Changes to the pelvic floor during birth.During a vaginal delivery, or attempted vaginal delivery, the muscles and nerves stretch significantly to allow the passage of the baby from the inside to the outside. The pelvic floor is designed to stretch to 250% of its resting length, much more stretch than any other muscle of the body. However, depending on the circumstances of the delivery, that stretch to the tissues may be temporary but sometimes if there is a greater degree of stretch, a longer duration of stretch or the need to use instruments such as forceps, the tissues may be injured and not be able to return to their predelivery state. Due to the constantly changing circumstances of each mother’s labour and delivery it is possible to injure other structures around the pelvis during vaginal deliveries such as the pelvic bones, the tailbone, the nerves and the tissues that hold the pelvic organs inside the body. For those who have a caesarean section delivery the pelvic floor has undergone the stress of the pregnancy. There may have been stress to the vaginal and pelvic floor tissues and muscles if a vaginal delivery was initially attempted, and then in order to access the baby for delivery the abdominal wall tissues and muscles are injured as they are cut to access the baby therefore also need time to heal and recover. We know the scar takes at least 3 months to heal to a reasonable strength when it can then start tolerating more stress and loading. Due to these significant effects on the structures around the pelvic floor and pelvis it is very important to allow time for these injured tissues to recover follow childbirth, and to rehabilitate them in a safe manner. Pelvic health physios can help to guide women in this recovery, as well as check if there has been injury to the pelvic floor muscles or other structures during childbirth. Allowing the appropriate time to recover and rehabilitate from the normal adaptions from pregnancy, childbirth and the potential injuries that may have occurred is beneficial to optimize recovery and to address any symptoms or difficulties women may be having in the 4th trimester, but also to reduce the risk of pelvic health problems later in life. Pelvic floor physical therapy has been proven to reduce the risk of pelvic organ prolapse, urinary, bowel, and sexual dysfunction and pelvic pain.
When to begin Pelvic Health Physiotherapy;It is highly recommended to start pelvic floor physiotherapy around 6 weeks following delivery. This is to screen for any potential injuries, and to help to guide recovery including exercise and return to sports and fitness whether your goal is circus performing, running 5km or 50km. Having said that, it is never too late to see a pelvic floor physio. Many pelvic health symptoms that occur after having children and are often thought to be a ‘normal’ consequence are in fact common but not normal. They are a sign of pelvic floor dysfunction and often respond very well to pelvic health physiotherapy. A good example of this is leaking when you cough, sneeze or jump on a trampoline- this is common but not normal!
Postpartum physio can also help with:
- Difficulty peeing or emptying the bladder, leakage of urine, and bladder urgency or frequency
- Constipation, difficulty with bowel movements, and leakage of bowels
- Painful sex, diminished or absent orgasm
- Separation of the abdominal muscles
- Restoring core function and strength of the abdominals and pelvic floor
- Pelvic floor and pelvic girdle, low back, and hip pain
- Caesarean section and episiotomy scar tissue and pain
- Pelvic organ prolapse prevention and/or treatment
- Eliminate pain from trauma to the pelvic floor and muscles
- Reduce pain from nerve damage in the pelvic and pelvic floor
Meet our team…..
Jo Dowle;Jo joins the team with a wealth of experience and education in the area of pelvic health, both in the private setting and from within the public system. With her solid background in musculoskeletal physio, Jo is able to thoroughly investigate symptomatic dysfunctions from both inside and outside the pelvis and apply education, manual therapy and exercise to address her patients’ symptoms and functional limitations. Jo has had much experience working with pregnant and post-natal ladies and has a special interest in helping women return to exercise or higher-level sports after childbirth. Jo has also undergone training to fit a range of pessaries for both prolapse and stress incontinence and works with the patient’s healthcare provider to ensure this is done safely. Fun fact about Jo: Jo lived in Nepal for 2 years and worked with leprosy patients.
Jacqui Bath;Jacqui Bath has wide ranging experience as a physio and has treated a range of clients from high level athletes playing contact sports to physical facilitation rehabilitation programs with the more elderly. She has extensive experience as a musculoskeletal physio and since having her own children, she has also completed further training to become a Womens’ and Pelvic Health physiotherapist. Jacqui has a special interest in core stability and strengthening, including Pilates and incorporates this into preparing her patients to return to exercise and sports. Jacqui has completed a Postgraduate Diploma in Public Health, focusing on health promotion and prevention, Hauora Māori and promoting healthy active lifestyles. Fun fact about Jacqui: Jacqui was one of the first women in New Zealand to referee rugby.
