MuTu System Exercises with Wendy Powell

Our friend Wendy Powell, a postpartum recovery and fitness expert in the UK, has created MuTu System, a 12 week program to get your body back into health after pregnancy. It offers great explanations of posture, body mechanics and nutrition. Wedny has shared with us some great exercises for getting rid of what she calls ‘mummy tummy’ (hence MuTu!) and healing pelvic pain. Check out some of them below, and learn more about her and MuTu System on her website here.

All text + images copyright ‘MuTu® System Limited 2014’

Lie Back + Squeeze

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Lie on your back with your knees up + a small ball between your knees. Bring your knees into your chest far enough so there is no strain on your abs to keep them there.
Turn your feet out. Exhale as you squeeze the ball + draw your belly button towards your spine. You’ll feel your pelvic floor contract at the same time. Relax + repeat.
As well as the ‘belly button to spine’ movement, another way to make sure you get it right is to imagine your lower abdomen as a clock face, with your belly button as 12 o’clock, pubic bone at 6 o’clock + your hipbones as 3 + 9. As you exhale, draw in your belly button, draw up your pelvic floor + imagine pulling 3 + 9 o’clock apart. Inhale + relax, then repeat. Keep your spine in neutral + don’t let your pelvis tilt as you move.

Lamp Post Pee

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Start on all fours, with shoulders directly over hands, hips over knees. Keep your arms straight + try to shift your upper body weight into your fingers rather than all on your wrists.
Exhale + engage your core muscles (gently draw in your lower abdomen as you breathe out + move) + lift one knee out to the side. Just off the ground is fine, but no higher than parallel to the ground. Bring it back down as you inhale, then repeat.
Try not to let your weight shift right over to the supporting leg, you want the movement to happen by rotating at the hip, not by leaning or twisting your whole body to one side. You are stabilizing your torso + engaging your core as you lift your leg, + then relaxing as you lower.
It’s harder to initiate or feel a pelvic floor contraction when you abduct your legs, but be assured that the transverse muscle + the pelvic floor can co-contract – one movement is making sure the other happens!

Exercising While Pregnant

By Fiona McMahon, DPT

If you were paying attention to the Boston Marathon this April you probably heard about 35-year-old Amy Keil of Minneapolis who ran the 26.2 mile course while 7.5 months pregnant. Reactions to pregnant women competing at a high level run the gamut from awestruck at the mother-to-be’s sheer fortitude to furious at the seemingly blatant disregard for the health of her unborn baby. Seeing these athletes compete at high levels sparks the questions, how much exercise is safe for these women and how much physical activity should the average woman get while she is pregnant?

Up until recently, there has been a dearth of scientific studies examining the effects of high-level exercise on the health of the mother and her child. In 2012, Linda Szymanski and Andrew Satin published an article in the American Journal of Obstetrics and Gynecology examining the effects of strenuous exercise on the fetal and maternal well-being in both physically active and inactive women. In the study women were classified by self report as “non exercisers” (women who exercised for less than 20 minutes for fewer than 3 sessions a week),  “mild to moderate exercisers” (women who worked out for at least 20 minutes per session up to 3 times a week), and highly active exercisers (women who exercised greater than 4 times a week).

The women in this study participated between the 28th and 32nd week of their pregnancy. The participants ran on a treadmill with a 2% incline that increased every 2 minutes until the grade reached 12%, at which time the speed was increased by 0.2 miles per hour every 2 minutes. When the women no longer wanted to continue, they were allowed to stop and the well-being of their fetuses was examined by measuring the blood flow through the uterine and umbilical arteries, fetal heart rate, and maternal heart rate.

The women all reached a heart rate of well over 140 beats per minute, which was beyond the traditional limit on physical activity in expectant women prior to 1994. All women also exercised at a perceived exertion rate consistent for the definition of strenuous exercise. The study found that the blood flow through the uterine and umbilical arteries did not significantly change with exercise in any of the groups of women who participated in the study indicating that in short duration strenuous exercise may not be harmful to the fetus. The study did find that five women in the highly active group experienced fetal heart rate decelerations when they finished running on the treadmill. The fetal heart rate returned to normal within 2-3 minutes and did not meet the inclusion criteria for fetal bradycardia (slow fetal heart rate). The authors of this study were reassured by the transient nature of these fetal heart rate changes in the highly active group.

The work presented by Linda Szymanski and Andrew Satin provides athletes who are pregnant with some reassurance that they are not harming their baby by continuing to exercise. The authors do point out that the work presented in their article should be interpreted cautiously as it includes only one data point from the third trimester of pregnancy and should not be taken as definitive proof that strenuous exercise absolutely won’t harm an unborn child.

