Spring Physio

Do you generally associate muscle pain or discomfort as an issue with tightness in a muscle? It’s a common assumption!

➡️Our muscles work best in “mid range” (see graph) which is basically the middle of their full range of motion.

If a muscle is too tight (working in the short range) then the muscle won’t work properly (for example in a ).

Muscles can also become elongated through posture, inactivity (eg. lots of sitting) and muscle imbalance. This means the muscles are trying to work but from a position of stretch, making it harder for them to engage (eg. The abdominals after pregnancy).

Both scenarios can cause an imbalance and over compensation by other muscles.

In summary, muscle pain can arise from a variety of sources, including:

🔴Shortened muscles (muscle tightness)
🔴Compensation strategies for tightness/elongated muscles groups that are not working properly
🔴Weakness in the muscle leading to it becoming overloaded and painful

It’s not surprising that stretch programme doesn’t always sort out our pains and niggles! This is why a thorough assessment of injuries is so important, so the root cause can be established.

The content of this post is based on the work of Frankham et al (2023). You can read the full journal in the spring edition 2023.

The study highlighted the need for a holistic approach to management of pelvic girdle pain in pregnancy, taking into account biopsychosocial as well as biomechanical influences.

The study is a very interesting read. It challenges your day to day management of patients with this kind of pain and has definitely reminded me to assess the mind and body together.

Classes return next week and spaces are still available for the Friday morning pelvic floor and core class 9.30-10.20
Book your place here!
https://spring-physio.uk1.cliniko.com/bookings

Just one space left for the new term of pelvic floor classes starting next term:
Wednesdays 9.30-10.20
Book your place here!
https://spring-physio.uk1.cliniko.com/bookings

Classes have taken a short break over the summer, but 1-1 physio and personal training are still available. I've now set up the bookings for classes restarting in September, please see details below. Selina's personal training classes have proved to be a wonderful addition to our programme and we have now increased the number of classes available.

Pelvic Floor and Core Class:
Wednesday 9.30-10.20am : 6 week course commencing September 6th 3 SPACES LEFT
Friday 9.30-10.20am: 6 week course commencing September 8th
1 SPACE LEFT

The class is physiotherapy led and bespoke modifications are made as required, in a small group setting.

Any questions? Email me [email protected] or DM me.

Pelvic Floor Friendly Strength and Circuits - Small Group Personal Training
This is run by our resident personal trainer, Selina. It is a small group personal training class to build strength and fitness, whilst respecting your pelvic floor health. Max 5 per class.
£60 for a 6 week term.

Wednesdays 7-8pm FULLY BOOKED
Thursdays 7-8 pm SPACES AVAILABLE

Any questions? Email Selina [email protected]

Address: Spring Physio, Brownings Farm, Lewes Rd, Blackboys TN22 5HG.
Parking is available on site.

Follow this link to book any of the above classes:
https://spring-physio.uk1.cliniko.com/bookings
(Find classes under the groups tab. Select the start date of your chosen class which will automatically book you on to the full term).

Our new timetable of classes in our Blackboys studio is now out! We are now adding a new strength and conditioning class on Wednesday evenings at 7pm, starting on the 14th June. £45 for a 5 week term.

Our strength class is run by Selina, a women's health personal trainer. It is high on intensity, low on impact. If you want to build fitness and strength in a pelvic floor friendly way, this is the place. These are small group sessions, so perfect if you want to build your confidence returning to exercise.

Bookable by the term (5 weeks) and adhoc sessions subject to availability.
Questions? Email [email protected]
For bookings :https://spring-physio.uk1.cliniko.com/bookings
(Select group sessions and then 14th June on the calendar)

If you would prefer 1:1 training, Selina offers slots throughout the week.

Here is our new timetable of classes in our Blackboys studio for after Easter.

Our pelvic floor class is suitable for most pelvic health conditions and is physiotherapist led. It is a small group class and tailored to your specific needs.

