Can I run yet? Advice, videos and checks by specialist physio Amanda Savage

Can I run yet? 10 things to check before you take your post-baby body for a run

 

Can I run yet?  is a popular request from postnatal mums in  physio clinic. Before you dash out that door, use this postnatal checklist to make sure that your body is primed and ready for a successful, rewarding and injury free run.   Download a printable of the 10 checks here.

We all love running

Running is a fabulous free, effective, fun way to exercise which appeals to many new mums .  It’s heart, lungs, legs, bum.  It burns calories quickly.  You don’t need anyone else to do it with (but can if you want to).  It is magic time ALONE.  You can listen to music, your music.   You can go at any time of day for 15 mins or 50, depending how lucky you get with your childcare. It lends itself to an erratic life, no class commitment required .You can even run in the rain.

Where will you start?  Plan to avoid injury and disappointment

  As a specialist physiotherapist I tend to pick up the problems that have developed or show up from mums running too soon, or without realising that their body wasn’t ready.  These are things like sciatica, back or groin pain, recurrence of their antenatal pelvic girdle pain, incontinence and vaginal prolapse. 

Run before?  Often I worry that those who ran pre-baby are  most at risk of injury as it can be difficult to work out where to re-start .  You always remember what you were doing at your peak (!) but it can be tricky to find that “sweet spot” distance/time/pace to start back from.  

Before you had your baby(ies) were you an erratic jogger, more into 5k fun runs or a half marathon junkie?  What was your peak?  Can you remember how you started out and built up from couch to that first 5k?  You are going to need to take yourself back closer to the beginning  to allow your body time to build the skill-sets of running in the right order – but don’t worry – it will all come together much quicker than the first time you took up running.

Or never at all?  Or are you a complete newbie?  Perhaps running is the only exercise option you are going to have with your post-baby lifestyle and its all new to you?  You can take up running from any level of fitness but it is important to learn more about the process and tried and tested techniques of getting from couch to 5K+ so that you have fun, enjoy the process and don’t get disheartened.  Follow all these steps and you will be out their running with the pros before you know it.

 

Can I run yet?  a Mum’s Pre-run CHECKLIST

#1      Good Shoes     

Will your shoes absorb 80% of the impact?       

Your shoes are your first line of defence against the high impact of running.  

Each step sends a jolt of high pressure, 4 times your body weight, through your ankles, knees, pelvis and spine. When running that can be 800+ steps per mile!   If your foot moves to much on landing this can affect the biomechanics throughout the body and leads to common conditions such as plantarfascitis, ankle/knee strains, sciatica and hip pain.

The softening effect of the pregnancy hormones takes a while to return to normal, taking longer if you are breastfeeding.

TASK 1:  Check your trainers

  • Look at the soles.  If the tread pattern has worn away it is a sign of degrading and loss of cushioning.  The sole should feel squishy not wrinkled and tough!
  • Try them on:  with sports socks and make sure there is a gap of around half a centimetre between your longest toe and the end of the shoe as your feet will expand as you exercise.  Many women’s feet flatten and change shape during pregnancy and rather like your bust you can need to be re-fitted for shoes.
  • Re-lace: Don’t try to secure a gaping shoe by tying the laces too tightly. Laces need to be tied firmly but not so tight that circulation is restricted during exercise. There are lots of different ways to lace shoes for your indivdual foot type.  
  • review your orthotics:  if you needed orthotics before, now with the changes of pregnancy you may need them reviewed or refitted – book an appointment with your podiatrist or physio and let them know you want to run.
  • go shopping with professional advice:  Take your old shoes down to the nearest reputable sports shop for more advice.  Many now have either a treadmill (often with video) or a force plate to create a picture of the pressure points in your foot which may provide useful information.  A trained assistant  will watch you run, give advice and help you try different styles.      In Cambridge we have Up and Running & the sports shop at David Lloyd.

#2        Flexible back & pelvic symmetry      

Can your pelvis transfer your weight from leg to leg?

Running is a sequence of standing on one leg then the other, just speeded up so you don’t see it.

TASK 2:  wobble test

 Try standing on one leg for a few seconds, then the other.  Did they feel the same or different?  Were you markedly more ‘wobbly’ one way, or have to jut your hip out to balance.  Any pain triggered?  Was it easier to move from right to left than left to right (or vice versa).  Did one way just require more ‘thinking’?    

  If this simple test from one leg to the other makes you suspicious that you have a problem shifting your weight evenly, once you hit 3000 running steps this could lead to a back or pelvis problem becoming unmasked. 

 

Check your technique:  With an expert.  If you already have a suspicion that your back or pelvis is not ‘right’     DON’T run yet because it is likely only to get worse.

