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
- 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.
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
- Joint mobilization
- Dry needling
- Ice or heat treatment
- Progressive exercises to improve flexibility and strength
- Activity modification advice
- Technique correction
- 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.
Our greatest asset – movement!
If you’re going to jump on the movement train and try to increase your exercise this year, that’s a great aim, and we applaud you for it. Movement is key to everything we do, and as humans we need to move often in order to stay healthy. Moving often is very important, but we must also move WELL in order to get the most out of our bodies and be truly healthy.
Why is movement so important?
Our bodies are designed to move. Not only do we need to be able to physically move from place to place to carry out our daily tasks, but the insides of our bodies also rely on our movement to function properly. We’ll explain more, but first have a think about what it would be like to be unable to move. Without movement, we cannot reach for the box of tissues, kick a ball, blink or swallow. It’s easy to take it for granted, until you no longer have it. For some people in this world, having a lack of, or inability to move is a reality. There are conditions which change the way we move, or stop it altogether. Neurological conditions such as motor neurone disease, Parkinson’s disease and progressive supranuclear palsy are examples of progressive conditions that alter a person’s ability to move. As conditions progress, a person eventually requires help with daily activities, including toileting, dressing and eating, to name but a few. Hopefully this puts into perspective how important movement is, and how those of us fortunate enough to be able to move should make it our duty to move often, move well and make the most of life.
Benefits of moving
The benefits of regular movement include:
- Improved muscle and joint function: Movement is pivotal for our muscles and joints (and other body tissues) to remain fully functioning. If we want our muscles to get stronger, we have to contract and relax them over and over. Movement also helps to keep a steady production of fluid that nourishes the insides of our joints.
- Reduced pain: This is where moving well plays a big role. Our body systems have to work in unison in order for our movements to stay efficient. As soon as something in the chain begins to fail (e.g. muscle injury, joint restriction), our movement becomes inefficient and this paves the way for pain to develop. Following injury, we need to retrain our movements to a more efficient level in order for pain to disappear for good.
- Improved mental health: Movement in the form of exercise is a great way to keep your mental health in check. When we move, our body releases hormones that make us feel good. Endorphins (known as the happy hormones) are hormones that are released when we exercise. Regular movement equals regular release of hormones, and if you feel good, your mind remains clear, your motivation levels increase and your concentration levels improve. You become a more productive person, and you feel great for it. The world becomes your oyster!
- Improved circulation of fluids around the body: Our body relies on movement to help with the flow of different fluids around the body. Our lymphatic system (our bodies defence and waste disposal system) relies almost completely on our movements and muscular contraction in order to pump lymphatic fluid around the body. We also need to move to help pump blood from our limbs back up to the heart.
- Improved digestion and regulation of bowel movements: Moving helps our digestive system function more efficiently, by aiding with passage of food along the digestive tract and out again when we need to open our bowels. Movement is one form of treatment for constipation!
- Improved sleep: Regularly pushing our bodies during exercise can help increase the amount of deep sleep we get each night. Our bodies need this to repair and rejuvenate for the next day.
- It helps us to remain independent beings: As we have already mentioned, when we lose the ability to move, we become dependent on others around us to help us get through each day. Working on your body every day, ensuring you are moving well and often, will help you to maintain independence into your latter years.
What happens when we don’t move?
It seems pretty straight forward that if we don’t move regularly, we are leaving ourselves open to a poorer functioning body. Essentially, the reversal of all the good things mentioned above:
- A weak body: If you don’t use it, you lose it! Lack of movement leads to weakened muscles and bones, stiff joints, and an increased risk of injury.
- Increased pain and swelling: Poor movement patterns lead to injury and pain. Lack of movement can also cause fluids in the body to pool in the extremities, leading to swollen limbs.
- Increased rates of depression and low mood: No movement means we don’t get that regular boost of the happy stuff. Over time this can lead to low mood and an increased risk of developing depression.
- Increased weight gain: Lack of exercise is a big risk factor for becoming overweight and developing many other related conditions including diabetes, high blood pressure and heart disease. People who move less and are overweight also at higher risk of becoming constipated.
Looking to make some changes? We’d love to help you get where you want to be. Come and see us today, and we can look at you move, pick out what needs working on, and set you the task of putting it right. Don’t take movement for granted, it is a gift. Let us help you move well each day so you can keep your body functioning, your mind stimulated, and life good!
Taping for treatment
Have you ever been to the physio for a treatment and left all wrapped up like a mummy? Tape. It’s one of the various tools in our arsenal that we sometimes call upon to help a person in their recovery from injury. But we joke of course – no-one ever leaves us with that much sticky stuff on, that they resemble an Egyptian from the afterlife. Although tape can be a life-saver!