Wednesday class starts 19th April FULLY BOOKED
Friday class starts 21st April 3 spaces left 9.30-10.20
Bookable by the term (6 weeks)

Our strength class is run by Selina, a women's health personal trainer. It is high on intensity, low on impact. If you want to build fitness and strength in a pelvic floor friendly way, this is the place.

Thursday class starts 20th April FULLY BOOKED

Bookable by the term (6 weeks)

Questions? Email [email protected]

For bookings :https://spring-physio.uk1.cliniko.com/bookings

Here are my top tips for looking after your pelvic floor during your gym sessions!

1. I do not recommend lifting belts. Whilst they may enable you to lift a heavier weight, they also create more intra - abdominal pressure, which creates more work for the pelvic floor and core.

2. You do not need to brace your abdominals whilst you work out. Bracing has a similar effect to using a belt - it creates more pressure because there is less space in your abdomen when you suck your tummy in. Instead, aim to engage your pelvic floor on exertion against gravity eg. rising from a squat, rising from a lunge or rising from a deadlift. Once you've completed the exertion, completely relax your pelvic floor.

3. Listen to your body! If an exercise is causing pelvic symptoms such as heaviness of leaking this is a sign your body cannot cope with the amount of pressure you are creating during that activity. Reduce the impact of the weight to a level that doesn't cause symptoms (and get referred for some physio!)

4.Exhaling is a great way to manage pressure (which is key to good pelvic floor health). Try to time your exhale with the exertion during resistance training ctivities. When doing aerobic exericse, try to keep your breath relaxed.

A c-section is a big op and so it's really important to take it easy in the first few weeks, especially because you will be having broken sleep and learning to look after a tiny human!

These are my top tips:
1. Avoid constipation
Constipation can cause you to strain which is not good for your pelvic floor and will also put pressure on your wound.

2. Rest
Easier said than done! But take every opportunity that you can, sleep aids healing.

3. Painkillers
It is important to keep pain under control. If you feel that the medication that you've been discharged with isn't doing the job, speak to your GP.

4. Help
If you've got help around you, make the most of it!

5. Infection
Common signs of infection are: oozing from the wound, fever, redness/warmth around the incision and/or an offensive smell.

6. Gentle movement will aid recovery but don't go mad! Stick to walking and gradually increase distance according to your comfort levels.

It can be tempting to think that once your c-section wound is healed you are back to full health. But there are so many more structures that have been disrupted by the incision - fat, muscle, connective tissue and the uterus. This will take time to fully heal - there will be swelling, bruising and internal stitches. Everyone's healing journey will be different which makes it so important to listen to your body in terms of progression of movement.

If you are struggling with regaining abdominal strength after c-section consider seeing a physio. They can help make sure the scar is not adhered and help you strengthen your core and abdominal muscles.

There is a lot of education around perineal massage to prepare for birth, but often women are unaware that their postnatal perineal scar can benefit from some massage.

The scar can become tight, tender or hypersensitive. This can cause discomfort during s*x but is very treatable and will often settle quickly once you start the massage.

Key points:
Start gently. Begin massaging the skin around the scar and then progress to the scar itself. Move in circular, horizontal and vertical motions to mobilise the scar effectively.
Use a non perfumed oil eg. olive oil.

This is just a snapshot of a survey conducted by the fawcett society. You can see the full report here:
https://www.fawcettsociety.org.uk/Handlers/Download.ashx?IDMF=9672cf45-5f13-4b69-8882-1e5e643ac8a6

We have to remember that menopause is not all doom and gloom - some go through menopause with no symptoms at all. But for those that do have symptoms, these can significantly impact a woman's ability to work and progress in her career.

What are your experiences? Have you had a supportive employer? Do you feel it's hard to put menopause symptoms on a sick note? Have you had to alter your career path as a result of menopause symptoms?

Perineal tears are common during childbirth and vary in degrees of severity. The most common tear is a second degree tear, which involves some tearing to the skin and perineal muscles.

