How much should you hold your pelvic floor muscles during everyday activitites?
Are you supposed to think about them?
Or should you just let them do their own thing?
First it depends if you are a naturally tense or relaxed person? Then to consider whether they have fully recovered after childbirth? They should work on ‘automatic pilot’ going up and down through a variety of gears. But you might need to re-train that skill.
MIght your pelvic floor muscles be just wafting about?
Do your pelvic floor and tummy abdominal muscles support your internal organs and your back as you go about your day? Or might they have a tendency to droop when you aren’t paying them attention? Might you have a pelvic floor with a tendency to “waft about”??
Its probably the most common thing I point out to mums in clinic. Even if you have been religious about using Squeezy App and doing your daily pelvic floor targeted exercises. You may have one more step to go. Making sure that your pelvic floor joins in more when you do more and knows how to relax when you relax.
Should you hold your pelvic floor muscles up ALL DAY ?!?!
Yes…. and ….No. Just like your abdominals and all the other muscles of your body your pelvic floor is not a one gear, one trick pony.
We have moved on from the concept of “on” or “off”.
We realise now that your brain needs to decide at any given moment how much muscle activity is “enough” for the task you want to do. A well trained and exercised pelvic floor can automatically choose to be completely relaxed, fully sharp and contracted, with plenty of medium level options in between.
What is Your Resting Tone?
This is the amount of activity your muscles have at rest. Where they sit naturally when you are not thinking about them.
Untrained muscles, or muscles after childbirth or an episode of injury, can have terribly low resting tone.
To be fair – I think this mama is asleep – but how many of us look like this when sat on the sofa (#GBBO)??
Too Little Tone:
…leaves us “hanging” off our ligaments with a tendency to overstretch joints and muscles into saggy patterns. This has obvious cosmetic fallout. Also you will have difficult stabilising movement (getting weird joint clicks and clunks), or be vulnerable to injury. Untoned muscles are responsible for issues like incontinence, bladder urgency, difficulty emptying bowels and pelvic organ prolapse.
Or do you relate more to this Mum – fired up & alert, all the time ??
Too High Tone:
…has you perched on the edge of your seat, tense glutes, shoulders up, neck muscles tight like guitar strings – leading to neck pain, shoulder aches and pelvic pain. Sometimes also responsibe for incontinence, urgency and difficulty emptying bowels too. I know seems weird! But too MUCH pelvic floor tone can be a problem as well as too little!
Video: grading pelvic floor control in standing, carrying, reaching and JUMPING!
Today’s video was made last year, in collaboration with Tena. This is part of a series teaching pelvic floor from basics to more advanced. A Pelvic Floor Exercises 101!
In this video, experiment with me and the lovely models as we explore finding our pelvic floors and controlling how much they work – even as we move handweights and try a bit of stretching & leaping too. It takes practice to improve your “automatic pilot” function for every day life.
So Mama’s. Pelvic Floor Muscles for Real Life. No pelvic floors just wafting about! Practice standing up. Add some hand weights. Stretching.
And if you want to get back to running or that trampoline you gotta practice JUMPING too!!
The information contained above is provided for information purposes only. The contents of my blogposts, articles and my videos are not intended to amount to advice and you should not rely on any of the contents if you are not a face to face client of mine. Professional advice should be obtained before taking, or refraining from taking, any action as a result of the contents of this article. Amanda Savage disclaims all liability and responsibility arising from any reliance placed on any of the contents of this article or video.
Why stretching around the pelvis could help the pelvic floor work better….
Pelvic floor STRETCHES? Are you puzzled? Were you thinking that my advice would be to work on tightening up and strengthening your pelvic floor?
Did you know that taking time to stretch and align the muscles all around the pelvis might help the pelvic floor work better? YES! Just once a day for about 6 minutes can make Mums so much more comfortable – and find their pelvic floor muscles really perk up. FAST. It’s not crazy. If your pelvis is wonky or your back is stiff – just tightening up the pelvic floor muscles won’t improve bladder control. Because the muscles can’t work properly together if they are at funny angles!