So you may be thinking that you absolutely have no intentions of running until exhaustion when you are pregnant, but should you still exercise? Much of the research published on activity and pregnancy says yes.

In a 2012 review conducted by Tiffany Field in infant behavior and development, exercise was found to be protective against depression, cramps, edema (swelling), low back pain, and gestational diabetes. She found the Tai Chi was particularly helpful in improving oxygen consumption, and that yoga reduced stress.

Safety is important to keep in mind while exercising when pregnant. The pregnant body undergoes a multitude of different changes that will affect your ability to exercise. During pregnancy your blood volume will increase. With the blood volume increase, the ratio of plasma to red blood cells (your body’s oxygen delivery system) will change leaving you with relatively few red blood cells compared to plasma, which will make you feel more tired more quickly. Your need for oxygen will also increase as you progress through your pregnancy. Your growing baby will also put pressure on your diaphragm making the amount of oxygen available for exercise decrease. These changes may make you feel more tired than you would when you were not pregnant and you may have to cut back the amount of activity you do.

The American College of Obstetrics and Gynecology (ACOG) advises that women who are inactive be examined by a health care professional before starting exercise while pregnant. They recommend that women try to get 30 minutes of exercise a day. They advise women with a history of pre-term labor or fetal growth restriction to reduce their activity in the second or third trimester. The ACOG recommends athletes with uncomplicated pregnancies continue to exercise as tolerated during their pregnancy.

What warning signs should you look for when exercising while pregnant? The NCAA has released guidelines on exercise in their Policy on Gender Equality. Athletes should not start exercising, or should stop exercising, if they experience vaginal bleeding, leaking of clear fluid from the vagina, headaches, chest pain, decreases in fetal movement, calf pain, muscle weakness, or breathlessness prior to exercise.

While the jury may not have completely reached its verdict on whether or not ultra intense athletic events are safe while pregnant, exercising at mild to moderate levels while one is pregnant is largely considered to be safe and to yield many benefits to expectant mothers. Keeping an open dialogue about your fitness goals with your gynecologist can help you to formulate a fitness plan that will allow you to reap the many benefits of staying active while pregnant.

Stay tuned for more Blogs on prenatal pain and leakage, postpartum pain and other conditions, and sexual health after childbirth.

Sources

  • Davenport M, Giroux I, Sopper M, et al. Postpartum exercise regardless of intensity improves chronic disease risk factors. Medicine & Science in Sports & Exercise. 2011; 951-958
  • Ferreira C, Alburquerque-Sendín. Effectiveness of physical therapy for pregnancy related low back and/or pelvic pain after delivery: A systematic review. Physiotherapy Theory and Praticce. 2013: 29(6):419-31
  • Field T. Prenatal exercise research. Infant Behavior and Development. 2012; 35: 397-407
  • Hogshead-Maker, N, Scrensen E. Pregnant and Parenting Student- Athletes: Resources and Model Policies. NCAA Gender Equity.
  • Noon M, Hoch A. Challenges of the pregnant athlete and low back pain.  Curr Sports Med Rep. 2012; 11(1):43-8
  • Szymanski L, Satin A. Strenuous exercise during pregnancy: is there a limit? American Journal of Obstetrics and Gynecology. 2012

The Pain No One Wants to Talk About

By Fiona McMahon and Amy Stein

Imagine if you will, Sheila. Sheila is an active 30-something who has just come into her own. She is moving up the ranks at work, she is in a stable and loving relationship, and is even thinking about having kids one day. Imagine Sheila begins developing pain in and around her vagina that makes it painful for her to have sex with her partner, sit for long periods of time, or even wear tight pants. Sheila begins missing work because she can’t bear to sit for eight hours a day, she stops working out, and her relationship with her partner has become increasingly strained. Sheila feels increasing shame that she is not the sexual person she once was and is hesitant to bring her pain up to her doctor because she fears there is nothing he can do, or even worse, he might think her pain was all in her head.

Now imagine Sheila’s pain isn’t in her vagina, but rather it is in her back. You could imagine that the version of Sheila, with the back pain ends up faring much better than the version of Sheila with the vaginal pain. Sheila with the back pain isn’t embarrassed to bring her pain up to her doctor. She may even talk to her friends about their back pain and treatments and practitioners that have helped them.  Sheila is given all the tools, resources, and support of the healthcare community and her friends to help treat her back pain and return to the person she was before. The version of Sheila with the vaginal pain remains unsure of where to start. She is embarrassed and feels alone in her journey. She has bounced back and forth to doctors, urologists, gynecologists and even psychologists but has found no cause or relief in her pain.

