Losing the baby weight

After giving birth just over a week ago to my son, it might be appropriate to write about the extra baby weight and some realistic expectations and real medical facts. Although it may not be directly related to physiotherapy I still feel it is an important topic worth mentioning. 

Once the baby comes out, why o why does the tummy not go back to the way it was? Well first of all you have breast tissue, increased blood supply and for the first 6 weeks you still have an enlarged uterus. In fact, depending on the size of your baby you might not look that much skinnier than when the baby was inside you.

The most important thing to remember is slowly is the key to healthy weight loss, especially if you are breast feeding. Starving your self is not a responsible way to lose weight, especially as you are now responsible for not just your self but also your newborn, and your baby needs to grow (you don't want to put your baby on a diet with you) The body needs to heal and it does this with the right nutrients. You need to be drinking plenty of water and eating from all the different food types in a

balanced diet.

Exercise is also another key way to lose weight, finding the sport that you like and enjoy is always a good start to keep you focused, but don't over exert yourself. You need to listen to your body; rest post birth is important in your recovery. In fact the body takes 2 years to fully recover after birth, although most feel fine much much sooner than this time frame. Within the first 6 weeks post birth it is very important to listen to your body and go and take the mid-day nap when the baby is sleeping.

A healthy happy mummy is a healthy happy baby. But if your are suffering from any aches or pains and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you privately or through Leumit in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Understanding Round Ligament Pain

Round ligament pain is a sharp pain or jabbing feeling often felt in the lower tummy or groin area on either or both sides. This believe it or not is one of the most common complaints during pregnancy and is most common during the 2nd trimester.

There are several thick ligaments (ligaments are what joins two bones together) that surround and support your uterus. One of these ligaments is called the round ligament. This connects the front part of the uterus to the groin (hence that is where the pain is felt).

As your baby grows and your uterus and tummy therefore also grow the round ligament is therefore forced to stretch. If it becomes too stretched it starts to strain. If this happens then sudden movements can cause the ligament to tighten quickly (a bit like an elastic band snapping quickly). This is what causes a sudden and quick jabbing feeling. Ligaments are suppose to tighten and relax slowly when bones bend and straighten.

The symptoms of round ligament pain include a sharp sudden spasm in the belly. More often affecting the right side more than the left. The pain also only lasts a few seconds. Some exercises may cause the pain as well as rapid movements such as sneezing, coughing, laughing, rolling over in bed and standing up too quickly.

How can the pain be relieved?

If you feel it is necessary then you can take over the counter painkillers like paracetamol or acamol. Make sure you are not taking Nurofen (Ibuprofen).

Specific exercise is very good for this. Some exercises are counterproductive to round ligament pain but exercises that keep your stomach and core muscles strong are good. Stretching is also helpful. Often one of the more helpful exercises is putting your hands and knees on the floor, lowering your head and pushing your backside into the air.

Try to avoid sudden movements. Change positions slowly, especially standing up.

Bend and flex your hips before you cough, sneeze or laugh to avoid pulling on the painful ligaments. Heat can also help relieve the pain, but make sure not to put the heat directly over the baby.

Round ligament pain is often quick and not long lasting but you should be aware if anything changes and when to go to the doctor immediately; for instance, severe pain, pain that lasts more than a few minutes, fever, chills and pain on urination and if you are having difficulty while walking.

Stomach pain during pregnancy could have one of many different possible causes and it is important for your doctor to rule out serious conditions such as inguinal hernia, appendicitis, and stomach, liver and kidney problems. Pre-term labour pains can sometimes also be mistaken for round ligament pain.

Physiotherapy is not your first port of call on this one. The diagnosis should be made by the doctor first so that everything else can also be checked. Upon diagnosis and only after that is physiotherapy then appropriate to advise on correct exercises.

If you are suffering from round ligament pain and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you privately or through Leumit in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Exercise After a C-Section

Getting the right balance after a C-section is extremely important. Your body needs to recover and rest is very much needed. Rest whenever you get the opportunity in the first 4-6 weeks. Whenever the baby is sleeping, forget the housework and take a nap too (and anyone who knows me personally will know that me saying forget the house work is not something to be taken lightly.)

Eventually your body will start to feel like yours again and exercise can help the healing process along. A good form of general exercise is walking, starting with as little as 5-10 minutes daily and gradually building the time up to 30-40 minutes over the first 2 months.

