Valerie Gommon Midwife’s Blog

Archive for the ‘Association of Chartered Physiotherapists’ Category

A guest blog written by Moira D’Arcy, Women’s Health Physiotherapist at St Judes Clinic, Leighton Buzzard.

Protecting Your Back During Pregnancy

During pregnancy changes in your body can affect your back and your posture.  As the weeks pass your weight is no longer centred in the middle of your pelvis but moves forward with the weight of the growing baby.  For most women their posture adapts to compensate for this shift and you may find yourself either slumping forward and flattening out the curve in your low back, or counter balancing the weight by leaning back, at your upper body, which leads to a greater curve and a shift of your weight on to your heels.  The muscles of your back, lower abdomen and your pelvic floor are designed to move and stabilise the joints in your back and pelvis but as your baby grows they are put under more potential strain.  This, along with the adaptations you may make to your changing shape, combined with hormonal (hormones are chemicals that carry messages around your body) changes that loosen the ligaments around the pelvis, can result in low back pain, upper back pain, pubic bone discomfort and general postural strain.

What can you do to reduce those risks?

Stand Tall – imagine that someone is making you feel taller by pulling a string attached at the back and top of your head at the same time as you tightening your tummy muscles and pelvic floor as much as you are able.

Sit Correctly
– make sure your back is well supported. You may prefer a dining chair to a soft chair or sofa.  Placing a small rolled up towel in the hollow of your back may help if you are finding your back is adopting a flattened posture.

Avoid Heavy Lifting
– Your loosened ligaments make them vulnerable so ask for help whenever possible.  If you do have to lift, make sure you hold the object close to your body, and bend your knees rather than your back.  If you are shopping divide your goods into equal loads for each hand.

Wear Comfortable Shoes
– Generally, if you are finding the curve in your low back increasing, flat shoes may be more comfortable as heels will accentuate the curve.

Adapt The Way You Carry Out Your Chores
– eg when vacuuming stand in a walking position, with the Hoover in front of you, then move your feet to the next area and Hoover in front of you again.  Don’t be tempted to push it so far away from your body that you end up bending and twisting your back.

Exercise Regularly
– but unfamiliar routines may damage the joints that loosen during pregnancy so it is wise to seek advice if you are unsure of the suitability of your exercise regime. The most appropriate forms of exercise include swimming, walking, aqua natal classes, Pilates and yoga.  It is important that the instructor is qualified or experienced in teaching pregnant women.  If you are experiencing pelvic girdle pain, or symphysis pubic dysfunction, then always seek advice from a Chartered Physiotherapist prior to beginning any exercise.

You can reduce the risks to your pelvic area and pubic joint by:

 

  1. Standing evenly on both feet.
  2. Sitting on both buttocks and not crossing your legs.
  3. If you have other small children don’t carry them on one hip.
  4. Avoid movements where you are swinging your leg sideways, for example when you get in and out of bed, or a car, turn your hips, pelvis and back in the same direction, while keeping your back straight, so you are moving as a whole and not twisting.

Once your baby is born there is a period of time, while your hormones re-adjust and you resume your usual tasks, when your spine remains susceptible to damage.  This may even be increased by a busy, unfamiliar schedule involving lifting and carrying car seats and prams, combined with feeding postures, picking baby up from their crib and carrying them. It is important to protect your back in the same way you did when you were pregnant.

If you find you cannot resolve your discomfort with this simple advice seek the help of a Chartered Physiotherapist who will be able to identify your specific problems and aggravating activities.  They can then provide you with a tailored programme that will fit in with your schedule.  They can also advise and provide you with supports to relieve/reduce low back pain and pelvic girdle discomfort. 

This information is provided by St Judes Clinic and is intended as general advice during and after pregnancy.  For more detailed advice please book an assessment with us or seek further medical advice from your GP.

Moira D’Arcy  Grad Dip Phys MCSP AACP APPI

Practice Principal

St Judes Clinic

26 Lake Street

Leighton Buzzard

LU7 1RX

Tel: 01525 377751

E-mail: enquiries@stjudesclinic.com

http://www.stjudesclinic.com/health/pregnancy/

I was delighted to read Ulrika Jonnson’s article in today’s Daily Mail about Stress Incontinence.  How brave of this woman to admit something that most of us keep secret, Ulrika will have helped thousands of women with the public admission of her problem.  www.dailymail.co.uk/health/article-1160211/Ulrika-reveals-embarrassing-health-secret-TV-presenter-breaks-secret-taboo-incontinence-affects-millions-women.html

Stress incontinence is a large problem affecting 1:4 (or maybe even 1:3) women at some stage in their lives.

Urinary incontinence can be broken down into “frequency” (often associated with infection), “urgency” (usually caused by nerve pathway damage), “overflow” (when the bladder is atonic and has lost the ability to empty correctly) and “stress”.

Stress incontinence occurs when the intra-abdominal pressure rises abruptly when under stress, (e.g. coughing, laughing, sneezing).  Urine loss is likely to be small in volume, however it is not unknown for the stress to act as a “trigger” causing a complete void (perhaps when suffering from mixed “urge” and “stress” incontinence).

There are various theories and several predisposing factors to stress incontinence, these include the ageing process, denervation during childbirth, multiple pregnancy, multiparity, large babies, obesity, chronic cough, intra-abdominal mass (e.g. fibroids/tumour) and constipation.

Many women manage the problem day-to-day basis with the use of panty liners and by doing pelvic-floor exercises, but in many cases it can be treated, so speak to your GP about it or contact your local continence clinic – you can contact many of these clinics directly for a consultation www.bladderandbowelfoundation. org/continence-clinic-directory –  more than 70 per cent of cases can be helped, so it is very important to overcome your inhibitions and ask for help!  www.continence-foundation.org.uk is another really useful site.

Pelvic Floor Exercises

The first-line treatment for stress incontience is to do Pelvic Floor Exercises.  The muscles are in the bottom of the pelvis and form a sling that supports your pelvic organs (bladder, uterus and bowel) and are a vital part in preventing bladder and bowel incontinence. They also play a part in sexual function and are important during pregnancy and childbirth.

It is important to make sure that you are using the right group of muscles and contracting them in the right way. It helps to be lying down or sitting forward when you first try to do the exercises and you need to breathe normally.

Imagine that you are trying to stop yourself passing urine and at the same time trying to stop yourself passing wind. The muscles should feel as though they ‘lift and squeeze’ at the same time. The buttock and thigh muscles should remain relaxed but a gentle tightening in the lower part of your tummy muscles is quite normal.

You should try to do your pelvic-floor exercises at least three times a day. Most women aim for ten long squeezes followed by ten short squeezes. It can take three to five months before you notice an improvement.

Tighten pelvic-floor muscles and hold for several seconds and then relax for the same length of time. Repeat until muscles feel tired.

Tighten your pelvic-floor muscles for a second and then relax. Repeat until muscles feel tired.

One of the best booklets I have come across is “Fit for Motherhood” produced by the Association of Chartered Physiotherapists in Women’s Health www.acpwh.org.uk/docs/FitforMotherhood.pdf

There are also devices that can be bought to help you, for example www.tenscare.co.uk/index.php?action=products&product=75 or vaginal weights www.aquaflexvaginalweights.com however I really do encourage you to pluck up the courage and speak to your midwife or doctor first and ask for a referral to a physiotherapist.


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