We at Beyond Basics see it as one of our key missions to open a dialogue about the millions of women (and men!) who suffer with pelvic pain and provide them with treatment options to help them return to their former selves. We recognize for many women and men, pelvic pain is a profoundly sensitive subject that can be difficult to talk about. We also recognize that the consequences of letting pelvic pain go unchecked can deeply affect an individual’s, and their family, friends and colleagues’ quality of life.

Let’s start our conversation with the type of pain Sheila was experiencing. Someone like Sheila might start her journey thinking she has a urinary tract infection or a sexually transmitted disease, but when the results of her medical tests come back negative, she and her healthcare practitioner may not be aware that her pain could be caused by musculoskeletal dysfunction, which can be treated by a trained pelvic floor physical therapist.

Patients who lack a clear cause of their pelvic pain may have muscle spasm or nerve irritation, in their pelvic floor muscles, weakness, or bony misalignments. We refer to these problems in the pelvic floor as pelvic floor muscle dysfunction (PFMD).  PFMD can occur from a variety of different causes, a fall while skiing, stress, chronic illness, or previous acute infection.

PFMD can occur in men, women and children, of whom may experience pelvic, abdominal, hip, back and/or lower extremity pain.  In addition, men may experience pain in their testicles, groin, tip of the penis, or perineum. Women, like Sheila, may experience vaginal pain with penetration (superficial or deep), burning in the vulvar area, or pain in their clitoris. PFMD can significantly impair one’s ability to enjoy sex, causing painful penetration in women, and post ejaculatory pain, premature ejaculation, difficulty reaching climax, and erectile dysfunction in men. Patients with PFMD may also experience urinary and gastrointestinal issues and/or incontinence.

A pelvic floor physical therapist can diagnose PFMD by performing a specialized pelvic exam, where the therapist will test the strength of the pelvic floor muscles, their ability to relax, and whether or not the pelvic floor muscles are in spasm or are shortened. A pelvic floor physical therapist will also examine the skeletal alignment, the strength and range of motion of the hip and core muscles, and the muscles and fascia of the abdomen, back, lower extremities and perineum to assess for other possible biomechanical contributors to the patient’s pain and symptoms.

Based on what the physical therapist finds, he or she will develop a specialized course of treatment for the patient. Sometimes scarring is the culprit in PFD. Conditions like endometriosis, episiotomies, and abdominal and pelvic surgeries can all cause scarring. Scarring can lead to tissue adhesions, which don’t allow the tissues of the abdomen, trunk and pelvic area to move freely. Tissues that can’t move freely, whether from shortened muscles or from scarring, can impair motor control, visceral function (i.e. intestines) and contribute to pain. Tissue restrictions and shortening can be effectively treated in physical therapy by using manual techniques to mobilize the restrictions both internally and externally. In addition, the pelvic floor physical therapist will correct bony misalignments that may be found upon exam.

Weakness is a common contributor in PFMD. Weakness can cause the organs of the pelvic cavity to drop lower in the pelvis due to a lack of muscular and connective tissue support. The dropping of these organs can cause discomfort that worsens over the course of the day. A patient with weak pelvic floor muscles can be guided through an exercise program to strengthen his or her pelvic floor.

Pelvic floor physical therapists may also use different tools besides their manual skills to address PFMD. Some women experience pain during penetration because the skin and muscles of their vagina and/or perineum are too tight. In this case, a physical therapist may use vaginal dilators to gently stretch these tissues allowing the patient to comfortably be able to accommodate her partner’s penis or a sex toy during penetration.

Biofeedback is a tool that can help improve a patient’s awareness of his or her pelvic floor muscles. Biofeedback is used to show the muscle activity of a patient’s pelvic floor as a display on a computer, allowing the patient to see the action of his or her pelvic floor in real time. For a patient who is experiencing pain, a physical therapist can use biofeedback to teach a patient how to properly relax his or her pelvic floor muscles allowing for better pelvic floor function.

Having pain is hard. Having pelvic pain is arguably even harder. We as a society attach so much shame to this area of our body that sometimes we end up closing ourselves off from possible treatments when something goes wrong with our pelvic floor. We at Beyond Basics hope you have found this article helpful and encourage you to seek help from a pelvic floor physical therapist if Sheila’s problems seemed at all similar to your own. We hope this post has helped you to reconsider pelvic pain and the options that exist to help you return to your old self.