Today we are exploring WHO might need to do that (and WHY) and HOW to do the right stretches really well (and quickly).
VIDEO: Pelvic Stretches for Mums
Why we need to do pelvic floor stretches before we strengthen
The muscles must work together to control and move the pelvis.
You could picture your pelvis muscles working together just like the guy-ropes on a tent. If there is a good balance through every part of the rope network the tent sits upright, symmetrical, self-supporting – it holds strong but can sway in the wind as needed, able to adjust to change in the environment with ease. You can easily open the door and push your way in with no effort or move bags of kit back out. The tent has full height, the groundsheet is stretched perfectly corner to corner without wrinkles or twists.
Magic, when all is well…
In a similar way when the muscles around the pelvis have good length to allow the pelvic bones to sit symmetrically, at the right angles, you can sit comfortably on a chair, or move efficiently transferring your weight seamlessly and effortlessly from one leg to the other as you walk or climb stairs. Your back feels comfortable, hamstrings don’t get injured, bowels empty easily, bladders fill and empty without trouble, pelvic organs stay securely inside, sex is comfortable.
But problematic if out of kilter
However, there are problems if one or more guy-ropes is overtightened..
Changing the tension in some of the guy-ropes on one side of the tent will cause distortions to the tent not only on the side of the ropes that have been tightened but also on the opposite and/or diagonally opposite side. In the video (above) see how this distorts my ability to whistle – even though there is nothing wrong at all with my mouth muscles?
Symptoms can seem logical: soreness right where the scar is making sex painful or tampons uncomfortable, or making wearing tight clothing irritating. Or more distant issues can develop like sciatica, persistant pelvic girdle pain, bladder irritability or constipation.
Are you out of kilter? A hidden consequence of childbirth?
Did you have a difficult pregnancy with pelvic girdle pain or back pain, or just a very heavy baby (!). Were you limping around a bit towards the end?
Did you have to work your pelvic support muscles very hard during your labour? Lots of squatting, using your legs to support you? Or maybe your legs had to be up and held at a funny angle for a while? That would be something that would make your inside thigh and abdominal muscles work very hard.
And of course the common scenario that causes this type of guy-rope problem is an episiotomy or perineal tear during childbirth. The scar that forms can be more rigid than the original tissue – creating a pucker or pull on one side of the pelvic floor.
If after your baby you were really sore you might have found yourself sitting sideways in your chair, or sitting awkwardly on the edge? Or you might have limped around trying to stop everything hurting? Unfortunately, very quickly it can become a habit to have tension in the pelvis.
So tbh there are not many mums who wouldn’t benefit from doing some pelvic floor stretching!
Quick Guide: Technique
Which style of stretches & when?
Use static stretches (the ones you ‘hold’ for 10-30s). No bouncing!
Start with once a day to learn and enjoy the stretches. Then you are looking for 2-3 opportunities through your day to stop and deliberately release tension and stretch the different muscle groups. Pick stretches to suit the environment you are in. Once your problem has settled then drop to a once a day holistic sequence to keep the muscles stretched for ever.
They are best done when the muscles and soft tissues are a warmer temperature:
when you get back from a trip to the park,
after an exercise class, or dance-a-long with the kids
warmed up by a bath or shower,
after a TV snuggle under a blanket before climbing into bed….
How many & how long?
Hold each position for a comfortable stretch for 30 seconds, repeated 3 times.
Research shows that you do not achieve anything extra by doing more reps or increasing the time.
If you have a lot of pain start with fewer shorter stretches eg 2 repetitions of 15 seconds each.
Quick Guide: 3 Favorite Pelvic Floor Stretches for Pelvic Flexibility
#1 Hip Flexion with opposite leg extension
Hip flexion: gently draw one knee to your chest then let the other leg slide out straight. 30 seconds letting gravity do the stretching work. 3 x each side.
#2 Butterfly Stretch
Adductors: 20-30 seconds gently easing out the inner thighs with gravity. 3 x
#3 Happy Baby Stretch
upper hamstrings: ease the “sit bones” wider. 20-30 seconds. 3 x
Let me know if this helps you?
