Think Santa this Christmas!

Let’s spell it out loud and clear: SANTA (Straighten up, Active, Neck long, Take breaks, Action)

Take the S for Straighten up:

Good posture decreases our susceptibility to back pain.

Call on the A for Active:

Eating so much over the festive period requires us to be more active. Get outdoors, go for a walk, take a beach or park run with family and friends.

Sound out the N for Neck long:

Constantly looking down at our phones puts enormous strain on our necks and spines. Create ‘no phone’ policy during the festive period, allowing festive gatherings to be true social occasions. When using your phone bring it to eye level, so your neck is long.

Sing out T for Take breaks:

Christmas is always a busy time putting up decorations, wrapping presents and cooking up Christmas feasts. Our spine often feels the constant strain that we place on our bodies. Ask for help so that you are not doing all the tasks at once or on your own. Allow yourself to take frequent breaks.

Finally move the A into place for Action:

Do some simple movements outside of your repetitive movement zone as demonstrated by Santa. The action of arms out or arms up and a knee lift to the bent elbow is so easy.

Thank you, SANTA

Knee pain: The ins and outs of patellofemoral pain

Do you get knee pain? Well this month we are looking at the knee joint and specifically talking about patellofemoral pain. So what does the word patellofemoral actually mean? You can break it down into ‘patello’, which refers to the knee cap, and ‘femoral’ which refers to the long bone (the femur) that runs down your thigh from your hip to your knee (remember, the thigh bone connects to the leg bone, the leg bone connects to the ankle bone, and so on!). The connection between your kneecap and thigh bone is called the patellofemoral joint and we’re going to look at some of the problems associated with this part of the body.

The phrase ‘patellofemoral pain’ is an umbrella term for many causes of pain at the front of the knee. The knee is a complex joint made up of lots of different parts, ranging from the bones that form it, the ligaments that hold the bones together and the various soft tissue parts that form and cross the joint, such as joint capsules, muscles, tendons and fat tissue. All of these (and more) can be involved in pain at the front of the knee.

Knee anatomy

women holding sore knee

The knee can bend and straighten, as well as twist and shear forwards and backwards a little. When our knee is straight, the kneecap, which is held over the knee within the tendon of the quad (thigh) muscles, sits over the end of the thigh bone. As we bend our knee, the surface of the knee cap and end of the thigh bone come closer together and slide over each other in a lovely smooth way, allowing us to perform movements like squatting, jumping, walking and running (basically anything that bends the knee) more efficiently.

What are the causes?

The main causes of patellofemoral pain include overuse of the various parts that make up the knee, or problems that affect the smooth gliding or ‘tracking’ of the kneecap over the end of the thigh bone while moving.

With an overuse issue, think of a person who spends their days walking up and down stairs, or having to squat down constantly. The constant bending and straightening of the knee can lead to overloading of the joint and surrounding tissues, leading to irritation and pain. Another example is that of a runner who may start to get knee pain having recently increased the distance or the amount of days in the week they run.

As we mentioned earlier, the kneecap is held within the quad tendon as it crosses the knee. The quads attach higher up at the pelvis and hips, and down below on the shin bone. So it makes sense that any issue that affects the back, pelvis, hips, ankle and feet can all lead to poor or incorrect tracking of the kneecap over the joint. Common issues here include muscle weakness of the glutes (buttock), quads and lower leg muscles, a twisted thigh or leg bone, and weakness in the ankles and feet, such as having a collapsed arch of the foot. Some people also have a misshapen kneecap, or one that doesn’t sit perfectly over the joint as it should, which can affect the line of tracking over the joint. Throw in having to consider a person’s size and weight, how they walk and run, and the types of footwear they use, and you can see there is a lot to consider.

Unfortunately ladies, this is one of those conditions that affects us more than our male counterparts. Researchers believe this may be because we tend to have wider hips than a man (yep, thanks for that). A woman’s wider pelvis increases the angle where the bones in the knee joint meet. Therefore, leaving more room for imbalance, misalignment or issues moving. Interestingly, research exists that looks into the link between the menstrual cycle and knee pain in women. Whilst the evidence is not 100% conclusive, it is believed that during the different phases of the menstrual cycle, sex hormones can affect the activation of the thigh muscles (quads) and how the body’s nervous system functions during lower limb movement, leaving a woman at potentially higher risk of injury in the knee region. Watch this space… When research catches up, we’ll fill you in on the finer details! What doesn’t break us, makes us stronger eh!

