Pregnancy and Postnatal Physiotherapy

Reasons for aches and pains in the Childbearing Year

In the child bearing year many musculoskeletal changes occur within the women’s body. It is important to respect these changes during pregnancy, post-delivery and into the postnatal period. The pregnancy softening hormones continue to have an effect on joint tissues for some months postnatally.

Pregnant and post-natal women commonly experience fatigue. When you feel tired, muscle systems do not provide the usual support of joints and soft tissues. This results in movement patterns being often poorly performed and posture becomes sloppy. Repetitive movements of bending, lifting and carrying an increasing weight is also a daily challenge. These physical changes and challenges may place strain on tissues, leading to pain, tightness and movement difficulties.

Common Pain Complaints in the Pregnancy/Postnatal Period

Skilled physiotherapist’s, who have a special interest in women’s health, are trained in treating common pregnancy and postnatal complaints.

These may include:

  • Back pain and sciatica
  • Pelvic girdle pain, sacroiliac joint, pubic symphysis, coccyx pain)
  • Buttock muscle/piriformis pain
  • Headaches and neck pain/stiffness
  • Shoulder and mid back pain
  • Movement difficulties (walking, sit to stand, turning in bed)
  • Carpal tunnel syndrome, wrist pain
  • Pelvic floor weakness (poor bladder/bowel control/prolapse)
  • Abdominal muscle separation and bulging (rectus abdominis diastasis)
  • Post caesarean pain (after healing)
  • Postural problems and pain
  • Thumb/wrist pain (De Quervain’s tenosynovitis)
  • Breast engorgement and mastitis

Physiotherapy Treatment Options

At Physiotherapy for Women our physiotherapist’s listen, assess, treat and educate pregnant and postnatal women. Having provided Pregnancy and Postnatal Physiotherapy Services to Adelaide women for over twenty years, we have the knowledge and skills to select the physiotherapy treatment option appropriate for each presenting condition.

The aim of physiotherapy is to gently restore balance, strength and flexibility to your body, selecting techniques that are right for you. Some of the treatment options we may use include:

  • Joint and spinal mobilisation
  • Massage techniques
  • Exercise prescription
  • Corrective taping and strapping
  • Core and pelvic floor muscle training
  • Clinical Pilates
  • Heat and cold therapy
  • Patient education
  • Ultrasound
  • SRC shorts/leggings
  • Splints and support

Physiotherapy is a great way to reduce painful symptoms, feel more mobile, be flexible and comfortable in your movements, strengthen your body and minimise the reoccurrence of injuries. This means you can stay active during your pregnancy as well as optimise labour and your postnatal recovery.

 

Healthy Breathing and Physiotherapy

Healthy Breathing and Physiotherapy

Breathing is our life force, but how often do we spend any time thinking about this vital process. Do we know how poor breathing can create pain that may eventually require physiotherapy?

A good breathing pattern uses the diaphragm, which is the muscle that separates your chest cavity from your abdominal cavity. The diaphragm is also a core stabilising muscle of the trunk.

Healthy breathing has depth, fullness and freedom. The cycle of in and out breaths are not controlled. They happen naturally. The abdominal muscles relax with a diaphragmatic in breath, allowing the belly to become round. On the breath out, the diaphragm relaxes and the belly flattens.

Unhealthy breathing is shallow, where upper chest movement takes over from diaphragmatic movement.

Ineffective breathing patterns have become a part of our busy, modern life styles. Constant demands and daily stresses encourage our primitive fight-flight mechanism to be permanently switched on.

This mechanism is necessary when we are exposed to a threat or perceive danger. Our human body responds to the stress with:

  • Shallower breathing
  • Breath holding
  • Faster breathing pace

Living with ineffective breathing patterns is energy sapping. Upper chest breathing and breath holding encourage the wrong muscle systems to be working. This leads to musculoskeletal changes in the neck, ribcage, shoulders, mid back, low back, and pelvis.

Over time the musculoskeletal changes to muscles, joints and nerves of the upper trunk, spine and pelvis promote poor posture and this leads to weakness and pain in different parts of the body.

Therefore, many conditions presenting for physiotherapy, may have unhealthy breathing patterns being one of the causes creating or adding to the problem.

Physiotherapists working in women’s health often need to include breathing awareness into their treatment program for some of the following conditions:

  • Headache, neck and shoulder pain
  • Pelvic floor muscle weakness, urinary stress incontinence and prolapse
  • Rib and mid back pain
  • Back and sacroiliac joint pain
  • Hip and buttock pain
  • Pelvic pain

A Physiotherapist can provide you with proactive treatment, strategies and advice where healthier breathing patterns may be an important option for you.

Tennis Elbow

What does Tennis Elbow mean?