Try the three stretches (or 15 mins guided video sequence) every day for a week and see what you notice changing? Improved posture, easier squatting to the floor, better bowel opening, more pelvic floor awareness? Do let me know?
Have you heard of the “lift” exercise for your pelvic floor muscles?
You know – the one where you go “up up up” and then “down down down”. It’s been around for years. Even my mother knows it!
However, there lately seems to be some confusion about how to do it and WHY?!
Sometimes the lift has an awful lot of floors (I heard recently of 9!) and I worry that there’s an awful lot of over-gripping going on. Everyone thinks its goal is to make your pelvic floor stronger but I think its most important purpose is to help you have more control.
In the video below you can practice it with me, just the way I teach it in physio clinic – and you will be relieved to know that my lift only has 3 floors (but it does have a basement).
Top Tips: for a MODERN lift exercise
Make sure you use ALL of the pelvic floor (the back, front and sides) – not just focus on the bladder opening (see Pelvic Floor School)
Start with 3 floors – will be surprisingly tricky if you have only previously done all or nothing!
Practice going up first with a crash after the top
Then practice starting at the top and coming down slowly
Add a basement level as you come down to tune into the feeling of relaxing fully
Finally put it all together practicing up and down
For an even more advanced elevator pitch:
Build up to discerning between 5 floors (think of gears in a car).
Be mindful of being able to breathe at each level
Notice that coming “down” IS a more skilled activity than going up (practise it!)
Think about WHEN IN REAL LIFE you might choose to use each type/level of pelvic floor activity
Improve your awareness of letting go into the basement.
What’s the point of the pelvic floor lift exercise?
In the past all the focus was on contracting your pelvic floor muscles as MUCH as possible. More is more kind of approach. This is how we used to do everything in the 80s when this exercise had its hay day. Sweatier, heavier, stronger, faster. If your leotard & tights weren’t dripping you weren’t trying hard enough!!
However, this is 2021 and we know an awful lot more about muscles, how they work and especially how they are supposed to function to keep us dry, supported and painfree.
Why do we need to be able to find different levels of pelvic floor squeeze?
You need to be able to do your BEST squeeze for a few short seconds if you are going to cough, sneeze or pick up something really heavy (top level).
But you also need to be able to maintain a MEDIUM hold when you hold your baby on your hip at playgroup, or carry your bags of shopping back to your car (middle level).
You need a “background” (postural) LIGHT level of support ALL the time you are on your feet (lowest level).
And finally – you need to be able to RELAX and STRETCH out so that you can properly empty your bladder & bowel and have comfortable sex (basement level)
Why do we need to practise control of the journey up and down?
In every day activitites you move between the lower levels. Just as your neck muscles quietly get on with holding your head up and shoulders level, so your pelvic floor muscles need to automatically create a support shelf between your legs for your pelvic organs to rest on. This shelf needs to sometimes work a little harder to absorb the bumps in the day. These come and go from dashing about, bouncing down the stairs, hopping over stairgates and shouting for the kids dog. But when it is not needed so much the shelf needs to relax and rest quiety, conserving energy, allowing blood flow.
Sporty people (be that zumba netball or running) should practise for 5 “gears”. You will need to keep shifting gears 3-5 zone – as you need a skilled pelvic floor to be background steadily supportive but reactive to a change in direction, hitting a ball, jumping a kerb, picking up a sprint.
Everyone needs to be able to “let go” WITH CONTROL all the way down to find 0 & -1. A vital skill for holding a full bladder until you have reached your toilet and managed to get your clothes down! If you tend to crash down you will be having leaks before you are quite getting there.
Is running making you feel leaky, heavy or vulnerable? EVB Sports Shorts could be your new BF.
What are EVB Sports Shorts?
EVBs (as they are affectionately called) are sports kit – shorts, capris or leggings. Specially designed for women who feel vulnerable when they run or take part in higher impact activities. Women’s health physiotherapists recommend them for those who need to find discreet ways to manage a bladder or prolapse problem. They add an extra layer of support to your body from the outside. Special panels lift and protect your bladder and pelvic organs.