  • if you had PGP during pregnancy and it is still niggling, go back to your physiotherapy team and ask for a postnatal review and assessment of your spine
  • if you think that your delivery might have triggered a new back or hip problem ask your GP to refer you for a physiotherapy assessment

Focus your training:

 

#3     Glavanised gluts           

Have you got one bottom better than the other?                

The other big load bearing muscles are the gluteals.  As you stride forward each buttock needs to help take your weight and create forward propulsion.  Weak bottom muscles and you will overuse your hamstrings and calves causing cramp or muscle strains. 

TASK 3: the pilates bridge with knee fold test

This task mimics the job the gluts have to do when you run.  Check your gluts are working equally well right and left with this task – you should feel your buttocks not your hamstrings take your weight and your foot should feel that it can just ‘float’ off the floor.

picture of pilates bridge with knee fold to test running technique

Lie on your back with your knees bent, feet flat.  Draw yourself up into a bridge position.  Are you hips level?  Can you feel both gluteals (bottom muscles) working evenly or is one side doing all the work?  Now focus on supporting your body weight with your right leg and let your left knee fold in over your hip.  Feel the work in your right bottom.  Then put your foot down and repeat folding your right knee in.  You should feel your buttocks not your hamstrings take your weight and your foot should feel that it can just ‘float’ off the floor.  You should be able to move smoothly from one side to the other without dipping hips, cramp in feet or hamstrings or rapid fatigue.

Check your technique:  To work on reducing hamstring and foot cramp see my video with 3 top tips   “How to bridge without getting cramp”

Focus your training:    before you go out running and risk an injury, build up your muscle strength and co-ordination by doing a few sessions of my postnatal pilates sequence specifically designed to Galvanise your Gluts.

#4  Abdominal control  

Can your abdominal wall hold strong at peak run?        

A traditional head lift/crunch style abdominal exercise doesn’t reflect the role the abdominals have to play when you move.  In a sit-up/crunch you are keeping your legs still and moving your upper body – but when you run you need to keep your body still and move your legs!  At full sprint both your feet will be off the floor at the same time.

TASK 4:  The Pilates double table top position reflects this action well. 

Can you do 10  leg extensions from table top postion, maintaining neutral spine, a lightly engaged core and while breathing naturally???  Your abdominals should not bulge or dome.  NB:  Start with your arms by your side (arms back, seen in the picture, is the more advanced version).

Can I run yet? tabletop with leg extensions mimics running action

 

 

Check your technique:  If you find your abdominals bulging you are not strong/co-ordinated  enough to run yet.  It may be that you need to improve your technique: see this video   3 Tips to Control Abdominal doming in Tabletop position

 

Focus your training:  Follow my postnatal Pilates sequences Mind the Gap I progressing to Mind the Gap II for a few days –  you will see a great improvement of your ability to control the abdominal wall which will mean you have back and pelvic support when you are running.

#5  Primed Pelvic floor      

Is your pelvic floor ready to take high impact?      

Postnatal pelvic floors can be slow to react and need waking up before you run. No good getting half way down the road before you start to think – ooh all a bit floppy and leaky….. where’s my undercarriage support….???

TASK 5:   35 second  pelvic floor pre-run priming routine:

Turn your toes out, like a ballet dancer.  Tighten your pelvic floor and notice how this position favours the back passage (the anal sphincter) just like you are stopping wind.  Pretend you are having tea with the queen and made the mistake of baked beans for lunch.  You need to effectively close the anus opening without clenching your buttocks more than a smidgen and without it showing on your face.  Do 5 on and off squeezes, not trying to hold, just good squeeze, let go completely.

Then turn your toes in, like a pigeon. Now when you tighten up underneath it should feel different.  Less going on at the back and more focus at the front, around the bladder tube and vagina area.  Let the area be soft, almost a bit saggy,  then lift and tuck the vagina up inside.  Let go – completely.  Then repeat 5 on – off contractions.  Best lift you can do and relax.

Finally turn your toes into your normal standing posture.  Now try to do both the previous actions at the same time.  Most people start with the back tightening and then like a big zip come forward to lift and tuck the front.  When you let go each time now it should feel like there was a bigger ‘up’ and a bigger ‘drop’.  Repeat.  If you are feeling clever add in some side to side tension too!

When you have done 5 squeezes with your toes turned out, 5 with your toes turned in and 5 with everything together you will have done 15 really good pelvic floor muscle contractions.  NOW your muscles will awake and far more ready to cope with the impact as you run.

Check your technique:  If you need to refresh your knowledge of pelvic floor anatomy do watch the videos in our Pelvic Floor School.

 

Focus your training:  Pelvic floor need more attention?  Check out my Pilates for your Pelvic Floor routine.  20 mins everyday for a week and you should already feel an improvement.  If you don’t then organise a proper vaginal assessment of your pelvic floor muscles with a specialist physiotherapist.

#6   Connected core      

Have you warmed up your brain connection to your core?

