All Women’s Health Physiotherapy appointment at Sussex Physio Pilates are with Senior Physiotherapist Claire Yuill.
Claire combines her 20 years’ experience as a Musculoskeletal Physiotherapist and Clinical Pilates Teacher with Specialist Woman’s Health Training to holistically assess and treat Pelvic Dysfunctions such as:
- Urinary Incontinence
- Bladder Dysfunctions
- Pelvic Pain
- Pelvic Instability and Weakness
- Pelvic Organ Prolapse
She also offers a MummyMOT postnatal assessment for new, and not so new Mums – Assessing tummy and pelvic floor strength and function.
Stress Incontinence – leaking urine when you cough, laugh, sneeze or jump is usually caused by weakness of the Pelvic floor muscles (that form the floor of the core). Guided pelvic floor strengthening is often a large part of treatment.
Urge Incontinence (or Over Active Bladder) – Leaking urine when you feel a sudden urge to ‘go’. Pelvic floor exercises can also play a part here, but often the bladder needs to be ‘re-trained’ in it’s habits.
The pelvic floor is a group of muscles that form the ‘floor of your core’. They, just like other muscles of the body, can become weak (often after pregnancy or menopause) or tight (due to pelvic pain, injury or stress).
Examining the pelvic Floor:
Women’s Health Physiotherapists assess the pelvic floor by performing an internal examination. This allows us to determine the tone and strength of the muscle lift, as well as checking that you are working the muscles in the right way.
This part of the assessment can be performed at the 1 st appointment, but only if you feel comfortable and give your valid consent.
You are welcome to bring a Chaperone.
Founder of Sussex Physio Pilates, Senior Physiotherapist Claire Yuill has undergone additional Specialist Women’s Health training with the POGP (Pelvic, Obstetric and Gynaecological Physiotherapy), Dr Ruth Jones, Maria Elliot and Kate Walsh at The Mummy MOT
The MummyMOT® is a detailed Post-natal Physiotherapy assessment of the abdominal and pelvic area, from 6 weeks postnatally (though still beneficial years later!)
We believe your body deserves to receive as much care & attention as your baby's.
It will check your posture, breathing, tummy gap and pelvic floor strength.
Following the assessment, you will receive an appropriate safe exercise programme tailored to you, and a report of the findings and advice given.
In brief, most Postnatal women would benefit from a Mummy MOT!
It is very common for women to have postural changes, and weakness in their tummy or pelvic floor muscles after having had a baby. These weaknesses create instability, muscle imbalances, and poor core strength around the pelvis, which can cause back pain, pelvic pain, bladder and bowel weakness (leaking) and pelvic organ prolapse.
Identifying these muscle imbalances as early as possible can help avoid or reduce these symptoms.
Many women also feel that they want their body checked before returning to sport postnatally.
"After attending your Mummy MOT®, your Physiotherapist may recommend (if appropriate to you) the options of home exercises, Physiotherapy or Clinical Pilates follow ups, Group Pilates and/or working with a Personal Fitness Coach.
Mummy MOT® Practitioners work closely with Holistic Core Restore® Fitness Professionals, who are specially trained in Women's health with Burrell Education.
The Holistic Core Program continues on from the Mummy MOT® to improve functional strength for Mums while retraining the Pelvic Floor and reducing Diastasis Recti.
We are happy to recommend our local Holistic Core Restore® Coach Erica at Sussex Fitness.
Once your core is retrained to a good functional level, Erica from Sussex Fitness also runs boot camps that work you hard, but at the same time protect your pelvic health. There is no high impact work and it is suitable for all levels of fitness.
Diastasis Recti occurs when the main abdominal ‘6 Pack’ (the Rectus Abdominis) separates down the middle due to the over- stretching of the line of connective tissue (the linea alba) that joins the 2 sides of the muscle together.
It often occurs in Pregnancy, although not exclusively. During Pregnancy the rectus abdominis muscle stretches greatly, up to 50cm! This can give a ‘stretch weakness’, which together with an increase in the intra-abdominal pressure (ie. the weight of baby, womb etc) can cause the muscle to divide as the diagram below shows
Sometimes it’s just a small separation, that you may not even realise you have whilst you’re still expecting (or even afterwards). Other times it’s a wider or longer division, in which case a hernia (bulge) can sometimes be felt or seen.
Either way, you are not alone, as it pretty common, occurring in between 30 – 66% of ALL Pregnancies (Boissonnault & Blaschak 1998). You are also more at risk if it’s not your 1st baby (and your core was already weakened), if you had a large baby, have a small pelvisor if you did exercises that over-strained the rectus abdominis during pregnancy.
Many separations will naturally close during the first few weeks after having baby. Many others need a little help with protecting against further strain and correctly re-training your abdominals (see the advice below).
If all that fails your GP can refer you on for a surgical repair. This is not rushed into however, as you’ll usually need to have completed your family before a doctor will consider it, and you’ll still need to re-train your abdominals after surgery.