Full disclosure: this post is not sponsored but I received a free pair of shorts to trial. If you find this article helpful and decide that you would like to buy a pair, please use my affiliate link – there is no extra cost to you but a small share to me, which helps to support this site.
Would you benefit?
Do you find your bladder leaks a few kms in? Or get a feeling that your entire lower half moves about too much as you pick up your pace? Or that you beloved run is counterproductive at the moment – straining and fatiguing your core muscles? Do you finish feeling leaky, achey and with vaginal or anal heaviness, spoiling the rest of your day?
Sound familiar? These specialised sports shorts/leggings have helped mums with these symptoms.
How do they work? More support everywhere that matters…
EVB Sports Shorts are made of a specialist high quality stretch material. This is designed to create more lift and support for the perineum and abdominal wall. They aim to BE your essential support muscles while you work on recovering yours (with your pelvic floor exercises).https://supportedmums.com/pelvic-floor-school/
They are not just guess work or cosmetic. Their inventor, Yvonne Brady, is a chartered engineer (as well as mum of 3 and regular marathon runner). Her company have invested over a million in R & D, including projects with physios, to design-in specialised support panels. These are in the gusset, to support the pelvic floor and in the front panel to support the abdominal wall.
Ultrasound studies have shown they mimic the role of the pelvic floor muscles. They lift the bladder neck and prevent the anterior vaginal wall from moving down. Also it may be that better positioned muscles and tissues will themselves function better. Or the better positioning will train them to do what they should be doing when you run.
Reality Check – I tried them out..
I had seen and heard physios rave about these. But I like to try things out for myself before highlighting them here. I asked Yvonne to send me a pair to try and to show my mums in clinic.
Sizing – do it properly – no guessing
You size yourself by measuring your waist and hip size. NB: Not guessing!! It’s really important that you have the right size for NOW. Not who you would like to be! They need to be really tight to work well. However, if they are too tight they will they be horribly uncomfortable. And I worry that you would risk the waist band pushing down into your tummy. There is a useful video guide to sizing on their website
The shorts, capris and leggings are intended as outerwear (knickers on underneath) – available in black
The “Boxer Brief” is available black or nude to wear underneath other clothing.
Getting them on:
They come beautifully packaged with clear instructions.
They warn that fitting into them first time can take a few minutes due to the technology they supply. Everything reassures you that you can pull them hard. “they will not rip”, it says, but I had to read that twice to have confidence! It really is a wiggle process to get them over your hips and pulled right up to give gusset support. Once you get there (!) they do fit like a second skin (with benefits) and were entirely comfortable.
Initially I wasn’t sure about the “look” for going out out. I am not normally a tight tight shorts person and a more fairweather jogger. But you will see on the website pictures & happy testimonials of proper mum runners! They are meant to be worn as your outerwear, shorts or capri style, with normal underwear underneath. However, the bottom-conscious could easily fit another pair of leggings/looser clothes over the top.
Returns & Exchanges
Yvonne is passionate about her EVBs and wants women to feel confident to make an investment in themselves. Customer support is quick and responsive with generous & fair exchange & returns policies.
I support women designing for women.
I firmly believe that self-care is not self-indulgence. Looking after our bodies after birth is essential. Exercise is fundamental to both physical & mental wellbeing. Fit mums enrich their own and their kids’ lives.
We live in a modern world. With amazing technological inventions to help us enjoy our sports & hobbies and care for our bodies. Mums need Good Kit too.
The information contained above is provided for information purposes only. The contents of my blogposts, articles and my videos are not intended to amount to advice and you should not rely on any of the contents of if you are not a face to face client of mine. Professional advice should be obtained before taking or refraining from taking any action as a result of the contents of this article. Amanda Savage disclaims all liability and responsibility arising from any reliance placed on any of the contents of this article, blog or video.
I’ve just listened to Rachel Horne speak on the Why Mums Don’t Jump podcast about her journey back to running after 3 babies.