Runners can be a little guilty about using running to warm up (yes you know you do).   The purpose of the ‘warm up’ is literally to bring your muscles and tissues to a warmer temperature to make them less likely to injure (like bringing eggs to room temp before you bake!).  A brisk walking pace before you break out into a jog is recommended.  Or…because I am a multi-tasking kind of person – you could do some household chores while at home  – hoover, mop a floor, hang out the washing – anything that makes you feel that you want to remove a layer.

TASK 6:  pre-run prep

But I also recommend that you warm up your brain.  5 simple tasks (you will recognise them from the checks above) to focus your neural connections on the muscle actions that you need to run well.  Have your kit on (including shoes), do this right in the hallway before you dash out the door.

  1.  5 spine curls (loosen the connection back to pelvis)
  2. 10 leg stretches (the walking action)
  3. 10 knee folds (the  jogging action)
  4. 10 double table top legs (mimcs legs in full sprint)
  5.  10 bridge with leg changes (primes the gluts)

TIP: or if you only get your run in the evening when your partner comes in from work – do your warm up while the kids are in the bath – even half an hour before you actually go will still be effective – you will be warm and all the right connections switched on – then as soon as you have the requisite childcare …you can be gone!

Focus your training:  If you are better disciplined with a voice to keep you attentive and help with breath and timing the  10 minute Pre-run Prep in my postnatal pilates sequence has it all covered. Follow the links for free access to these professionally made videos.

#7   Protected Bust   

Are your post-baby assets protected ?                       

Everyone pays attention to a good bra fitting postnatally. You may need your sports bra re-fitted too.  

Especially if you now have a bigger bust.  Protecting and caring for your delicate breast tissue is  important after the stretching through pregnancy and breast feeding.  An ill fitting bra will press on your trapezius muscles (running along the neck and back) which can cause pain and discomfort.

 

TASK 7:  put your old sports bra on

Wear it for about five minutes to assess comfort and fit. Lift your arms up, bend down and jump to see if the bra and breasts stay in place. If you find spillage over, under or at the sides, reassess!

There are two types of sports bras.  For small to medium busts compression bras press the breast against the chest wall to minimise bounce and enhance support as you move but if you are bigger than a 36B you will find you need an encapsulation bra (who thought that name up?), so that there is support for each breast in a proper cup.

 

#8    Support Pants        

Extra layers in all the right places.

Again, its all about support.  The best pair to reduce joggle.  Of the belly, of the pelvic floor, of your back.  Maybe even wear two pairs?  

  • JoJo Maman have a good pair of postnatal ones that are made of thick lycra. You can wear the tummy panel high up to under the ribs to help hold your tummy, or roll back (like yoga pants) to reinforce the pelvis.  They also have a vest that comes down to give tummy support if you prefer support top down rather than bottom up.
  • Or tight cycling shorts under your running ones to come up higher over your tummy. 
  • If you plan to do a lot of sport invest in the clever design of the  EVBsport.com * range of leggings, shorts and capris.  They have special extra support stitching for the abdominals and pelvic floor areas. Designed from the ground up by a running mum.  

* this is an affiliate link, if you make a purchase by clicking through from here I receive a small commission  at no further cost to you. Thank you, this helps to support this blog.

#9  Bladder and bowel check        

Be prepared for unexpected events

Your Bladder:  Running is going to make the bladder jig up and down. You could get bladder leaks on running, even if you have been fine for normal activities till now.  Running is a higher impact activity than most other things and could unmask a pelvic floor problem.   If it happens, you are not going to panic as on this website we have all the information you need to sort it out.  At the same time it could happen and we don’t want it to spoil your first run because you didn’t expect it. For that first run have a good quality panty liner in place so that anything unexpected doesn’t embarrass you.  Any signs of bladder trouble default to brisk walking, which can be just as effective for fitness and calorie burning, for now.

   If you are already experiencing bladder leaks please don’t run yet  sort it out with advice from us here at Supported Mums or by getting in touch with your local specialist physiotherapist.  And meanwile  there are lots of other ways to get fit which are more pelvic floor friendly.

Your Bowel:  The pelvis is a compact space. If the bowel is full it will feel uncomfortable when you run and could put pressure on the bladder causing unexpected leakage.

TASK 9   wees and poos before you go!

Leave time in your routine to have the option to empty your bladder & bowel before you go out.  You need privacy and TIME for a good poo.  Take a book to read – it helps switch off your thinking brain and let you relax.  

Check your technqiue:  Watch 3 Ps for a Perfect Po  Then enlighten family and friends!

 

Focus your training: The bowel is controlled by the Pelvic floor too?  Check out my Pilates for your Pelvic Floor routine.  20 mins everyday for a week and you will already feel an improvement.

 

#10   Motivation & Pacing?     

Aim to under-achieve!

