregnancies, but for some ladies it may heal up before it is noticed.

Why does it happen?

The rectus abdominals are the tummy muscles that run down the front of the tummy, from ribs to pelvis. I like to think of these are being like a zip. There are 2 bands of muscles that run down with connective tissue called the linea alba in between. When you are pregnant this area has to expand to accomodate the growing baby. This means the tissues and muscles are stretched, hence this separation can occur. For some it may occur sooner in pregnancy than others which can be due to a whole host of factors. Your pre-pregnancy muscle tone, your collagen type, if you are hypermobile or not, your nutrition and your current exercise routine can all be factors.

What can I do to help in pregnancy?

During pregnancy itself there are things you can do to minimise this seperation.

  1. Keep your core strong. Pilates is an obvious option! Do make sure that any exercise classes you attend or DVD’s that you do at home are suitable for pregnancy and taught by someone who knows what they are doing. A weekend pre/postnatal course is not enough and yet that is often the level of qualification fitness instructors have. So it is worth having a chat to check their knowledge base out and question any moves you are not sure about.
  2. Breathing is a great way to activate your core and practice the skills you will need postpartum to help with the healing. Breathing into your ribcage, your back, your tummy and pelvis. Letting the breath expand you and your muscles relax. Then exhale from the pelvic floor upwards and your core should engage.
  3. Don’t overload yourself. Loaded moves like lifting or anything that makes you strain should be reduced. This can lead to pressure on that abdominal area. Always exhale on exertion.
  4. Log roll like a pro. When you get up from lying always log roll onto your side rather than sitting up. In fact any sit ups, planks, or intense core work should be stopped.

What can I do to help after baby?

Initially you need your rest, so don’t feel the pressure of bouncing that body back or jumping into exercise. Exercise is the last thing on the list for healing, read here for why. Instead here are 3 things to do:

  1. Deep breathing. Use that core breathing to help your core fire and relax (the video below has breathing tips), your pelvic floor engage and relax and to chill our your nervous system, read more on that here.
  2. Nutrition. Eating a diet with plenty of fibre to help your bowels work without strain, fluid to keep things moving nicely, protein for the connective tissue and muscle healing and fruit and veggies for those micronutrients and antioxidants. It all makes a difference.
  3. Posture. Keep on top of where your ribs, pelvis, shoulders and neck are. It is key. When breastfeeding, nappy changing and sleep deprived your body will start to round forward. Yet these rounded shoulders and slumped postures mean those tissues are saggy and it is harder for them to heal up. So take time in your day to correct your posture. Ribs over pelvis, shoulders down, neck tall, pelvis in neutral.
  4. Abdominal massage can be helpful. It is good to know how your abdominals feel and to give them some love! Check out my video on this here:

If you need some help then I offer a postnatal package of massage, assessment, breath work and nutrition tips, possibly movement if it is appropriate. You can contact me: priya@pilateswithpriya.co.uk or book a slot in my diary here.

A session may include:

  • Some yummy massage to release those tight areas in maybe your neck and shoulders.
  • Some abdominal massage too to allow those muscles to let go and heal.
  • A diastasis recti assessement.
  • Teaching you about core breathing.
  • Nutrition tips if wanted.
  • Movement advice.
  • Home care tips for what to do to help you heal.

 

How to help your nervous system

Modern life is stressful. Fact. One of the questions on our screening forms is “If your life stressful?” I’m always amazed if anyone ticks no. I actually need to change that question as it does not really matter how much stress is in your life, the important thing is how you are dealing with your stress?

When we are stressed our sympathetic nervous system is working full on. This is the system that responds to a threat or when something big and scary comes along and the body needs to go into “red alert”. For example a car is hurtling towards you and you need to move, you have a huge deadline to meet or the children are shouting and you are trying to get out the door fast! It is often call the “Fight or Flight” response.

The sympathetic nerves arise from the lower and mid-upper back spinal cord. When it is switched on there can be tension all over the body. Some of the main responses that occur in the body are:

  • increase in heart rate
  • dilation the pupils in the eyes
  • need to breath faster and more shallow breaths as the bronchioles dilate
  • contraction of muscles – pumped and ready for action
  • release of adrenaline from the adrenal gland causes you to feel on edge but ready to react
  • conversion of glycogen to glucose to provide energy for the muscles
  • decrease in saliva production: the stomach does not move for digestion, nor does it release digestive secretions.
  • decrease in urinary output, no need to wee as often!

Other processes that are not critical to survival may shut down in the body, so the whole body functions differently. Now whilst this is absolutely needed in a moment of danger it is not a way we want the body to be working long term. If you are living under stress long term then it could affect your breathing, your digestive system and your muscle.