This is one I want many mums to listen to. Not be inspired to run a marathon (though you might be). Nor to have a magical you-can-fix-this if-you-work-hard promise (though you will). Rather I want you to hear how she describes her body as one she respects and cares about. WITH it’s problems and limitations.
She IS going to run the marathon but she is not focused on perfection in the experience. She has moved her goal posts to reflect who she IS after her babies. After changes. After doing her physio rehab, gadgets and all. And still leaking when she runs.
Her goal is to run the first 5 miles dry. Not the whole thing without laking. She recognises that to have recovered after the deliveries of 3 children and achieve this, for her, would be an immense and worthy achievement. She lovingly says ” I would be so proud of my body”. Totally agree.
Why Mums Don’t Jump is a wonderful resource. Interesting interviews with mums and health professionals about living with bladder and prolapse issues after childbirth. Highly recommended.
IF you already know how to work your pelvic floor effectively, then YES! Definitely, Pilates can help strengthen the pelvic floor & teach you to use it in a functional way. Many specialist antentatal & postnatal physiotherapists are also experienced Pilates Instructors. Exercise is a key pillar of our physio training and Pilates has proven to be a style of exercise to really suit mums’ needs. Chosen carefully, some exercises can be started from the early days, even after a caesarean.
I am such a Pilates enthusiast that have made a series of postnatal exercise videos taking you from “birth to 6 weeks”, via abs & gluts focus sequences to getting ready to run. With Pilates for Pelvic Floor Strengthening to really target this most elusive bit! Join me here….
NOT if your pelvic floor muscles are very weak. Or even completely ‘switched off’. That’s when you do have perfectly good muscles but your brain is not telling them to work. Maybe because of some nerve problems since your delivery. Rather like having windscreen wipers but no button to switch them on in the rain. Or working too hard. Sometimes you are subconciously over-gripping since you had your baby. Perhaps still tense around an episiotomy scar or going into spasm when you sit or walk too long?
If your inside pelvic floor muscles are not ready (even if your outside seems fine), then unfortunatley, you could do an entire Pilates class with relatively little benefit. Some times things get worse:
you might feel more sore in your pelvis after a class than before.
it’s easy to accidentally bear down and stretch & weaken them more
or not reaslie that you have too much pressure on your bladder or uterus inside, encouraging a prolapse to appear as you exercise more.
Not sure what’s going on inside?
If you have any worries that your pelvic floor is not quite what it should be, or want to return to a high level of sport or fitness, get your technique checked before you do too much more DIY.
Ask your midwife or GP to refer you to a Specialist Physiotherapist. They will examine you and properly advise on your personal situation.
Why see a specialist physio?
There is so much a specialist pelvic floor physiotherapist can teach you to improve internal muscle strength, endurance & co-ordination. They will also check your posture, tummy gap, core strength & scars.
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.
We aim to help you understand how your body works. With a better understanding of your muscles’ strength, weakness or tension problems, your exercises will make sense & be motivating. We can show you how to help them to grow stronger or release & stretch. As well as how to be skilled at using them, to prevent incontinence and improve internal organ support!
It’s not just up/down squeezes!
We have lots of different ways of exercising. The standard post-birth exercises are great – but they are not the end of the story. See some new ideas in our Pelvic Floor School. To encourage proper muscle activation we have tricks & tips. We have more advanced and interesting exercises to get you back to higher level sport. Even great gadgets that can show you what you are doing and enhance your muscle work.
How to get support?
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 or arrange a virtual appointment.
Not near Cambridge? I believe finding a local physio is best for your longer term support. Women have a long journey from motherhood to menopause. Visit www.themummymot.com for a national directory of physios who specialise in caring for postnatal mums.
It is the very OPPOSITE of selfish to keep yourself fit and well.
Who is going to look after the egg(s) properly, if the Chicken is tired, weak, undernourished and demoralised? Do you need to focus on gaining energy? 10 Rest Tips today – essential reading for Mums (and their physiotherapists!)
Lessons learned (already) in 2020!