Humans have a tendency to try to over achieve and then feel disappointed and demotivated when we fail to reach our goals.  You can’t start back running where you left off months ago.  You will just feel unfit and disappointed.  The best advice I ever read for getting back into running was aim to underachieve.  You want to get home thinking – “that was great, I feel fabulous, I could easily have done more, I can’t wait to go again “.

TASK 10:  download a pacing app

There are lots of great couch to 5km programmes that will help you pace your run and lead you safely and effectively from nothing back to your 5 km and beyond. 

I highly recommend the much loved “Laura”  the voice of the Podcast “Couch to 5km” downloadable from the NHS choices website, and now also as a free app. It got me from barely able to run for 1 minute (I know, for a physiotherapist frankly quite shocking!) to a comfortable 20 min just like it said it would.   There are also extension podcasts for C25K graduates.  If you want to be able to listen to your own playlists there are many paid for options you could try.  

Run to enjoy the headspace

  • Half the week I ‘run’ rather than walk my dog.  My runs are my treat to listen to my favorite podcasts.   Now I’ve done the NHS couch to 5km app enough times I can set my phone timer for suitable walk/run intervals in the background to keep to a plan that challenges me but doesn’t over do it.
  • There are lots of books about Running and Mindfulness, or running as mindfulness (quick Amazon search will give you more than 5 recent ones).  Authors explain the benefits on mood, anxiety and sleep patterns.

Or run with friends for motivation and company:

  • if you ran before with a group ask your partner or family to help you with childcare specifically for that time-slot so that you can rejoin  the group you used to belong to.
  • Buggyfit classes and/or baby boot camps have lots of cardiovascular elements and you can take your baby in their pram.   This would be a good place to learn warm up and cool down sequences and find like minded local mums to get out running with.
  • If you are in Bath, Bristol or London you are lucky to have This Mum Runs  networks near you.  This Mum Runs is a community encouraging and supporting real mums into or back into running.  For beginners they run (paid for) courses to take you from new to running for 30 minutes.  You join a once a week group (at a mum friendly time),  led by a TMR trained coach called a “Runmaker” who helps with learning to pace and running technique.  Then you aim to do 2 independent runs on your own or with friends in between.  Graduates or those who can already run comfortably for 30 mins can join in a local, free running group, led my a Run Angel, thoughtfully on an evening or Sunday morning 8am.  Read more on their inspiring website.

Can I run yet?   If you can tick all 10 then Go run girl!

Missing a few?  We can support you

Specialist Physiotherapists help postnatal women build up their bodies to run again.  We work to pre-empt the most common problems that can arise if you run on an under prepared postnatal body.  I hope this  guide is a useful focus on the essential ground work to make your running the fun, useful, effective and safe activity that it should be.  Please don’t hesitate to ask questions in the comments below.

Please let me and other readers know how you have got on and which tips resonated with you?  We can all inspire each other.

Are you a list kind of girl?  – To Download a free printable check list CLICK here:

bladder leaks when running? 6 physio tips for discreet ways to stay dry and avoid a VPL

Bladder leaks when running? 6 discreet ways to keep dry and avoid a VPL

What do you do if you worry about bladder leaks when running, at the gym, your exercise class, or playing with your children ? Mums I meet in clinic tell me that they avoid events that require them to look “sporty”.  They worry about a VPL if they wear the normal figure hugging  gym kit.  They don’t want to stand out in a baggy tracksuit trying to hide a  pair of substantive knickers with a pad.  

There are  6 discreet work-arounds that I recommend to my physiotherapy clients

…….But first you have to promise that you will not use these ideas to make you complacent about a leakage problem or as an excuse to avoid the issue of your bladder for another 3 months.

Incontinence might be “common” (45% of women report bladder leakage at 3 months after birth, even 10% of those after Caesarean) …. but it is never “normal”. 

pelvic floor for runners

choose your sport wisely

Incontinence  is a sign of pelvic floor (or bladder) dysfunction. Something that needs addressing and that can be greatly improved or completely resolved with the right exercise and help.

Incontinence is also a sign of lack of pelvic floor support so you need to consider how pelvic floor friendly your sport is and may need to modify or lower the impact activities to protect yourself from risk of prolapse which is movement of the internal organs downward.

So, without endorsing pads and knickers as a solution, rather as a temporary, pragmatic stop-gap while you sort your pelvic floor out:

6 Tips to manage bladder leaks When running or with your sport:

 

#1.  A pad designed for bladder leakage not menstruation

Sanitary pads and incontinence pads are not made of the same thing.  The right pads for the task are worth the little bit of extra cost.   With the advent of new technology you will be amazed how slim a proper bladder leakage pad can be to hold a large amount of liquid.