Treatment

So, what can we do to help? Well prevention is key at first:

  • Make sure you’re strong
  • Think about correct knee alignment when walking, running, stair climbing and so on.
  • People within a healthy weight limit also tend to experience less pain.
  • When starting an activity, increase intensity gradually.
  • Always warm up properly.
  • Keep up those stretches!

But if you do have knee pain, it’s best to source help to find out what is going on. Because there can be a variety of reasons for knee pain, there is, of course, a variety of treatments. Here at Physio for Women, we assess all knee pain in a consultation. We figure out what is causing the issue, and help you fix the underlying cause. This could be treatment via massage or other manual therapy techniques, strengthening or stretching exercises, postural alignment work and more.

So, there’s no knee-d to be experiencing knee pain! Come and see us and we’ll get you hopping, skipping and jumping back to normal in no time.

Afraid to laugh out loud? Incontinence help is here!

Hello ladies, it’s blog time again! To celebrate World Continence Week (17th-23rd June), we thought what better topic than the pelvic floor and incontinence. For those of you who are not familiar with this condition, incontinence is the term used to describe uncontrolled loss of urine from the bladder or faeces from the bowel. It’s a tricky problem to get people to speak out about because as you can imagine, for the majority it is quite an embarrassing thing to have to admit.

Let us assure you, if you are experiencing such a problem, you share this problem with over 5 million other Australians. In fact, 1 in 4 people over the age of 15 are incontinent, and females account for 80% of cases of urinary incontinence alone. Shockingly common right?! Well the good news is, help is at hand. The majority of cases of incontinence respond very well to conservative, non-surgical treatment and can often be completely resolved. Interested to know more? Then please read on…

Types of incontinence

It is important to know that there are different types of incontinence, and the management for each is different based on the cause. Briefly, the different types of urinary incontinence include:

  • Stress urinary incontinence (SUI) – the most common form, where small amounts of urine leak due to small increases in pressure on the bladder during physical activity, or from coughing, sneezing and laughing.
  • Urge incontinence – where you get an unexpected, strong urge to urinate with little to no warning. This is usually as a result of an overactive bladder muscle.
  • Incontinence associated with chronic retention – where your bladder cannot empty fully, and you get regular leakage of small amounts of urine. There are many causes for this, including an enlarged prostate in men, or prolapsed pelvic organs in women, as well as medications and certain conditions, such as diabetes and kidney disease.
  • Functional incontinence – where you are unable to get to the toilet, possibly due to immobility, or wearing clothes that are not easy to get off in time.

Faecal incontinence is when you have a lack of control of bowel movements and you may accidentally pass a bowel movement, or even pass wind without meaning to. This may be due to weak muscles surrounding the back passage (ladies, unfortunately this can be following pregnancy and childbirth), or if you have severe diarrhoea.

Why so many females?

In short, babies and menopause! The most common type of incontinence that we see and treat is stress incontinence. Although seen across both sexes, women are three times more likely to experience it than men. It is very common in women following pregnancy and childbirth (when the pelvic floor muscles get overstretched, and sometimes even damaged), and during menopause (due to hormonal changes).

Pregnancy, birth and menopause can affect our pelvic floor. The pelvic floor muscles sit at the bottom of the pelvic bowl, spanning from the pubic bone to the tailbone (front to back), and from one sitting bone to the other (side to side). Imagine a trampoline stretched out and attached to each bony point and you kind of get the gist. When these muscles are strong, they help to support our internal pelvic organs (i.e. the bladder and bowel, and uterus in women) and wrap around the openings of the front and back passages, allowing us to control when we decide to do a number one or two. Following pregnancy for example, they may become weak and dysfunctional, and we can lose that ability to control voiding. It only takes something as small as a cough, or an activity like jumping or running (things many of us take for granted) that may cause a person to lose a small amount of urine.