If you’re reading this after you’ve recently had your baby, and you think you may have a diastasis recti, then I strongly recommend you ask your midwife or GP to check (or a Physiotherapist such as myself who treats Pregnant and Postnatal Mums).
Remember that this isn’t a vanity issue (well, maybe partly – but that’s FINE too!) - having separated abdominal muscles can contribute to low back pain and prolapses, as well as lowering self esteem.
It may be that several weeks or months after giving birth you still have the same post baby tummy (and possibly have been asked when you’re due!!). A ‘Mummy Tummy’ of sorts is pretty normal despite what the media would have us believe!...In the early days we're often not that bothered about ‘getting back in our jeans’…. looking after our new bundle of joy is the priority. It’s also normal to still have more fat than before lying on top of your tummy muscles (it's part of pregnancy, then the hormone Cortisol has a lot to answer for here, but I’ll save that story for another day...).
However if you’ve been increasingly more active, have lost a bit of weight, been doing some exercise, and weeks, months or even years later your tummy isn’t budging… (or maybe it even seems like it’s bulging out a bit more), then it’s worth checking for an abdominal separation.
The naval (belly button) is a weak spot in the abdominal wall and is often where the ‘gap’ is felt.
So don't just accept it.... You've just grown and birthed a baby.... you deserve to get stronger again!
Starting with what NOT to do - There are certain exercises to avoid - Any exercise that causes your abdominals to bulge out or ‘dome’ (always aim to draw the belly button inwards). These exercises (such as a full plank or raising both feet off the ground) increase the intra-abdominal pressure, so can make your diastasis worse. Prolonged stretches of the abdominals (ie. Upward dog or lying backwards over a gym ball) probably won’t be helpful.
Exercises that use the ‘sit-up’ or ‘crunches’ position – ie. raising your head and shoulders off the floor…
This does include SOME Pilates exercises, so it is vital that your Pilates teacher is aware of your Diastasis Rectiand modifies your exercises accordingly so they help you not hinder...
Heavy lifting - this includes baby in their car seat (they are heavy!) so if possible get someone to lift baby’s car seat for you, or plan ahead and ask your partner/a friend to put the seat in the car before you’re going to need it.
When lifting has to be done (baby from crib, washing etc ) bend your knees into a squat and hold in your deep core and pelvic floor first (see point 3) – We’re aiming to reduce the abdominal bulge.
Getting up out of bed – As above - hold in your deep core (see point 3) , roll onto your side and use your arms to assist you. Don't just use momentum to swing yourself up.
Wear a Support - This is never a popular one, (you probably won't feel your most attractive in it) but if your diastasis is over 3 fingers wide, it will help in preventing further strain on the connective tissue running down the middle of the abdominals, as well as encouraging your core to engagement and helping support your back.
A hospital Physio may give you a length of wide tubigrip to wear in the same way as a bump band, or you can buy them from on-line sites.
Watch your posture -
Start re-training your deepest abdominals and Pelvic Floor - ALWAYSstart by working on the deepest layer of abdominals first, our ‘Transverse Abdominis muscle’ (TvA). This muscle wraps around our middle like a natural corset, and is the foundation of ‘core stability’. It works in harmony with your pelvic floor, and together with tiny muscles in your back and your diaphragm this forms our central ‘Cylinder of Support’ .
However our TvA is s a subtle little fella, and requires some concentration to begin with. In modified Pilates we always begin (and continue) with working our deep core/our TvA muscle, together with our pelvic floor.
Imagine your knicker elastic has just tightened up(holding in the area below your belly button without tilting your pelvis), and at the same time you’re stopping yourself from passing urine by lifting up your undercarriage!
Until the distance of your abdominal separation is less than 2 fingers breadth avoid working your ‘sit-up muscle’ (rectus abdominis), although you can add working your next 2 layers of abdominalmuscles (your internal and external obliques/ your waist muscles) as long as you don’t bulge your tummy – we’re aiming for a FLAT tum when we exercise (think holding your belly button into your spine). Foot slides on all hands and knees is a good exercise, as is a bent knee fall out when lying on your back with knees bent up (feet flat on floor).
You also want to exercise your whole body, not just focus on closing the separation.
Think Strength and function rather than skinny!
Join a Post-natal Pilates Class - As a Physiotherapist who’s had 2 children, Claire Yuill set up ‘Mummy does Pilates' as part of her Physiotherapy & Pilates practice ‘Sussex Physio Pilates’ in Worthing, West Sussex. Her aim was to run Pregnancy and Postnatal classes for local Mums to come and exercise safely together (while getting some time for themselves too).
We cover all of the above – learning to hold our bodies in a neutral posture and to work our cores from the inside out as we work the WHOLE body.
Currently we runa Wednesday Morning ‘Mummy does Pilates’ class,
The golden rule before you start any class is to make sure the instructor knows you have a separation of your abdominal muscles and that the exercises are appropriately modified(ie. No head and shoulder lift, and no double leg lift).
Need some advice, or would like to book either a Physiotherapy appointment or 1:1 Pilates Session, then contact us now...