Blood is thicker than water.  The products designed to be used for menstruation are great for that purpose but do not to cope well with liquid.  As they are predominantly cottonwool based, if they get wet, they just go soggy and mis-shapen. If you are moving about they can get scrunched up, rub and leave your skin in contact with urine causing chafing and soreness.

be active to improve your strength and wellbeing

If you suffer with stress incontinence (leakage when coughing, sneezing, running or similar) or urge incontinence (leaking before you can get to the toilet on time) it is much better to use a pad designed for the purpose of catching & containing liquid.  Pads for bladder leakage are now using the technology developed for babies nappies, such as little gel beads that  swell with liquid, and fabrics that can wick fluid away from the surface.  This means pads can be much slimmer than they used to be, keep dampness away from your skin and have good odour control too.

Some of the main uk brands are Tena, Always, Poise  and Boots Staydry range.  Unfortunately, the organic brands (Natracare and Cottons) don’t have a specific incontinence product (yet).  The products are usually in the same ‘feminine hygiene’ aisle (or website section of an online store) but separated into one column of shelves for products for periods and one for bladder leakage.   The most common indicator is a row of variously filled ‘drip’ or circle symbols to indicate the level of leakage you wish to contain. 

In general pads for ‘lighter’ bladder leakage look and feel like pantyliners and come in boxes to keep them flat and compact.   This makes a good starting point if you are looking for something to keep you confident and safe against a small leak. 

If you suffer with more severe leakage and could potentially empty half your bladder, or would risk getting wet clothes then look at the pads in bags which will be more absorbent.  However, if you are getting that wet when you play sport your priority should be to solve the bladder problem further.  Talk to your physio about what they recommend.

2. MODERN waterproof knickers

Forget dated images of plastic pants,  the modern waterproof knicker is a far more sophisticated item than you could have ever imagined.

Pretty Clever Pants (previously called Diary Doll Pants)  

 £9.95 from  boots.com and amazon.co.uk  

Two pairs for £16.99 from Highstreettv.com  and £19.99 for 2 pairs of the new lace panel style.

Annabel Croft, the tennis player and TV presenter Carole Smillie (Strictly 2013!) invented these knickers to work with a protective pad – to give an extra leak-proof layer.   She originally thought of the concept for her teenage daughters coping with their periods but now they are marketed for periods, postnatal and pelvic floor.  One of those products you wish you had thought of yourself.

They look exactly like the classic cotton “girls pants” we’ve all worn in our day, complete with little middle bow but have a discreet waterproof panel back and front.   The panel feels like thicker cotton and importantly doesn’t rustle. 

They are designed to be worn with a pad but should give you the confidence to keep a pad thinner and lighter or to reduce your anxiety that your pad might overfill.

I like that there is attention to detail on the packaging, a range of colours including grey marl, an.

Shopping can be a little confusing as they were called “Diary Doll” pants for a a while but changed their name when they started being distributed by  High Street TV.

iconundies.com

When I first published this post last year these weren’t stocked in the UK  but I included their  website  as I liked their open-ness about the need for products to empower women to be active.  They have a rather quirky style of presentation and some bold adverts.  

Good news now available in the UK  through their website.

Five different styles too – from Hip Hugger, through classic bikini to thong.  Varying prices depending on style £16 – £24 (in this weeks 33.3% off sale to mark World Continence Week)icon u

 

3.  Knickers with inbuilt protection

Good for the environment.  Great if you are usually fine but like to know you have back up.  Possibly more discreet if you need a thicker pad than a liner.  Strip off in the changing room and no worry to dispose of a pad.  Disadvantage, once they are wet you need to change the whole knicker.  A couple of clients who have tried these swear they will never wear pads again, certain that the pad itself  was irritating their vulva and making their incontinence worse.

Protect Dry panties and maxie panties

£19.80 (VAT exemption available*) per pair or  www.imedicare.co.uk 

Protech panties have an inbuilt waterproof gusset yet are slim and discreet

pantie style white or black from www.imedicare.com

 or  www.stressnomore.co.uk

We are so lucky to be in the era of textile research and design and I am delighted to see this being applied to underwear.  The gusset in these  Protech knickers is hardly thicker than your normal good robust cotton “pants” but is made of 3 layers, an absorbent fibre (holding up to 40ml = 2+ tablespoons), an odour retention layer and wick away surface.  Like some of the best quality pads but fixed in place with sealed seams.  Quite a lot of bottom coverage here so you might like a skort or skirt on top to avoid a VPL (see below).

high waist black women's pants for incontinence
Black highwaist from www.stressnomore.co.uk

4. A subtle cover-up with skorts and skirts

It started with school uniform but now we can all wear skorts!  Skirts over shorts is now an on-trend look. Perfect for just hiding a good pair of  pants with a pad and getting on with whatever you wanted to enjoy doing. 