Your lower trunk will also need to be strengthened and stabilised. This includes pelvic floor muscle exercises - which should not be forgotten by any women, not just those who are post c-section. Pelvic floor exercise should be carried out at least 3 times a day. Holding a contraction for 10 seconds and doing 10 reps of these, and also doing a quick contraction with a quick release also doing 10 reps of these.

Transversus abdominal exercises are another main area to focus on, (which includes pelvic tilts).

Lie on your back with your knees bent and feet flat on the bed. Pull in your tummy and tilt your pelvis up, flattening out the lower back. Hold this position for 2-3 seconds and then slowly relax half way. Continue tilting your pelvis up and relaxing to the half way position. Aim for the movement to be slow and smooth.

If you are suffering from any pain and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Labouring with SPD: The Birth Plan

Making a birth plan is important in my opinion (even if you don't stick to it) and this is even more true if you suffer from SPD. In a midwife's ideal world there would be no pregnancy complications and everyone would deliver on their backs in stirrups, so that the midwife could maintain a good posture and control the baby easily. In many patients' ideal world they would deliver in a more upright position so gravity could help the labour and delivery along. By making a birth plan, you can consider all the different options and factors and work our what your preferred labour would look like.

If you suffer from SPD it is important before labour begins to measure how far you can open your legs in a pain free range. If your are very prepared you can buy a long piece of rope and tie it around your knees so you have the measurements of how far you are going to allow your legs to be open during the delivery, on hand. This is even more vital if you plan on having an epidural. This is because you will not feel pain while the epidural is in but will feel the pain afterwards if you have opened your legs into your pain range. With this in mind, a position that should definitely be avoided is a delivery in stirrups.

In the first stage of labour, movement and gravity play an important role. Most commonly, at this stage you are still at home, and timing your contractions. If you suffer from SPD it is still good to be walking around but not to be constantly climbing the stairs, which can often speed things along. Using the gym ball can also be good, by sitting on it and rolling your pelvis, but do ensure that your legs are not straddled too far open.

It is important to support your body in positions that are comfortable for you but to avoid straddling your legs, for example do not straddle a chair, however you can lean onto a chair or any other equipment.

In the final pushing stages there are many good options for positions. Being on your side is very good because the midwife can have good control and you can too. You can also be in a squatting position (as long as you are in pain free range). Any position where your legs are in your control and cannot be pushed open by someone else is a good position.

If you are suffering from SPD and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Tips for After a Caesarian Section

Those of you that have been through or will be going through a C-section rather than a vaginal delivery might notice a difference in recovery after the birth. You might not go through the pains of labour, you might be unlucky enough to have to do both but you will definitely realise that your body will need to recover once the baby is out. Your body will be sore in many different places and recovery time will be longer in comparison to vaginal delivery.

Rest whenever you get the opportunity in the first 4-6 weeks. A good form of general exercise is walking, starting with as little as 5-10 minutes daily and gradually building the time up to 30-40 minutes over the first 2 months. It is also important to do specific exercises to strengthen and stabilise the lower trunk. This includes pelvic floor muscle exercises, transverse abdominal exercises and pelvic tilts. I will go into more detail on these specific exercises next week.

It is also important to move in and out of bed correctly. Pretend you are still pregnant (yay). Move slowly and try to avoid using the abdominal muscles in the first 4-6 weeks. To get in: sit on the edge of the bed, lean down onto your elbow towards the pillow, bend your knees and lift your legs onto the bed, then roll onto your back. Reverse this action to get up.

When coughing and sneezing support your lower abdominals by placing your hands or forearms over the caesarean wound. Contract the pelvic floor muscles before the cough or sneeze. To clear your chest take three slow deep breathes in and out, then huff (as if to steam up a mirror), then support your cough as above.

Avoid all unnecessary lifting (so lots of excuses can be made to the hubby about housework.) Avoid lifting heavy objects (anything bigger than the baby) for the first 4-6 weeks. To lift, keep your back flat, draw your tummy in, squeeze your pelvic floor muscles and bend your knees. Keep the object close to you as you lift it up. Use your legs to take the weight of the lift and not your back. So avoid strenuous housework - this definitely includes but is not limited to the laundry basket and the bucket of water to wash the floor.

Driving should be avoided for 6 weeks but you will need to contact your insurance company for individual policies. You must be able to do an emergency stop without hesitation or pain before you can drive again.

You must also speak to your own doctor about pain relief, especially if you are breast feeding.

If you are suffering from pain would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

SPD After Labour

Symphysis pubis dysfunction (SPD) is a common condition found during pregnancy, presenting as pain around the pubic joint area. It is a separation by this joint that leads to pain, caused by the hormone relaxin that is produced in your body during pregnancy. Once the baby is born, the level of the hormone decreases (but is mimicked if you are breast feeding), and the pain will start to go away.