Treatment Options

There are a number of treatment options that could help. What is most important is that you come and see us first, so we can understand the issue and figure out the best course of treatment. Some treatment options include:

  • Pelvic floor and strengthening exercises
  • Manual therapy
  • Biofeedback (to monitor your muscle activation)
  • Weight loss
  • Reducing caffeine or alcohol
  • Fluid altering
  • Bladder training
  • Quit smoking
  • Medication
  • Surgery or other procedures

We hope you have found this blog interesting and helpful. Please join us in celebrating World Continence Week and help us to raise awareness for people living with incontinence. If you, or someone you know is looking for answers or advice on the management of these conditions, then please get in touch. We are ready to offer professional advice and/or treatment. No more leaking when laughing!

Stress urinary incontinence – what causes it, how to treat it and how to prevent it

Running, sneezing, jumping, laughing – they should be normal activities, but for some women they bring embarrassment or anxiety. Bladder weakness, incontinence and urinary leaking are common problems, especially in women after giving birth or going through menopause. There are many causes of bladder weakness, but today, we’re focusing on one of the most common: Stress urinary incontinence (SUI).

What is stress urinary incontinence?

SUI is where the bladder leaks a small amount of urine during activities that put pressure on the abdomen and push down on the bladder, like coughing, running or laughing.

What causes it?

The bladder

Stress incontinence in women is often caused by pregnancy,

childbirth and menopause. In a quick anatomy lesson, your urethra transports urine from your bladder out of the body, via a muscular structure called the urethral sphincter. The sphincter contracts to hold urine inside your body until you’re ready to go.

During pregnancy and childbirth, your pelvic floor muscles can stretch and weaken. The muscles normally support the urethra, so when they, or the sphincter muscles, are weak, they can’t do their job properly and hold your wee in. During menopause, the female hormone, oestrogen, is produced in lower quantities. Oestrogen helps maintain the thickness of the urethra lining, so sometimes with decreased oestrogen, the lining is affected, and some women experience SUI.

It’s most common with activities such as coughing, sneezing, laughing, walking, running, lifting or playing sport. Other factors that can contribute to SUI include diabetes, obesity, constipation, and a chronic cough (often linked to asthma, smoking or bronchitis).

How to treat it?

Every single person is different, so it’s always best to see your Pelvic floor physio so we can assess you and work out the best treatment plan for you. However, some common treatments we recommend to our patients include:

  • Pelvic floor exercises (see below for more information!).
  • Changes in fluid consumption: This could include drinking certain amounts of fluids at certain times of the day. Or it could involve cutting down caffeine or alcohol to see if they irritate your bladder.
  • Healthy lifestyle changes: Quitting smoking, losing excess weight or treating a chronic cough will decrease your risk of SUI, as well as improve your symptoms.
  • Bladder training: We may recommend a schedule for toileting, depending on the type of incontinence you have. This is more so used when it’s a mix of SUI and another type of incontinence.
  • Manual therapy: You may have some muscular imbalances that are inhibiting your pelvic floor from working properly or are impacting on other parts of your body. We’ll assess you, and then put together a treatment plan, which may include soft tissue massage, other musculoskeletal therapies, strengthening or stretching exercises, or more.

How do I prevent it?

Remember your physios, nurses, doctors, female relatives, mum friends (and the list goes on) telling you to do your pelvic floor exercises or Kegels when pregnant? Well, that’s one piece of advice you should listen to! In fact, it doesn’t matter whether you’re pregnant or not, you should always do your pelvic floor exercises to help strengthen those important muscles. Some basic pelvic floor exercises include:

  • Draw your pelvic floor muscles in and up, like you are trying to stop urinating mid-flow. Hold for 10 secs. Relax for 5-10 secs between each tightening and repeat 10 times. (Don’t actually do your pelvic floor exercises on the toilet – trying to stop while actually urinating can cause other bladder issues)
  • You can add faster pelvic floor lifts to the exercise by holding for 1-3 secs and relaxing for 1-3 secs. Repeat 10 times.
  • Progressing the long holds to 20 secs and then 30 secs may be a goal to reach for.