A quick google shopping search for running skirts and running shorts shows a range in price from £20-£80 offered by brands Decathalon, Salomon, Reebok and many others.

prettyfit.co.uk are stockists of the US brand runningskirts with a limited range but fun unusual prints £62  and I got rather side-tracked look at ALL the nice kit at gear4girls!  

5. Add extra support to your core from the outside

EVB shorts, leggings and capris

  www.evbsport.com    £60-£80

EVB capris may help support your pelvic floor when runningHave a look at these if you feel just generally ‘unsupported’ at the moment. 

Maybe not so much worried about leaks, but more that your entire lower half moves about too much and that exercise is straining and fatiguing your pelvic floor and core muscles. 

Company founder, Yvonne Brady tells her story of returning to running after her third baby and struggling with muscle strength.  Women’s health physiotherapists like myself are recommending these as an ‘extra’ layer creating more lift and support for the pelvis, abdominals and pelvic floor.

6. Add extra support to your bladder from the inside

The options have recently expanded for devices that aim to give support to the bladder from inside the vagina.  The three brands below increase in price, chiefly reflecting the number of times that they can be used:

Contrelle Activgard   (single use only)

£14.99 starter pack of 3,  £76 for a pack of 35  available www.desmitmedical.com (with VAT exemption*) or www.stressnomore.co.uk

Contrelle Activgard is a flexible foam plastic which you soak (to prevent drying the vagina), fold

double and then insert with an applicator into the vagina (not dissimilar to a tampon, but positioned nearer to the opening) to create uplift and support for the neck of the bladder.  They are disposable, single use only, but you can wear one up to 16 hours without removing it. 

Contrelle Activgard starter pack has 3 different sizes to try

You can still wee or have your bowels open as normal.

They work by providing more support for the bladder neck.  When you move fast (jogging, playing tennis) or  there is an increase in abdominal pressure (coughing, sneezing, zumba, aerobics) the pelvic floor muscle is supposed to support the bladder neck so that there is no leakage.  However, if the muscles are weakened and untoned that support can be lost.  Imagine a running hose pipe, lying on  soft grass.  When you lay your foot on the pipe you may slow the flow of water but you may not be able to stop it completely.  However, if that under surface is firmer, because you have laid your hosepipe on your garden path (aka a good pelvic floor, and/or the foam Contrelle Activgard in position) when you press down on the hosepipe the water flow stops. 

These work particularly well where you or your physiotherapist feel that the bladder has dropped a bit (prolapse of the anterior wall/cystocele).  Below is an informative video tutorial by a physiotherapy colleague Jane Appleyard. 

As these are a more expensive option than pads, they are most popular with mums who are generally not experiencing day to day stress incontinence but know when they are going to leak.  For example if they do a longer run, or go to a Zumba class.  They use them only once of twice a week. They can put one of these in before they go and not need to worry with other protection (or maybe just a pair of Pretty Clever  Pants “just in case”).  

Do buy a starter pack first, as like tampons they come in different sizes.  You will be able to use all 3 but there will be one size that feels best for you. Thereafter they come in big boxes of 35 at a time!

Contiform   Pessary    (re-usable up to 30 times)

£79.99 starter pack of 3, or £52.99 for an individual size  from www.stressnomore.co.uk or available on NHS prescription from your GP [code     ]

The principle of the Contiform and its position in the vagina is the same as the Contrelle Activgard but these are re-usable.

Contiform starter pack

The Contiform Pessary looks like a hollow tampon.   The smaller circle supports the bladder tube (the urethra), the larger surface lies against the floor of the vagina, giving support to the bowel wall.  They are made of a firm but flexible non-latex plastic and can be reused, with the guarantee  up to 30 times,  longer if not warn all day.

You can buy online or they are now available on NHS prescription.  You would need to tell  your GP about your symptoms, and ask him to prescribe a starter pack for you.  While you are there ask for a referral to physiotherapy too if you haven’t already got your own pelvic floor coach.

 

URESTA      (lasts a year)

 

And remember that promise….

Incontinence might be “common” (45% of women report bladder leakage at 3 months after birth, even 10% of those after Caesarean) …. but it is never “normal”.  It is a sign of pelvic floor (or bladder) dysfunction. Something that needs assessing and addressing.  Commit to doing something about your pelvic floor muscles.  Book an appointment with you GP to get a referral to a Specialist Physiotherapist for full assessment,  support and advice.  You can be much better than you are right now.  #beyouroptiMUM  #pantsnotpads

What are your tried and tested tips?  Please share your experiences with other mums in our comments section below.  Your story will inspire others.

Pilates spine curl vs traditional bridge – what’s the difference?

Spot the difference?

They look the same – bottom in the air – but the difference is how you get there.  If you are not sure about the difference between a classic bridge and a Pilates spine curl then do read on….