Whilst modern life is indeed stressful and you may not be able to change that… what you can do is to build in techniques to help your mind and body let go of the stress. I think this is vital to do and it’s certainly something I’m working on myself. I’m 100% lucky as I get to practise what I preach daily. Pilates is very much a way I destress. The breathing, mindful movement, the calm space and the concentration needed really calms me and grounds me.

Other great ways to activate your parasympathetic nervous are mindfulness (you can check out apps like Calm, Breathworks and Headspace), meditations (check out free ones online or try a class), a bath, massage, deep breathing and just more resting and crafting. How do you get your chillout time in?

 

 

Should I leak when I run?

Running is great for mental health, being outdoors provides fresh air, a new perspective and the pounding of your feet in a rhythm can help your thought processes.

However it is also known that the impact of running can elicit symptoms of stress urinary incontinence. That little bit of leaking that you get when you run, or the need to wear a pantyliner/pad is not how our bodies were designed to function and is a symptom that there is a bigger issue.

So should you run whilst you leak?

A review of 28 studies on continent and stress incontinent women showed the timing of pelvic floor activity in relation to movement was key. What does this mean? It means that co-ordinating your pelvic floor with your movement is crucial. This is something that comes with practice. Like any muscle the pelvic floor is one that needs training, but not just on it’s own via kegels. Don’t get me wrong, kegels are definitely useful and have a big role, but these need to be integrated into movement. So if your pelvic floor is not functioning properly when you run, it’s all about practicing moves to prepare for running using pelvic floor cues as well.

Does this mean you may need to stop running whilst you train your pelvic floor? Yes it may do, for a short period of time. Now whilst I completely understand that it is so hard to stop doing an exercise that you love and that is so helpful to you, there is a bigger picture to be seen. If you have the symptoms of leakage then continuing to put impact through a weak muscle can lead to it worsening. This could lead to prolapse, a condition where the pelvic organs descend… and you having to stop running for longer.

Think about it this way, if you had an injury in another muscle, such as a hamstring, then you would seek advice, possibly have some physio, work on exercises to rehabilitate and take time out from running whilst it healed. So why is the pelvic floor any different?

I’m running some brilliant courses that will help you get your pelvic floor up to speed.

Everywoman is a 12 week course with 6 weeks of in person classes and homework, then 6 weeks of online classes. Full support provided including some help with nutrition and stress regulation.

Next course starts in November

Athlete 12 is for you if your pelvic floor is already ok (no leaks) and you have already done come core work first. If you want to get stronger and fitter, it is a brilliant aid to improving your performance and having coached support without paying for a PT each week. This is a 12 week online course with workouts delivered to you and support from myself.

Want to sign up? Drop me an email priya@pilateswithpriya.co.uk

Why fixing diastasis recti is not all about movement.

So often I hear the phrase movement heals. Whilst I agree with that there is also a point where movement is not the first point of call. There are so many programs out there now and so much advice on what to do if you have a pelvic floor concern or abdominal separation. The over flow of information is confusing and can just add to the noise in peoples head. How do you know who to listen to? How do you know which advice is correct? As someone who has spent a number of years doing advanced study in this area I’d like to share my top tips. I certainly know that a new mum I did not get it right first or second time around… but third time lucky.
If you can you always want to get somebody who can put their hands on you and give you a thorough assessment. That might not mean that they do an internal assessment but you do you want somebody who can physically I do your body, what you move, and placed their hands on you whilst you breathe and use their hands to correct you and to release you. Now that might not always be possible, and I’m not knocking The online program set out there. However I do think if you can get a one-to-one hands on assessment with the women’s have physio or a very experienced fixed price that you want to do that before moving on to any other form of program.
When looking at a program always look at how rounded it is. If it just focuses on the movement then I would say it’s not a full program. There is so much work to be done before you get to the movement, for example:
I want to woman to be able to breathe properly In a full 360° breath.
I want them to be able to connect the pelvic floor, lower abdominals and feel their back expand as they breathe.
In order to correct your posture work is going to need to be done.
This is going to involve some release moves, possibly some soft tissue work.
It needs to be a daily approach. What you do in a class needs to spill out into your daily life.
It’s also really important to focus on you. Self-care cannot be underestimated. Finding ways to make yourself out of that highly stressed fight/flight state into the calm zen like parasympathetic nervous system is absolutely 100% important. This could involve meditation, mindfulness, breathing exercises, along path, or otherwise of chilling out. However you do it it’s important. If you are living in stress and tension you’re not going to be able to heal your body.
It’s only when all of this has been accomplished movement can be layered on top. That’s why I love doing what I do. I get to work with people either 1-1 or in  class and bring them back to that chilled out relaxed state.
If you want to get involved and get some help that focuses not just on the issues in your body but also on healing all of you, then get in touch.
What is best for you? Hard to say as I work on a person by person basis, we are all different.
If you have a significant diatasis recti or significant pelvic floor issues you are likely to need some 1-1 sessions.
If you have some concerns with leaking, a small separation or feel like your whole system needs a tune up then our Holistic Core Restore EVERYWOMAN 6 week course is for you.
If you want ongoing classes then our pilates classes are the best bet.