3rd and 4th degree tears are not common but are likely to cause more pelvic health issues than more mild tears.

As you can see the increasing amount of tearing results in more muscles being damaged.

Ideally all women should have a postnatal MOT after a baby but if you’ve torn it’s EVEN more important.

Don’t suffer in silence, if you have symptoms ask your GP to refer you, or else there are lots of private pelvic health physios all around the UK.

Our new spring timetable is now available to book. https://spring-physio.uk1.cliniko.com/bookings
Simply select the start date of your chosen course and you will automatically be enrolled for the 5 or 6 week course!

Pelvic Floor and Core Class:
Mondays 9.30-10.20am: 5 week course commencing 27th February
Wednesday 9.30-10.20am : 6 week course commencing 22nd February
The class is physiotherapy led and bespoke modifications are made as required, in a small group setting.

NEW!!! Pelvic Floor Friendly Strength and Circuits
Thursdays 2.00-3.00pm
This class is a new offering from our resident personal trainer, Selina. This is a great class to build strength and fitness whilst respecting your pelvic floor health.
£45 for 5 week term, starting on the 2nd March

Address: Spring Physio, Brownings Farm, Lewes Rd, Blackboys TN22 5HG.
Parking is available on site.

NB If you are new to the pelvic floor recovery class you will need to purchase a kit list which is £15.
*x

➡️Accurate diagnosis of a troublesome scar is important so that appropriate treatment can be given. A healed scar that becomes raised and red is often either keloid or hypertrophic.

There are a few differences that define whether a scar is keloid or hypertrophic but I find looking at the boundary of the scar tissue the easiest way to tell. A hypertrophic scar will usually stay within the boundary of the original incision site. However, a keloid scar will not remain limited to the original wound boundary and grow beyond it.

➡️Why is it important to know the difference?

Hypertrophic scars are generally easier to treat. It's important that clients understand the timeframe in which they expect changes to their scar to change so they don't become despondent if they don't see improvement quickly. I would always set the expectation that keloids need consistent, committed treatment and may not improve as quickly as a hypertrophic scar. Whilst treatment options are similar to treat these both types of scar, approaches are not identical and so accurate diagnosis is important.

If a client has existing scars which have become keloid I would definitely take a preventative approach early rather than wait for one to develop.

I was prompted to share this post because I've had a really nasty bout of coccyx pain in the last week. However - I've utilised some of these strategies and it's now almost resolved!

1. Offloading the tailbone is important during sitting. You can buy lots of different ring cushions on amazon but I find the blow up travel neck pillows have worked a treat for me!

2. The pelvic floor can often aggravate or contribute to tailbone pain so pelvic floor stretches can be very helpful in relieving symptoms.

3. Manual therapy doesn't work for everyone but when it does it's great! I then give patients a way of self treating at home.

4. You can try heat or ice, whichever gives relief. I definitely prefer warmth but see what works for you.

5. The coccyx is part of the spine so low back problems can also contribute to tailbone pain. Therefore it is important the spine as a whole is moving freely. Incorporate some spinal mobility exercises into your daily exercise programme.

6. Make sure you are not sitting in a slouched position because this loads the coccyx and can irritate it further. Make sure you're are sitting on your sitting bones (the bony bits in your bottom), not your tailbone!

Women's health physios do not just teach kegels! And this list is not exhaustive. These are just some of the most common things I see in clinic.

You can get a referral via your GP or there is a large private network of physios - you can search on the directory.

Really happy to announce that we are now offering personal training! For those who are ready to take the first step in their fitness journey, Selina offers 1:1 training sessions in a relaxed environment - perfect for beginners of all ages. These sessions are ideal for clients who don't want to work out in a busy gym environment.

Selina has a specialist training in peri/post menopause which perfectly compliments our women's health services.

For more info check out www.springphysio.co.uk/personaltraininguckfield

You may have diligently completed your pelvic floor rehab, but found your symptoms continued. What’s going on?