I was invited to go to a 3 hour workshop last weekend called NOURISH! – a lovely word-play on the combined skills of the leaders, Lavinia Brown (a life coach @bobmama_net) and Zoe Kirby (a nutritionist & yoga teacher @zoekirbynutrition). Both inspiring local Cambridge women.
The first step, was taking time to reflect (again) that the need to care for ourselves – mind and body – has to co-exist with all the demands that come with being a Mama Chicken (or Papa Cockerel, of course). And eggs don’t just come disguised as newly hatched chicks. There are career eggs, elderly parent eggs & partner eggs, not forgetting house, garden, friends, & pet-type eggs too.
Lavinia focused on the need for REST. Not mindfulness. Not sleep. Something a bit different. Something I hadn’t realised was different, or missing. REST.
Do we need it?
Lavinia led a brainstorm of ways to recognise that we need REST.
Together, we reflected on the familiar, but often ignored, Physical, Mental and Emotional signs & signals, that tell us that our body & mind are struggling to perform. They are different and combine uniquely for each of us. Think headache, loss of attention, and tearfulness as examples in each category. You may not know yet what yours are – but I bet you have an inkling of a few?
Signs & signals that rest is needed
Since the workshop, I have further simplified how to recognise my own need for rest. The analogy that is working for me is visualising myself as a Phone Battery. I am on the look out for LOW POWER MODE. If I peer into myself I’m no longer in the green. I’m in yellow. My internal voice is trying to say – girl watch out – you are dangerously close to red where Nothing Functions Well and next stop is burn out (physical = tight neck, mental = scattered + overwhelmed, emotional = short fuse and/or tears depending on hormone-levels!).
It’s when I need to Plug-IN
So REST for me is the analogy of plugging my phone into the wall for a short re-charge. Not that routine long-charging of my phone, to reliably give me the whole of tomorrow. That’s SLEEP. Rest is rather a choice to give up using my phone completely for 10 minutes, in order to benefit by getting sufficiently back into the green. Getting enough battery power for a proper 2 hours of full-function ahead. Delayed gratification in it’s most difficult manifestation?
We DO have choices
Since I started to think of Rest like this, it’s been fascinating to have noticed the choices I make regularly, subconciously (and mostly correctly) for my phone. I’m habitually on it. My phone rarely catches me out. So why should my body battery? REST now feels like a positive CHOICE that I make for myself. And a pleasantly guiltless no-brainer too.
Now, it doesn’t seem selfish or indulgent to ask myself “Do I want to get through my afternoon clinic offering my patients the best me, clear thinking, enthusiastic, energetic?” Of course. Then it’s perfectly OK to stop, close my door, eat my lunch, breathe & BE for 10 minutes. Me, plugged in.
Yes, even for naptimes!
Reflecting back to my own baby-days, sometimes, (not often enough), I would make the decision to shut my eyes FIRST as soon as baby was asleep. Even if I only had 20 mins half-nap I was always SO much more productive during the remaining time than if I had not bothered.
My 10 take home Rest Tips
(part inspirational Lavinia, part workshop after-thoughts)
# 1 A rest is as good as a sleep.
One of my mother’s favorite expressions. Meaning just lie there and “be”. This has value. Even (especially) at 2am.
# 2 Activities can be rest-full.
REST doesn’t have to mean Doing Nothing. Rest can be classic activities like walking, reading a book, gardening, baking, or doing some Yoga practice. Lavinia also pointed out activities which don’t appear “restful” at first glance, yet can be enriching and enlivening, such as having coffee with a friend, drinks out with the girls, going to an energetic exercise class, even cleaning (… as long as multi-tasking doesn’t take you longer to get out of the yellow than if you just literally plugged in and didn’t touch your phone for 10). If the intention (and effect) is to recharge your battery, not deplete it, you could have a long list of options.
#3 Rest can be INVIGORATING or SOOTHING.
Lavinia highlighted that we need each of these at different times. And that a single activity might be used for either gain (eg Pilates can be energising or relaxing depending what you choose to do) or going for a run might equally fire you up for your day ahead or allow your mind to clear from the one you just had.