Ashley Briscoe;Ashley Briscoe has recently moved back to her hometown of Christchurch after working in private practice in Auckland. Ashley has done multiple pelvic health courses and enjoys combining her pelvic health and musculoskeletal skills to empower and motivate her clients back into doing those things they enjoy after childbirth or pelvic injuries. At Birthcare in Auckland Ashley worked with women soon after childbirth educating and guiding women on postpartum recovery and safe return to exercise. Ashley is currently studying towards a Diploma in Pain Management with a focus on pelvic pain at the University of Otago. She particularly enjoys working with lower back, pelvic, glute and hip pain, again utilizing her pelvic health and musculoskeletal skills. Fun fact: Ashley has three schnauzers aged 3 months, 6 years and 7 years.
Susan Larson;Susan Larson is Active Health’s team lead for Pelvic Health and Cancer Rehab, with a Postgraduate Certificate in Pelvic Health and is a Certified Cancer rehabilitation Physio. She enjoys sharing knowledge gained from her extensive experience and education in pelvic health, cancer rehab and musculoskeletal physiotherapy with her team and enjoys working in a close team environment with others who share her passion for pelvic health. Susan’s area of special interest is rehabilitation of pelvic cancers, including gynecologic, prostate and colorectal cancers. Fun fact: Susan has jumped off 3 bridges, out of 2 planes, and climbed 21 14,000ft mountain peaks.
Now that winter is behind us, I am sure everyone is more eager to get out and enjoy the sunshine. Have you been thinking about getting back to some of your favorite hiking tracks or maybe set yourself some new running goals for spring. Well, there are some things you should consider before jumping up and getting into things.
If you have been more sedentary over winter or your schedule hasn’t allowed, you to be as active it is important to have a think about anything that may restrict you getting back out there.
There may be some underlying niggles that you haven’t thought of for a while. Prior to getting started think about your history of injuries and addressing ongoing problems before they impact on your function or get worse.
It is important to get a second opinion if you feel like you aren’t improving or need some advice. Working with one of our physios or podiatrists to assess any ongoing aches and pain, looking at your form and function or giving you some stretches/exercise to target those weaknesses.
Think about any specific braces or supports that you may need or feel more confident with. This may include ankle or knee supports.
If you have an old pair of sneakers, think about getting them updated and also making sure they are appropriate for the terrain. (Hiking – sturdy boots with good ankle support, thicker tread. Long distance running – cushioned footwear with good arch support).
If you are having ongoing foot/ankle/leg pain it would be worth getting a podiatry opinion and possible orthotic fitting.
It is important to ease back into things – depending on what you’ve been up to over winter you may need to start with lighter activity and progressively build your strength and endurance.
Start with smaller goals to then build up from. If you need to lower your pace then gradually progress things like your speed, intervals, distance, terrain.
Make sure to give yourself rest periods in between activity. It is important that your body recover from intense exercise.
Before you get going you should give yourself the best opportunity to succeed. This means not only preparing your gear but also your body. Thinking about fueling your body with nutritious food and hydration that will help you get through those longer journeys. Make sure you are well rested and giving enough time between when you were last active. You may want to include an active warm up/stretching before hand to get your muscles engaging. Check out and plan your route too, click here to find some good walking tracks to suit your level of fitness and experience.
Bring a pack!
There may be some things that you bring with you on longer hikes or runs. This important to keep you fuelled through this activity like more water or food. In case of an injury occurring while you are out it is important you have some way of contacting someone for help. You should also think about having some basic first aid supplies and possibly pain relief depending on the length of your hike/run.
Have fun hitting the hiking and running trails this spring.
.This is the first in a series of posts about Active Health’s Pelvic Health Physiotherapy program designed to improve awareness and understanding of pelvic health physiotherapy.
So what exactly is Pelvic Health Physiotherapy?
Pelvic Health Physiotherapy is physiotherapy designed to ease symptoms related to various pelvic health issues for both women and men. It is a specialized type of physiotherapy delivered by physios with extra training in pelvic health, in addition to their physiotherapy qualifications.
Pelvic health issues in physiotherapy generally fall into 2 categories: those associated with pregnancy and the postnatal period, and those associated with other pelvic health symptoms, such as concerns with the bladder, bowel, prolapse, pain or sexual activity, or related to surgery and/or cancer in the pelvic area. Of course there often is an overlap between these 2 categories!