I'll put the common causes into simple terms:

1. Urethral hypermobility
This is where the urethra (wee tube) has too much movement in it. Because it's wobbling around, it's harder for the pelvic floor to keep it clamped shut.

2. Hypertonic pelvic floor
This is where the pelvic floor muscles are too tight, so they do not relax properly. This can cause fatigue in the muscle and/or does not perform adequately to provide support when required to keep the urethra shut.

3. Overactive bladder
An overactive bladder can cause leakage from an overwhelming urge (eg leaking on the way to the toilet). This is treatable with physiotherapy but unlikely to respond pelvic floor exercises alone.

4. Constipation
Constipation causes increased pressure on the bladder making it harder work for the pelvic floor muscles to stop leakage.

5. Low oestrogen
Low oestrogen can impact the quality of our tissue and make the urethra/va**nal walls thinner and less elastic. This can increase leaking.

6. Lack of functional training
The pelvic floor needs training in co-ordination and speed of contraction. Sometimes you need a more varied programme to train the pelvic floor to prevent leaking in a particular circumstance. Eg. graded impact training for return to leak free running.

Pelvic Girdle Pain (PGP) is a common pelvic issue in pregnancy.

It is very common, affecting around 1 in 5 women in pregnancy. It can start any time during pregnancy.

There are many factors that can contribute to this issue. Here are a few:

➡️Weakening of muscles around the pelvis, increasing stress on the joints.

➡️A previous injury

➡️Baby positition

➡️Uneven strain or movement across the pelvis

The good news is that is treatable and usually your midwife or GP can refer you for NHS physio. There are also a wide network of private physios.

Treatment may consist of
✅Manual Therapy ✅Exercise ✅Acupuncture ✅Stretches ✅Lifestyle adjustments

H O L I D A Y G I V E A W A Y 🎉 I'm off on holiday next week so I'm leaving you with a giveaway competition until I get back. There are quite a few new designs available (you can view them in my etsy shop). The winner can choose any 3 prints, in either a3 or a4 size. You will receive the prints as downloadable PDF’s or high quality JPEGs. The great thing about digital downloads is they are super flexible. Print them for frames, laminate them and use as part of your education, make a mug, a t-shirt.... the list is endless 🤣. Competition closes on the 1st November. There is also a 15% off sale in my etsy shop for the next week. Use INSTA15 to claim your discount on 4 or more prints at https://etsy.me/3Jxa0vL

To enter simply follow the page, comment you want to be entered and tag someone else who you think might like to enter too! One entry per tag.

This competition is no way endorsed or sponsored by instagram.

Pelvic floor rehab is not just about kegels!!!… but they are the foundations. If you've been "kegelling" for a while and not yet seen the improvements you're looking for, now is the time to see a physio for a bespoke approach. A physio will set you a programme that is tailored to help your pelvic floor performs better with the activities or sports that cause symptoms.

The exercises shown in this post are just some of the many exercises that may be used. It is not a one size fits all approach. The take home is that you should not be scared to exercise. You just need help to know the right level, for the right time - then build on that little by little until you're back doing the things you love.

These are some of the most common compensation strategies I see during postnatal MOT appointments.

1. Breathing
A growing baby takes up a LOT of room and as a result breathing during pregnancy can be a bit "laziy" ie. not expanding fully at the diaphragm. Sometimes this becomes a habitual change, and so women have to relearn how to breathe into their diaphragm after baby is born.

2. Abdominal gripping
Most of us have sucked our tummies in at some point or another to get into that pair of jeans! But sometimes postnatally women grip their tummies ALL THE TIME, without even realising. Common reasons for this are that they feel more supported holding their tummy in, or they feel self conscious about the reduced tone of the tummy and gripping makes them feel the abdomen is flatter. Either way, it doesn't help recovery, because gripping the abdominals increases pressure and work for the core. It can also make the obliques work too hard, which can also hinder core recovery.