How a traditional bridge works

The traditional ‘bridge’ exercise has been around for years, taught as an exercise for the bottom muscles (officially gluteals, or buttOCKS as my Danish colleague  used to say) .  Most people also give a good push on their hands and feet.  If you tune in you will  feel it is a good  task for a bottom work out.   The usual cheat or incorrect technique for a bridge is to misfire and activate hamstrings, getting back of thigh cramp and missing the gluts workout altogether.

Try one now and notice how your spine behaves during a bridge?  Usually as quite an inflexible rod?  It just goes up and down in either one big piece or two sizeable chunks…bend at the waist – up.  This is because all the down pressure on the hands and feet makes you activate your back muscles, the erector spinae.  These little muscles overlap each other from one spine segment to the next.  This creates the effect of ‘stiffening’ the spine to make it solid and lets it behave as one rod-like piece.

How a Pilates spine curl is different

A Pilates spine curl uses a completely different technique to raise the body up.  You drive the movement by  drawing up through the pelvic floor and abdominal muscles (on the front of your body), allowing the spine muscles (on the back) to relax, letting the spine become fully flexible  (33 bones connected by elastic).  The spine should roll through its length.  The first movements occurring at the coccyx, then tilting back onto the sacrum, pressing through the back of the pelvic bones, then the movement travels past the waist, onto the lower ribs, aiming to come to a stop with your weight resting through your shoulder blade area (not your neck).  Hold the position for a couple of breaths.   Use the same technique in reverse to come back down.  Have a breath in, then as you breathe out, keep your strength and control through your front abdominal wall to allow yourself to pay out your spine slowly……..take as many breaths as you need….. to let the ribs soften onto the floor,then  roll down towards your waist area.  You may have to really focus to ‘land’ the waist and last few bones of the spine before the pelvis.  Try to land both sides of the pelvis together.  Then make sure you finish the movement properly by allowing the sacrum and coccyx to fully sink to their resting positions and then very last of all release the abdominal and pelvic floor muscles.  Breathe.  Repeat.

Physiotherapy advice

I recommend 6 repetitions on the floor beside the bed before you climb in for the night.  Get into bed with all the tensions and asymmetries of the day corrected.  A flexible body will mould to the mattress beautifully and not keep you awake fidgeting.  If you go to bed straight and aligned you have a much better chance of starting the next day in a good place.

 Let me know, in the comments section below, if this technique check was helpful to you and which other exercises you would like help with?

Can I run yet? tabletop with leg extensions mimics running action

3 Tips to control abdominal doming in tabletop position

Take care you are not training a pot belly

Do you have a suspicion that each time you bring that second leg up into tabletop position you get  an abdominal bulge or doming?

As tabletop legs is the starting position and foundation for so many of the advanced pilates and core exercises it is absolutely essential to master the art of getting in and out of the position without doming the abdomen.  Otherwise, if each time you move up into position you bulge or dome – what is it that you are actually training?  It could be a  pot belly.

Done well, tabletop legs will help correct a divarification

This is a really important technique to master if you want to correct a divarification and protect your pelvic floor.

It is a hard challenge to get right –  but so satisfying when you do.  You will know when you have got it  because suddenly the whole action feels weightless and even effortless,  the pelvic floor area feels included and the back feels safe and relaxed. And it makes you want to smile!

Tip 1: put your feet on a step.  Practice during the week at home with your feet on a small step (eg child’s step).  This slightly flattens the neutral spine and means  you ‘start’ 1/3 of the way into the leg lift.  This allows you to experience the ‘correct’ feeling over and over again until your brain is happy with the sensation of not needing to ‘flick’.  Then take it down to a phone-book height and last of all back to floor level.

Tip 2:  go onto tip toe first.  Sneaky little manoevre (but a better cheat than ‘the bulge’).  First leg up, then move onto the tip toe of the second leg before you try to lift it.  Your brain will feel the sense of the weight to come and make some subtle core adjustments to half prepare you so that the full lift will be easier.

Tip 3:  you get what you think about!   I say this over and over again because it is so true!  So here is my, as usual bit out the box, visualisation.

 Boats on a beach

Visualisation to help get legs up into tabletop without a bulge

You are on a pebble beach that slopes down to the water.  Think of the first leg coming up as a light-weight rubber dingy which you have to pull by its rope up the beach.  All it takes is a light tug and up it comes.  Now take the rope of the second boat – a big speed boat – much more unwieldy – if you just tug that rope you are not going anywhere  – you will just get a jolt – so rather take up the slack, lean into the rope, let the tension build and build below the surface, until the boat ‘wants’ to come up the beach, then once you have got that initial momentum started – you’re off!

Are you more of a visual learner?  Here is my first ever video, showing the 3 tips.  Even a Playmobil boat (and dog) to help with the visualisation.

Did this post help you?  Please let me know in the comments below if any of these tips worked for you?  Or do you have a trick yourself that would inspire or help others?  Your comments give me ideas what to write about next.  Thank you.