Tape has been used as a treatment tool for decades. There are many different types, each designed to aid the body in some way during the recovery period of an injury (anywhere from the onset of injury to return to sport training or match play). It can be used before, during and after activity. It is widely available, relatively cheap and is an excellent tool to use alongside other forms of treatment, including massage, joint mobilisation, needling and exercise therapy. A physiotherapist may even use it on your body even if you are not injured, in order to reduce the risk of one happening.
The reasons a physio may use tape are:
- To reduce pain
- To stabilise / support a joint
- To correct posture and increase awareness of a particular body part
- To aid in achieving efficient movement of a body part
- To prevent a joint from moving
- To reduce the risk of injury or re-injury
- To increase feedback to the brain of a particular body part
- To increase confidence in a person looking to return to sport / activity
- To reduce swelling of a particular body part
There are several different types of tape. Some of the more commonly used types here at Physiotherapy for Women include rigid and kinesiology tape (aka K-tape). Read on to find out a bit more on these types.
Rigid tape (aka sports or athletic tape) is an inelastic type of tape primarily used to provide stability at a joint. Joints that require stability may be those that move excessively, or where the integrity of the joint has been compromise. Like when you seriously sprain your ankle chasing your children playing tag or when enjoying a social netball match with your girlfriends. In the ankle sprain a ligament can be overstretched or torn, making basic weight bearing activity such as walking very painful. To assist the ligament to heal correctly, tape can be applied in a special pattern which provides a rigid barrier to specific movement which could further damage the ligament. The taping may be soon after the ankle injury (this depends on severity) or when your return to moving quickly and/or when you return to quick movements in a family situation or when back on the court. Rigid tape can provide support to the joint and give a person confidence to start using the joint as it should be, without fear of re-injury. This is usually a temporary treatment though as the aim of the physio and the injured person should always be to return to a pre-injury state, if it’s possible. In the unfortunate event that a person’s injury means they cannot return to a 100% pre-injured state and perform at a high level, tape is a cost-effective way of providing support needed to play, even if at a reduced intensity or level.
Here at Physiotherapy for Women, we are super conscious of what effect tape can have on a person’s skin. Some people are sensitive to the adhesive or glue that is used on the sticky side. And sometimes tape needs to be in place for many days at a time. For this reason, under-wrap was designed. Under-wrap is applied to the skin first to provide a barrier against the glue of the tape. The rigid tape is then placed over the top where its full effects can still be experienced. Your skin care is a priority of ours, so we always use under-wrap before applying rigid tape to an injured body part. We’ve got your back (or you knee)!
Other examples of injury where rigid tape may be used include knee sprains, pregnancy sacroiliac sprain, shoulder dislocations or ligament sprains, or in the treatment of plantar fasciopathy or a dropped foot arch.
Kinesiology tape (K-tape)
K-tape is an elastic type of tape that has several proposed uses. It molds to the counters of the body well and is designed to promote movement, rather than restrict it. K-tape may be applied to a body part to:
- Reduce pain and/or delayed onset muscle soreness (DOMS) following exercise
- Increase blood flow to, and drainage of fluid away from the body part
- Increase awareness of the body part to the patient
- To guide effective and efficient movement with minimal to no restriction
The increase of awareness of the affected body part is a particularly useful tool for us as physiotherapists when planning our treatments. After an injury, the intimate connection of the body part and the brain can become foggy. The brain may slightly lose its ability to know exactly where the joint is and what it should be doing. It sounds scarier than it is, but with exercise and rehabilitative treatment, this connection can be regained. K-tape is a great way of assisting with this, as the covering of the skin over the injured area provides extra input to the brain about what is going on at the joint(s). It’s complicated, but pretty cool huh?!
Another fantastic quality of K-tape following injury is its ability to assist the body in ridding fluid or swelling around an injury joint or muscle. The tape is applied in a special way which lifts the top layers of skin away from the underlying muscle to allow for greater flow of fluid… It can speed up the whole process considerably!
Ready for your dressing now?!
It depends completely on the type of injury and where you are in the recovery process as to which type of tape we choose to use on you. We will always discuss with you the benefits of tape so you can make an informed decision with us for your treatment and plan going forward. And don’t worry, we will avoid turning you into a mummy (often less is more with taping). If you are worried about skin reactions we can trial small patches of several different tapes on your skin before doing a big taping of a body area.
If you’re keen to learn more, or find out if tape can benefit your recovery, just ask next time you are in for a treatment with us.