3. Butt clenching and posture are linked but both can create additional tension in both the pelvic floor and the spinal muscles.

A physio can assess all this (and more), helping you to break little habits which can contribute to aches and pains as well as help your body recover in a balanced way.

Yoga stretches are a great way of letting go/relaxing the pelvic floor.

An important thing to note when doing stretches for the pelvic floor is that you want to visualise relaxation on the inhale, rather than the exhale. This is because your pelvic floor naturally wants to lengthen (or relax) on the in breath.

Try not to rush through stretch time, I always think better to do fewer stretches mindfully than lots in a rush.

Of all the conditions that I see in clinic - prolapse has to be be one that causes the most anxiety... for a mixture of reasons but most commonly....

1. As soon as someone hears the word prolapse they think something is going to fall out of their va**na.
REALITY: This is pretty unusual. Most prolapses start mild (eg there is some movement but it's still in the va**na). With the right treatment these can be managed well conservatively without surgery.

2. People are scared to move (becuase they are worried something might fall out).
REALITY: Movement is good for us! Yes, sometimes we may suggest a different type of exercise is better (for example moving to a lower impact option) until the prolapse is better managed, but fear avoidance is not going to help you manage your symptoms long term. **nalhealth **na

3. People think they are the only one with the problem.
IREALITY: It's horrible to feel like you are on an island of discomfort and you're too embarrassed to share it with someone. The reality is that 50% of women over 50 have a prolapse so even if you feel like you're on an island, you're definitely not. It's much more common than you think.

The humble squat!

I love to give squats as part of pelvic floor rehab. It is a great exercise... when done correctly...

Ideally the pelvic floor should automatically engage as you rise from a squat to provide support, but in reality this often isn't the case (particularly in those with a weak pelvic floor). Training the pelvic floor to automatically contract with this movement begins with reminding the body and brain through a voluntary contraction.

The reality is that as we move in the day we don't do so in perfect posture or form, but there is still benefit to optimising your technique in a structured strengthening session. Making sure you've got good hip/spine position, equal weightbearing and optimal breathing will all help to ensure the right muscles work during the squat (eg glutes), pressure is managed (helping your core) and certain areas of the body aren't overworked unnecessarily (eg your spine!).

Happy squatting!

Spring Physio updated their address.

Treatment room/studio for rent in Blackboys, just outside Uckfield Perfect for therapist, personal trainer or small group classes.. Parking on site. Hourly, half day or full day rates available. Message me for more information!

I've always seen clinically that combining the traditional kegel with functional rehab yields the best results. And research is starting to show the same (Crawford B, 2016).

But why is this?

Your pelvic floor (should) engage naturally in every day movement to support you when you're squatting/lifting/lunging. If you combine a voluntary contraction with a movement where the pelvic floor naturally wants to engage, it's likely to create a better connection.

There are a few circumstances where the brain can disconnect from the pelvic floor during functional movement, for example: post surgery (eg. hysterectomy) or post birth. In this situation doing functional rehab helps to remind the brain how the pelvic floor should be working in function.

If you've been doing kegels with little effect, it may be time to add in some functional movement retraining too. Ask your GP for a referral to a local women's health physio for bespoke assessment and treatment.

Every journey is unique right? So everyone's pelvic floor recovery journey is also going to be unique. Some people may find their pelvic floor muscles easily and have no issues contracting and relaxing them, whilst others may spend weeks on connection exercises. It will be dependent on many things - trauma, medical history, stage of life; to name a few.

When we have physio for a knee or hip injury, we don't just do one beginner set of exercises and expect it to be sorted. Instead, we build and progress as our strength improves. Muscle strength isn't just about the maximal ability to contract but also about how fast muscles can respond, and how long they can keep working till they fatigue. Every time your physio or PT tells you you are ready to progress to a new stage of strengthening - be encouraged! You are further along your journey towards recovery.