Can Pilates strengthen the pelvic floor?

If you already know how to work your pelvic floor effectively, then yes, definitely, Pilates can help strengthen the pelvic floor.   As both a specialist pelvic floor physiotherapist and an experienced Pilates Instructor this is my area of expertise and I have made a video of my favorite pelvic floor friendly pilates exercises (see below)..

BUT, if your pelvic floor muscles are weak, or ‘switched off’ when you are doing pilates (so they could be perfectly good muscles but your brain is not telling them to work) then you could happily do an entire Pilates class with relatively little impact on the muscles at all. 

Without a proper pelvic floor contraction, challenging Pilates exercises (or aerobics or gym work) might be working you hard, but you will not be getting the proper benefit, and you could even risk making your problems worse by stretching the pelvic floor rather than strengthening it.    So if you have any worries that your pelvic floor is not quite what it should be, do make sure you get your GP to refer you to a Specialist Physiotherapist to get your technique checked before you do too much more with an unprotected pelvic floor.

Video: Pilates for your pelvic floor

In this video I have chosen pilates exercises that my clients find help them particularly focus on the pelvic floor.  I give you lots of extra cues to keep you thinking about the muscles even while you think about your breathing, your abdominals and which way to move your arms and legs!  Pilates done well is a real ‘brain exercise’ too!

Below you can view a (silent!) trailer, then CLICK HERE  to view the full video at pactster.com.  Use my code AmandaPostnatal to view any Pactster video for free for a month (the usual free trial is only 14 days).

SPECIALIST PELVIC FLOOR PHYSIOTHERAPY

There is so much that a specialist pelvic floor physiotherapist can teach you to improve internal muscle strength, endurance and co-ordination.  Through post-graduate training we have the skill to properly assess and examine the pelvic floor muscles with a vaginal examination.  We do this in a kind and gentle way putting you as much at ease as we can and aiming to help you understand how they work.  Once, together, we have a better understanding of where your muscles are at presently, we can then show you how to help them to grow and improve your skill at using them to prevent incontinence and improve internal organ support.  It’s not just up/down squeezes!  We have lots of different ways to the standard exercises you may have already tried! To encourage proper muscle activation we have tricks & tips, more advanced and interesting exercises, even great gadgets that can show you what you are doing and help your muscles work.  

Specialist physiotherapists have passed exams to become full members of the Professional Network of Pelvic, Obstetric and Gynaecological Physiotherapy (POGP).    Ask your GP to refer you to the local NHS services (if you are Cambridge-based you can self-refer) or do come to see me at my practice (South Cambridge Physiotherapy).  

Was this post helpful to you?  Please do let me know in the comments section below.  Your feedback inspires me and others, and helps me to think about what to write next.

morning back stiffness? stretch and relax video by Amanda Savage

More granny than gazelle?

MORNING BACK STIFFNESS?

Do you wake with back stiffness, feeling rather like an old lady; starting the day with contorting stretches just to feel normal? Do you find that you struggle to get comfortable in bed at night?

The natural instinct is to try morning stretches to loosen and get going.  If this is working for you please don’t stop – but if it seems rather laborious and more like patching the problem each day rather than solving it – try for the week ahead doing some Pilates spine curls and streches before you go to bed.

WHY DO EXERCISES BEFORE GOING TO BED?

This has been a successful tactic for lots of my patients in clinic with niggly morning back stiffness. 

My theory is that by the end of a normal day of lifting, carrying, sitting, driving, and walking, the majority of people have lost pelvic alignment and their spines have resorted to stiffening the back muscles to keep us upright.  If you go to bed with a rigid lower back and asymmetrical pelvis then you are going to find a soft mattress uncomfortable as it distorts your shape further.  Furthermore,  you will eventually fall asleep but on a poorly arranged spine.  It won’t hurt when you are sleeping but it will complain as you start to move again next day.    

Mini-experiment:  You can feel this effect right now.  Try leaning your hand on the table or chair beside you so that your palm is flat with your wrist at 90 degrees.  It won’t hurt while you lean on it.  If you were distracted chatting to someone you could lean like this for a couple of minutes and not even think about it.  But when you release the pressure off your hand it will ache across the wrist joint and feel uncomfortable for a good minute or two before it wears off.  A night’s sleep on a stiff or crooked spinal column is a magnified version of this.

VIDEO: 10 minutes stretch and relax.

Below is a (silent!) trailer, to watch the video in full CLICK HERE.  Use my code ASpostnatal to access all the videos on Pactster free for a month.

Even if you don’t do the video try 6 Pilates spine curls, on the floor (the mattress will be too soft), before you go to bed this week and let me know how you get on?  And if you have any other tips for  waking with the suppleness of a young gazelle please do share below.