Tennis elbow is a painful condition affecting the outside part of the elbow. This area is called the lateral epicondyle and so the medical term is lateral epicondylitis. Tennis elbow is usually caused by overuse of the forearm. The outer elbow tissues become inflamed. This involves wrist and elbow extensor muscles being overused in repetitive movement and/or sustained postures. Many forearm muscles attach at or around the lateral epicondyle so when they are overused they pull too much on the elbow and make it sore. Patients typically develop this condition in association with activities involving repeated wrist extension against resistance or from activities involving repetitive or forceful gripping of the hand. This includes sporting activities such as tennis and squash, manual work such as gardening, painting, cleaning, sewing and knitting or working at a computer.

What are the symptoms of Tennis Elbow?

Common symptoms of pain, stiffness and inflammation occur at the outer elbow.  Pain can be constant or it just comes and goes with particular wrist and elbow movements. The elbow and forearm pain is often aggravated with grip, lift and twist activities. Even a simple activity of holding a pen and trying to write or turning a door handle can be uncomfortable.

Pain and tenderness is usually felt on the outside of your dominant elbow and into the upper forearm. The pain is often aggravated by wrist movements such as gripping, where the use of inflamed forearm muscles and tendon tissues near the outer elbow hurts. Knocking the outer elbow against furniture may produce sharp, intense pain.

Most cases of tennis elbow settle well with appropriate physiotherapy. This requires careful assessment by the treating physiotherapist to determine which factors have contributed to the development of the condition. The assessment findings determine a treatment plan which will focus on correction of the factors causing the pain. When simple, everyday tasks or sporting activity continues to be painful then elbow condition can be very frustrating.

Physiotherapy Treatment for Tennis Elbow

Physiotherapy treatment for lateral epicondylitis is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence. Physiotherapy treatment may be a selection of the following:

  • Soft tissue massage and myofascial release
  • Electrotherapy
  • Taping
  • Bracing
  • Joint mobilization
  • Dry needling
  • Ice or heat treatment
  • Progressive exercises to improve flexibility and strength
  • Activity modification advice
  • Technique correction
  • Education
  • Anti-inflammatory advice
  • Devising and monitoring an appropriate return to sport or activity plan

How long will my tennis elbow last?

With appropriate management, most minor cases of tennis elbow that have not been present for long can usually recover within a few weeks. In more severe and chronic cases recovery can be lengthy process and may take up to 6 months in those who have had their condition for a long period of time. For women experiencing tennis elbow symptoms, family and work activities can become quite difficult. Early physiotherapy intervention is therefore vital to hasten recovery and enable you to use your arm in everyday activity with comfort.

When do I use Heat and when do I use Cold

This is a question frequently asked by our clients in both consultations and exercise classes at Physiotherapy for Women. Hot and cold therapies have been used for centuries as healing modalities to promote health and well-being. Our physiotherapists will help you in your choice of thermal energy (hot or cold) with the following answers.

Cold Therapy Applications

When is an ice pack best used?

During the early acute phase of injury (first 24 to 48 hours) cold therapy or cryotherapy is a common choice. At this time of tissue trauma, cold can be applied in the form of ice packs, cold towels, ice compresses and iced water baths. Inflammation, swelling and muscle spasm are features of acute trauma.

What effect does cold have on tissue?

Cold therapy assists in reducing swelling by narrowing the blood vessels and decreasing blood flow to the injured tissues. As skin temperature is reduced, large diameter nerve fibres are stimulated. This leads to a local analgesia or numbing of tissues, which helps in pain control.

How long is an ice pack applied for best effect?

Apply the ice pack or cold compress to injured tissue for 15 to 30 minutes maximum. Do not apply again for a minimum of 2 hours. Usually, 3 to 4 applications of cold in a 24-hour period are advised.

What are the safety issues with cold therapy?

Avoiding “ice-burns” to skin is essential. It is always necessary to place a damp cloth between the skin and the ice pack. Never place a cold pack directly on the skin.

Do not use cold therapy in the following situations: open or infected wounds; cardiac issues; skin numbness; poor circulation; Raynaud’s disease; dermatitis or eczema flare-up; hypersensitivity to cold temperatures.

Heat Therapy Applications

When is a hot pack used?

The application of heat can be beneficial when the acute phase of injury (after 48 hours) is over, or when chronic soft tissue and joint pain and tightness are being treated. Heat can also be used before stretching, physical activity, soft tissue treatment or massage.

Heat can be applied in the form of heated gel, grain or heat-bead packs, electric blankets and pads, a warm bath, spa or sauna.

What effect does heat have on tissue?

Heat therapy assists in promoting healing, reducing long standing inflammation, decreasing muscle spasm and pain, enhancing blood flow, muscle flexibility and joint motion.

Heat increases blood flow to tissues by dilating blood vessels. This assists in delivering oxygen and nutrients to the tissue cells, removing cell waste products and promoting tissue healing.

Relaxation of muscles and the nervous system is enhanced in most people when warmth or heat is applied.