The secret sect

Since starting specialising in postnatal womens recovery I feel like I’ve discovered a secret sect. An un-talked about condition that is just normalised by ladies and it shouldn’t be. It has become something these ladies accept and life their life around. Why? Often I think life is busy, most of these ladies are mums and when you are a mum you are no longer at the top of the pecking order. The children come first, there is a lot less time for focusing on yourself and you learn to put up with those annoying niggles and problems.

Incontinence, leaking and those accidental moments should not be a normal part of life. Whether it be having to avoid the trampoline, “sneeze pee”, not being able to wait until you get in the door for the toilet or needing to wear a pad when you run, it is not how your body is built to function and it can be improved upon.

Maybe you have had some help in the past and it has not worked? Or you have squeezed your lady parts over and over with no improvements? Well it’s time to start over. Yes those kegels/pelvic floor exercises are important but if you are not doing them correctly they won’t work and there can also be other muscular imbalances in your body that are the sticking point. Our bodies are connected from head to toe, this means that your foot position and your neck position impact your pelvic floor! So if you feel you need a fresh approach then here are my tips:

  1. If you have any heaviness or dragging in your pelvic floor region go and get checked out by a womens health Physiotherapist. Yes this costs money but it is well worth knowing what is happening in your body. I recommend a Mummy MOT for ladies who want a once-over post baby.
  2. Be committed. Your pelvic floor is a group of muscles like any other in your body and it takes time to see progress. However after a few weeks you should be noticing improvements. It takes work all of your week and not just the session you work with someone. I encourage people to do daily, focused work using the exercises we do in a session and to also focus on their posture as much as they can in the day, plus some dedicated breathing time. So you need to carve some time into your day to do all of this.
  3.  It is NOT all about the work however. For some people it is all about the RELAXATION. Over-working a muscle leads to it being tight and weak. So if you live life in your stressed place the relaxation phase can be the key.
  4. Get your breathing assessed. Oh my days, so many of us do not breath properly and all kinds of funky things go on connected with this. It could be you are pushing down on your pelvic floor when you breath out and it needs a re-train.
  5. If you aren’t a fan of lying on your back doing Pilates moves then it doesn’t have to be that way. There are plenty of ways to incorporate your pelvic floor rehab work into variations of the exercises you like.
  6. Find a practitioner who you can work with, someone you like, who really knows their stuff, who has worked with lots of ladies with success and who you be open with. Facebook can be a great place to get recommendations. I work with women on a 1-1 basis and via the Holistic Core Restore courses.

Get in touch if you need to chat or to find someone who can help. Most importantly do not suffer in silence and get some support.

Prepare to Plank

Let’s talk planks.

An amazing exercise for building core strength, for working the whole of your body and there is so much you can layer and add into a plank.

Also one of the exercises that therefore needs great technique or a lot can go wrong. All too often people are encouraged to dive head on into a full plank without knowing the hows, why’s and why nots. I love a challenge, but I don’t like the planking challenges. Personally I do not see the benefit to being able to hold a static plank. I have a body that rarely stays that still and so far more useful is a moving plank with levers and motion.

Many people are just not strong enough to launch into planks. These are not beginner exercises. Done incorrectly the intra-abdominal pressure will build up and it has to go somewhere, so if you have weak abdominals these may sag and bulge or the same with your pelvic floor. I remember attending a mums and babies fitness class with mums there 6 weeks after having baby – all being told to plank for 1 minute. If your core is not ready, do not do a full plank, if you have recently had a baby and you are rebuilding your strength, do not plank, if you have a weak pelvic floor, do not plank. Now that may sound harsh and rather black and white… so here is the softer version. There is a version of a plank that everyone can do, it is just finding your level and knowing which muscles to use plus ensuring you breath.

So what about if you really want to plank or if you are in a class with planks and you need a variation? Here are some plank progressions for you, including a standing version that I use with my pregnant and postnatal ladies.

 

I’d love to hear how you find these. For more videos and tips do follow me on Instagram and Youtube.