Try and make pelvic floor exercises part of your routine. For example, do them when you brush your teeth each morning and evening, and when eating lunch. There are also many more exercises to help you, including core exercises such as Pilates.

Pelvic floor exercises should not cause any discomfort or pain. If you have a history of pain with intercourse, vaginal exam or using tampons, or if you have trouble emptying your bladder or starting a wee, you should see a Pelvic Floor Physio prior to starting pelvic floor exercises.

If you’re experiencing urinary leaking, are pregnant, have given birth (at any point in your life!), or if you want help with a preventative program, please come and see us. It is always best to see a Pelvic Floor Physio to get an individual program and to be confident on correctly tightening your pelvic floor muscles. We have helped thousands of women with stress urinary incontinence over the years and would love to help you live a happier, less-anxious life, so you can laugh all you want without having to worry about incontinence!

Pelvic pain in pregnancy

pregnant woman holding hipsYou’re growing a human – a tiny person that will change your life and body forever. Of course, we expect changes and some discomfort as our body adapts to our growing belly, but seriously – this pelvic pain is another level! But what is it?

Pelvic pain during pregnancy can be from a range of things, but Symphysis Pubic Dysfunction (called SPD) is a pretty common cause. It can also be called Pelvic Girdle Pain (PGP). SPD & PGP can be explained as a bunch of signs or symptoms relating to pain in the pelvic area and lower back. It also includes musculoskeletal pain radiating to the upper thighs and crotch area.

So why does this happen? At certain stages throughout pregnancy, your body produces the Relaxin hormone, which relaxes the ligaments, producing more movement in the pelvic region to allow for expansion, not just for the baby to grow, but ultimately for the delivery of bub. This relaxation of the pelvic ligaments leads to increased joint mobility.  Where the ligaments usually provide support to the joints, the muscles now have to step in and help stabilise them – they get overworked and that’s when the pain starts. Symptoms of SPD can vary widely – from mild discomfort to severe pain that can see women bed-ridden or needing walking aids.

It’s hard to say how many women actually experience SPD in pregnancy. Research suggests it’s somewhere between 4 – 84%! The variation is because of the wide range of definitions and diagnosis of SPD, as well as differing research cohort selections.  However research also suggests that the incidence rate increases during the later stages of pregnancy. So what influences its onset, and how do you treat it?

Influences of SPD

While there is no way of accurately predicting which women will experience SPD, common factors that might influence the onset include women:

  • who have a history of low back pain or trauma of the back or pelvis
  • with an increased number of previous pregnancies
  • who partake in physically demanding work
  • with a high Body Mass Index (BMI)
  • experiencing emotional distress
  • who smoke
Treatment

There isn’t one particular treatment, but common treatments include:

  • Physiotherapy: Research suggests that women receiving physio treatment reported less pain in the mornings and evenings than those women who didn’t have treatment.
  • Acupuncture: As with physio, acupuncture helped with pain, and functional movement.
  • Pelvic support garments: Research suggests that these improved women’s ability to do things like walk and perform basic movements.
  • Exercise: This can also help improve functional movement and help decrease pain, but ensure you visit your physio first, to understand what exercise is right for you, your condition and your pregnancy.
  • Rest: It’s not always possible to rest completely but try to limit doing the activity that causes the most pain, avoid standing on one leg, limit weight-bearing exercises like climbing stairs or standing for long periods of time.

Pelvic pain in pregnancy is common. If you are experiencing pelvic pain, your first step is to see your physio to understand what it is and how to treat it.

In the meantime, try changing your routine by sitting down to get dressed and rotate those stilettos for low heels or flat shoes. One of the best things to try is pretend you’re always ‘walking around in a pencil skirt’ – take small steps, and when getting out of the car, slide your bottom 90 degrees and get out with your legs together. Heat might also provide some temporary relief.

To help you see an end point of your pain, know that SPD usually sporadically fixes itself after birth. And of course, holding that tiny human in your arms makes up for the grief (and you can remind them about the pain they put you through for years to come).