What are the safety issues with heat therapy?

Always protect skin from heat burns by placing several layers of towelling between the skin and hot pack.

Never lie down or fall asleep on a hot pack as both situations increase the chance of skin burn.

Application of a hot pack should be for 15 to 20 minutes.

Discontinue heat treatment if there is an increase in discomfort.

Maintain hydration by drinking water before and after immersion in baths, spas or saunas.

Pregnant women need to avoid immersion in hot baths, spas and saunas.

Very young and people who are elderly or frail need to be monitored for the entire time of heat therapy. Avoid warm water and saunas with these age groups.

Avoid heating in the following situations: acute injury or tissue trauma; open or infected wounds; swelling; severe bruising; areas of skin numbness; peripheral vascular disease; diabetes; poor circulation; poor thermal regulation; abnormal tissue and tumours.

Common Clinical Examples Using Heat or Cold

Pregnant women experiencing pubic symphysis pain often feel relief with a small ice pack placed on a moist flannel over the pubic bone.

Gluteal or buttock / hip muscle pain can be soothed with a hot pack and protective cloth placed over the top buttock muscle area in side lying.

Strained ankle or knee joints which are swollen and painful, will benefit from an ice pack application with protective moist cloth.

Tight shoulder and neck muscles related to holding and feeding a baby will benefit from a hot pack applied to the top shoulder and neck muscle area.

Our well-trained Physiotherapists can assist you if you still feel unsure as to what to do. Phone our friendly receptionist on 84433355 and make an appointment in our women’s health physiotherapy clinic.

3 Common Walking Myths Busted!

Walking as an exercise needs to be understood and respected. It is time to dismiss the commonly held idea around walking not being a worthwhile workout. Here we present the truth about three walking for exercise myths.

Myth #1: 10,000 Steps is the Holy Grail

“Wow, I’ve done it” is a common thought and produces a feeling of achievement when your fitness tracker signals you have hit the 10,000 step target. Perhaps this often used walking target is really only an arbitrary number when it comes to health benefits.

At Columbia University, Carol Ewing Garber, PhD, professor of movement sciences, believes the 10,000 step goal requires some rethinking.  “ will result in health benefits,” Garber says. “But it should be noted that … there is benefit even with small amounts of walking and the benefits increase with the more steps you walk each day.”

Garber proposes that we change our goal setting thinking from how many steps we’ve walked in a day to how much moderate intensity exercise we do each week.

Based on research, Garber suggests that we aim for 150 minutes of moderate intensity exercise per week. This moderate physical activity approach is thought to be less overwhelming to new exercisers. However, moderate intensity exercise will continue to be effective in lowering blood pressure and improving glucose tolerance.

Research published in the British Medical Journal has shown that even when a step count is minimal, walking an additional 2000 steps per day will assist to lower body mass index and boost insulin sensitivity.

Myth #2: Walking Doesn’t Help With Weight Loss

A gentle stroll is certainly not going to do the work required for weight loss. However, a stroll is still better than lounging around watching soapy dramas from a burning calories point of view. Leslie Sansone, fitness expert and well known for creating Walk at Home Workouts, has the evidence to support her claim: “Walking works for weight loss!”.

In a research study at the University of Virginia, overweight women lost more belly fat over a 12 week period when they did the following combination:

  • Three, 30 minute high intensity walks per week.
  • Two moderately paced walks per week.

When looking at the calories burnt when walking, a second study showed that 20% more calories were burnt by varying the speed of walking compared to maintaining the same pace.

Sansone recommends incorporating high intensity interval training (HIIT) into your walking program. This means a slow paced 5-minute walk to warm up, then 30-seconds of brisk paced walking. To complete this interval, you do 4-minutes of regular paced walking. The interval is repeated four times. You finish with a 5-minute slow paced walk to cool down.

The HIIT walking program assists you with living a long and healthy life.

Myth #3: Walking is Only For Those Who Can’t Run

For many people new to exercise or for those recovering from an injury, walking is an excellent “gateway exercise”. Once a level of stamina and cardiovascular fitness is achieved, walkers can transition to running.

However, not all walkers want to run — and that is fine.

Garber says, “Walking is a good exercise for everyone”.

A study looking at high cholesterol, hypertension, diabetes and heart disease, were shown to be lower in regular walkers compared to runners. This study was published in the journal Arteriosclerosis, Thrombosis and Vascular Biology.

Whilst walking around the block is better than no physical activity, the health benefits of walking are maximised when the walking workout is of sufficient time with added intensity levels. Garber suggests using your fitness tracker to focus on duration, distance or calorie expenditure. Remember whether you walk or run it is the amount of exercise that is important to achieve health benefits.

The words of Sansone sums it up beautifully – “If you start fitness walking today, you will instantly feel better and know you’re doing something good for your body, mind and soul.”