#4 QRT – QUALITY REST TIME
QRT is a similar concept I have heard of in the past. We identify our QRT options by taking time to notice the activities that feel like quality time even though you are busy – they are the ones that put you in “the zone” where time goes by without you noticing and/or feeling depleted by the task.
#5 Put the BIG rocks in first.
That old chestnut. REST FIRST, there is always space to DO more. Particular relevant to naptimes?!?
#6 Make a go-to list for yellow moments
When you are in LOW POWER MODE it is likely that your thought processes are slower, so it is harder to think what would get you out of the mode. Keep your list handy.
#7 Why don’t we rest?
How do we self-sabotage our intentions? WHY do we do this? This part of the workshop was incredibly valuable but personal. Not prepared to share! But do a tiny bit of thinking and you will know that we all do this. Multiple reasons!
#8 ACCEPT low power mode
Sometimes you truly CAN’T actually plug in. But I’ve noticed there is another potential choice – if I don’t want to go red I might have to accept that some functions need to switch off, or are just not an option anymore. I have to choose wisely how to use my last bit of power.
For example when I find it’s impossible to make brainy decisions, I can still get some banking done, or answer some low-key emails . Or I persuade myself & The Child into a simple card game, as less effort than arguing over homework. I’ve even been known to curl up for some TV-time. I need to Power Right Down until I can find a proper socket time-slot to re-charge.
#9 Don’t be the Victim
Lavinia’s harshest truth (put very kindly of course). Am I waiting for someone to give me permission to rest? Or offer me the rest on a plate – “ooh you look tired, here sit down, I’ll cook dinner….”. Sure that would be nice but she points out that we disempower our Self by waiting for a Shining Knight , with the risk of becoming bitter and resentful when one doesn’t turn up. Do I go around plugging other people’s phones in for them? No. Do I even remind other people to charge their phones? No! It is MY responsibility to keep my phone charged.
#10 Anticipate: spot patterns
Why am I overwhelmed by friends for supper tonight? Why did I say let’s meet up but now wish I could go to bed? I want to ENJOY the social stuff like I planned, not resent that I overcommitted? This is definitely one of my regular patterns. How to refresh a work-depleted Friday night battery? Get a proper boost to see me through a fun & fulfilling late night? I’m experimenting with a) knowing I need to do this and b) methods – Long soak or quick shower? Read for 10 mins? Sort the socks with a podcast?!
What are your triggers/patterns?
Have you noticed that with Small Ones, 4pm is no longer the end of the day? It is merely the lull – before the real work begins! Teatime, bathtime & bedtime are physically and mentally Hard Work. Could you re-charge/re-boost just before it all kicks off? Or get baby to bed, then have 20 mins “time-out” so that you can re-focus on your relationship with your partner and your own personal to-do list – rather than an antisocial crash-out from exhaustion?
# Bonus . And one for you – Reframe?
Do you want to go to your regular postnatal class, Pilates (spinning, run, swim ….) but feel that your power mode is too low to even get you out the door? Perhaps Re-frame? Going to your class could be the equivalent of plugging yourself in for an hour, giving you a couple of day’s worth of power, in exchange for that short weary drive (in practically red-mode) to get you to the hall/studio/pool?
Does this concept of Rest vs sleep resonate with you?? Which of the Rest Tips had your name on it? What do you do to stay out of the yellow zone? How to you re-charge?
What do you do if you worry about bladder leaks when running? Or at the gym, your exercise class, or playing with your children ?? Mums I meet in clinic tell me that they are avoiding events that require them to look “sporty”. They worry about a VPL if they wear 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. Heaven forbid a party or wedding?
I’m an experienced women’s physio so I know pads aren’t (and don’t need to be) the solution but they could be a vital part of your journey out of the Miserable Place.
Tips to manage bladder leaks when running or active:
full disclosure: this article contains some affiliate links marked*. As an amazon associate I earn from qualifying purchases. If you make a purchase by clicking through from an affiliate link I receive a small commission at no further cost to you. Thank you, this helps to support this blog.