 

 

 

Postnatal Care – is it enough?

I’m not even sure where to start with this post. So I will start with my own experience. I’ve had 3 babies in the past 7.5 years and my youngest is about to turn 2 yrs. With each baby, my own recovery, my own postnatal journey and the care offered to me, has been different. I’ve had 3 babies who have lost weight post-birth, 2 of which required a period in hospital, each baby has had a tongue tie and it’s always been a stressful start in those initial weeks. Now I’m a well-educated, opinionated, determined (or bloody stubborn) kind of girl, which has got me through. What I have been, and continue to be surprised at, is the lack of support that is out there for new Mums. I had a hyper-tonic pelvic floor before babies, after babies I was complete unprepared for the change in my pelvic floor! I also had a diastasis recti after baby 2 and 3.

Having baby 1 is overwhelming, you are learning new skills constantly and becoming a new family. Subsequent babies are also equally overwhelming, suddenly you have to balance everyone’s needs. The babe becomes the most important in all of this and Mums come way down the list. But they shouldn’t. The early postnatal period is a critical time for recovery, by offering good support at this stage and preparing Mums we could actually help prevent some problems later on. Even by helping Mums with some simple stress management and practical ideas it could help them feel looked after, nurtured and reduce their cortisol levels. I know I was highly stressed after having my 2nd baby and it really had an impact on my body. Techniques such a deep breathing, meditation, mindfulness and just having time off for Mum can make such a difference. I now recommend Mums have a 2 week chill-out after baby as much as they can and call in lots of help.

Mums are usually offered a 6-8 week check, however this is often more for baby than for mum. It’s a quick assessment and I think a lot more could be offered at this stage, however resources are thin on the ground. The Mums that I see and my experience is that pelvic floor is not really discussed, perhaps a cursory “are you doing your exercises”, abdominal separation is rarely checked but there is a screening for Mums mood and contraception.

Whilst it is great that Mums and babies are seen by the GP and continue to be monitored by the health visitors, I feel we are missing a vital opportunity. A chance to talk to women about their bodies, what is not right, where could they be signposted to get more help. I’m not suggesting these teams can provide the answers but they could link in with NHS or private services who could. For example, local women’s health physiotherapists and postnatal fitness instructors who really specialise in this type of rehabilitation.

We need a revolution in postnatal care, more chat, more information sharing, more love, more respect for how women’s bodies change and more holistic care. I’d love to know your stories and thoughts.

Why being flexible isn’t always the aim.

Some people come to us thinking that Pilates is all about the stretch and that they need to be super flexible to be any good at it. Confession, ahem…. whilst we have super flexible people who teach for us and I envy their ability to do the splits I’m not a bendy ballerina.

Whilst I totally can work on my flexibility and improve it, I’m also aware that being super bendy is not always a good thing and you can overstretch for your particular body. Yup, I’m saying it doesn’t always pay to s–t–r–e–t–c–h.

 

Let’s think about that over-stretching:

  1. If you are hypermobile or have Ehler-Danos Syndrome then pushing your body past it’s normal range of movement into the hypermobile zone is possible for you but not a good idea. Over time moving out of the normal range can increase your risk of injury, sprains, dislocation, joint pain and can lead to the joints popping out. Pilates is one of the best forms of exercise for these conditions as a good teacher will watch your range of movement and help you work out exactly what you need to strengthen. By strengthening the areas around the hypermobile joint it can help you stay strong.
  2. The effect of hormones. When you are pregnant and postnatal you definitely do not want to be overstretching. At this point of life your ligaments are laxer and you may have a greater range of movement. But moving too far and stretching too much can lead to your muscles becoming overstretched. This leads to pain/injury for you which can then be an ongoing weakness in your body. Relaxin can take up to 4 months to leave the body after you stop breastfeeding. This can also mean your body is not as strong as you expect it to be. I remember after baby 2 really struggling with some of the harder pilates moves until I stopped breastfeeding (I fed baby until he was 16 month) and then a couple of months later my body was at it’s peak once again. So don’t rush things and risk a lasting weakness.
  3. If your body is causing a muscle to be tight for a reason. Sometimes the body is protecting itself. Much like we do not work muscles in isolation, it can be detrimental to stretch a muscle in isolation too. Instead we need a whole body approach and to think through why an area is tight. Is it due to a certain posture you adapt most of the time – in which case work on the posture. If it is due to pain elsewhere in your body and you are compensating, then the area of pain needs to be dealt with too.

Anyone can overstretch their bodies. Our collagen make up is genetic and we just aren’t all born with stretchy joints, ligaments and bodies. So whilst stretching is of course good for us, listen to your body.