Pelvic Health Physiotherapy; pre natal & post natal
Pelvic Health Physiotherapy during pregnancy and following childbirth is designed to both support the body as it changes during pregnancy, and to assist with recovery. Through exercise, muscular support during all of the trimesters can be optimized, women learn how to connect with their pelvic floor to aid with labor and delivery, and the pelvic floor and core can be rehabilitated after delivery.
Pelvic Health Physiotherapy also address various musculoskeletal or pelvic floor concerns that may occur before or after the baby is born. These can include pelvic/hip/back pain, bladder or bowel issues, difficulty moving and walking to name a few. It is highly recommended to have a pelvic floor check around 6 weeks following delivery to screen for any potential injuries, and to help to guide exercise and return to sports and fitness. More on this to come in a future post….
What else we can offer;
There is a large body of evidence to support the use of physiotherapy for conditions such as pelvic floor dysfunction, pelvic pain, bladder or bowel dysfunction, pelvic organ prolapse and sexual dysfunction. These methods may include hands on techniques, exercises for strengthening or release, education for bladder, bowel habits and lifestyle factors, release of scar tissue and connective tissue, functional dry needling and more. In addition, some pelvic health physios are trained to fit pessaries. These are medical devices designed to support the pelvic organs in conditions such as prolapse and some forms of bladder leakage. pelvic health physiotherapy near me
Pelvic Health Physiotherapy may also ease symptoms and help the management of pelvic pain. Conditions such as endometriosis, painful bladder syndrome (interstitial cystitis), vulvodynia and chronic pelvic pain. Due to a body of research demonstrating pelvic floor muscle involvement in these conditions, many health professionals are therefore including pelvic floor physiotherapy as a vital part of their patient’s medical care. All of our pelvic health physiotherapists have both musculoskeletal training and pelvic floor training, which is essential when treating the complexities of pelvic pain. See more about this page women’s pelvic health physio.
For a more detailed list of conditions that can be helped with Pelvic Health Physiotherapy click here
If you suffer from any of these pelvic health symptoms, or would like help and guidance during pregnancy or postnatally please contact us to see one of our Pelvic Health team in Christchurch and Rangiora.
Back pain is something most of us have experienced. It can occur during exercise, from repetitive lifting, or sudden awkward movements. The most common cause of lower back pain is a strain or sprain of the ligaments in the spine. The lower back is especially vulnerable to injury as it carries the weight of the upper body and is involved in twisting, bending movements.
There are two common types of lower back injury.
One of them is a lumbar sprain. The lumbar spine is the name of the 5 vertebrae of the lower back leading down into the top of the pelvis. A lumbar sprain occurs when the tough tissues know as ligaments surrounding and joining the bones get overstretched or even torn.
The other common injury is a muscle strain. This is usually known as a pulled muscle and refers to when the muscles are overstretched or overused and start to tear.
Both types of injury have very similar symptoms and require very similar treatment. When the ligaments of muscles are stretched or torn in any injury, it can cause inflammation. The inflammation is a natural response to injury. It is when blood rushes to the injured area to help repair and restore the injured tissue. Other symptoms can include stiffness, pain that worsens with movements, soreness to touch the area, or difficulty standing or moving.
If you find yourself with a lower back injury…
- Get yourself an ice pack. Put ice on the lower back for up to 20 minutes every 6-8 hours.
It may feel good to lay flat on the floor to help the muscles in your back surrounding the injury to relax.
- Book into see a physiotherapist to help you release any tight back muscles and get you moving again. Click for Christchurch, Rangiora or Hamilton.
- Sleeping with pillows under your knees a good way to release the muscles while you rest overnight.
- Once you can move, it is good to stay mobile. This will help improve your injury, making sure you keep your spine in a neutral position while doing any bending movements.
Once you are feeling more mobile and your pain is improving it is a good idea to start stretching.
Two stretches to try;
- Knees to chest. Lying on your back, bring your knees up towards your chest and give them a hug with your arms. Gently pull your knees close to your body, ensuring that when you stretch you aren’t increasing your pain. This can be done with one leg at a time of you are particularly stiff.
- Cat Stretch. On all fours, bring your knees under your hips and your hands under your shoulders. Tuck your belly button up towards your spine. Tuck your chin and arch your spine. Imagine you are trying to create space in between each vertebra and lengthen the muscles in your back.
When your back pain is manageable you should work on strengthening your core and back muscles. Any movement is great for blood flow which will help reduce any muscle stiffness. Talk to your physio to help create a core strengthening program to reduce the risk of re-injury and keep you active for life!