#1. Use a pad designed for bladder leakage not menstruation
Sanitary pads and incontinence pads are not made of the same thing.
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.
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. They also use fabrics that can wick fluid away from the surface. This keeps damp away from your skin and reduces your worries about odour.
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.
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.
but if you need more than a light pad
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 or disposable pants (see #3).
#2 Disposable Pants
No one really believes that these look like “normal” knickers. However, their big advantage is the all-around cover, front, back and sideways. For an activity involving lots of changes of direction and position (aerobics, yoga, kids tumbling) they will give the most protection against bigger leaks.
Put your biggest PE pants over the top to hide them at your waist line.
However, if you are getting this wet when you play sport your priority should be to solve the bladder problem further. Talk to your physio about what they recommend for you.
#3 Knickers with inbuilt protection
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.
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.
Disadvantage – once they are wet you need to change the whole knicker. However, ideal for things like the gym – if you get bladder leaks when running on the treadmill or other higher impact classes. Strip off in the changing room and no worry to dispose of a pad.
Note: a couple of clients who have tried this option swear they will never wear pads again, certain that the pad itself was irritating their vulva and making their incontinence worse.
* use SUPPORTEDMUMS at checkout for a 15% discount
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.
These are made by the same manufacturers as the Thinx range of period pants. A forward thinking company with their open-ness about the need for products to empower women to be active. And addressing sustainability and waste. They have a rather quirky style of presentation and some bold adverts.
Five different styles: from Hip Hugger, through classic bikini to thong. Varying prices depending on style £16 – £24 . They sent through some samples lately for me to show in clinic. The colours are fun: deep orange, blue, nude, grey and black. They are made from a silky rather than cotton fabric, much more like an ordinary fashion knicker.
NB: they are hand wash only which you might miss in the instructions (and then be very cross about!).
#4 A subtle cover-up with skorts and skirts
It started with school uniform but now we can all wear skorts! Perfect for just hiding a good pair of pants with a pad and getting on with whatever you wanted to do.
£20-£80. Offered by brands Decathalon, Salomon, Reebok and many others.
#5 Add extra support to your core from the outside
Maybe not so much worried about leaks? More that your entire lower half moves about too much? Or that exercise is straining and fatiguing your pelvic floor and core muscles. Have a look at these if you feel just generally ‘unsupported’ at the moment:
EVB 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. To create more lift and support for the pelvis, abdominals and pelvic floor.
Most of my clients have gone for the shorts style, giving the option of wearing them underneath any of their other leggings.
# 6 Add extra support to your bladder from the inside
The options have recently expanded for devices that aim to give support to your bladder from inside the vagina. Often called pessaries. The devices/brands you may see advertised include Contam, Contiform (available on prescription) and Uresta. The devices increase in price, partly reflecting the number of times that they can be used – from single week use only to monthly to reuseable for a year.
These work particularly well where you or your physiotherapist feel that the bladder has dropped only a little bit (prolapse of the anterior wall/cystocele). Yet everything else inside (particularly the uterus) is still well supported. You both feel you have created a good layer of muscles through exercise but could do with a bit more support when you are trying to be more active
……that you will not use these ideas to make you complacent about a leakage problem. Nor 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”.
Incontinence is also a sign of lack of pelvic floor support. You may need to consider how pelvic floor friendly your sport is (ummm….trampolining….)?? Or you may need to modify activities to protect yourself from risk of pelvic organ prolapse.
DO use these stop-gap options to get comfy, happier and more active NOW. But please, please 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.
What are your tried and tested tips? Please share your experiences with other mums in our comments section below. Your story will inspire others.
Can I run yet?is a popular request from postnatal mums inphysio 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.
Are you a list kind of girl?– To Download a free printable check list CLICK here:
#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.
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.
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.
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).
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.
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.
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.
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.
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 isimportant 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.
Are you a list kind of girl?- To Download a free printable check list CLICK here:
#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.
Are EVB shorts a new mum’s best friend? 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.
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:
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 willfeel 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,thenroll 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.
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?