Well this is the scenario in most cases, however for some people this pain can linger or even start after labour itself. Due to the hormone relaxin, your ligaments are more soft and stretchy to enable your baby to be born. Due to this, labour itself (especially if it is a traumatic birth or you delivered in stirrups) can cause a separation at the symphysis pubic joint.

SPD after labour will get better but in some cases it can take time. The good news is there are things that can be done to speed this healing process along, one of those being physiotherapy. After your physiotherapist has assessed you they will give you lots of advice on movement techniques such as keeping your legs closer together during activities that you need to carry on with your daily living. They will help you find comfortable positions to carry out tasks that are important to you. They may also decide to give you crutches if they feel you will benefit from them, along with a specially designed SPD belt (this is different from a back support belt). They will also guide you on specific exercises and design you a personal home program exercise session. Of course this program will also include pelvic floor exercises that every woman should include into her daily routine.

If you feel you need to, you can also take pain killers and over the counter anti-inflammatories. It is important to remember that you can only take anti- inflammatories after labour once the baby is out and NOT if you are still pregnant and suffering from SPD. This is true even if you are breast feeding. If you are pregnant and suffering from SPD, you can only take over the counter pain killers such as Acamol and must go to your doctor if you need something stronger.

.

If you are suffering from SPD and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Diary with a Capital Pee: Keeping a Bladder Diary

When trying to improve any area of your life you will only know if you have done so by recording the figures and measuring the change. This is the reason I ask my patients who come to me for pelvic floor rehabilitation to keep a diary. In the diary I ask them to jot down the following activities:

• Date / time of day
• Type and amount of fluid intake
• Type and amount of food eaten
• Amount of urine excreted (small, medium, large)
• Amount of leakage (small, medium, large)
• Activity engaged in when leakage occurred
• Was an urge present? (Yes or No)
• Change of pad required?

It is very important for all women to be doing their pelvic floor exercises every day. The reason being that we have so many factors against us that we need to be one step ahead of the game. Pelvic floor muscles get weakened with every pregnancy. 65% of pregnancies come with incontinence. Although lots of women then have no incontinence problems once the baby is out, it is important to remember that the muscles have been weakened so exercise is still crucial.

If you are lucky enough not to fall in the above 65% you are still not home free because the actual delivery can also cause weakness. 60% of women who have had 4 or more babies complain of incontinence.

I am very pro breastfeeding, it has many advantages and I do it myself, but unfortunately it is also a contributing factor, due to hormones. As mentioned in previous blogs, relaxin weakens joints and ligaments, and it takes 3 months for this hormone to leave our bodies after birth - but while we are breastfeeding, this hormone is mimicked. It is more important for breastfeeding mums to do their exercises and they often see little improvement for there efforts – but it would be far worse if they don't.

Another contributing factor is the neurological one. It is important to remember your pelvic floor contracts reflexively before we cough or sneeze. Reflex inhibition is the brain’s way of protecting a part of the body that is damaged. Unless these reflexes are re-established, chronic injury can be a result. You are probably more familiar with ankle sprain, and probably know that if the ankle is sprained badly there is a tendency for that ankle to twist and give way again. When treating sports injuries the physio concentrates on retraining the protective reflex action of the muscles around the ankle. There is no point in treating the joint without re training the reflex. So to it is the same with pelvic floor after childbirth. The protective reflex contraction of the pelvic floor when you cough or sneeze is lost, but this protective reflex can be re-learnt. You can teach yourself to actively squeeze and lift before each cough or sneeze.

Even if you do not suffer incontinence post-birth, the muscles have gone through a real beating and exercise to regain strength should start no later than 24 hours post delivery.

The pelvic floor muscles fatigue like all other muscles do. It is important to realise that fatigue is also a contributing factor to the fall of the pelvic floor. Therefore rest is also important, especially just after giving birth.

Quite often if you have recurrent cystitis/urine infections it can lead to bladder instability. It is the inflammation in these cases that is the cause of your incontinence.

Now let's mention menopause. Many women sail through life blissfully unaware of the time bomb ticking away between their legs. Quite often they are totally unaware of the stresses and strains that have weakened their pelvic floor until they reach menopause and this is the final straw. During menopause the oestrogen level drops. Oestrogen factor is also responsible for the thinning effect that can occur within the vagina and urethra. Meaning the pelvic floor needs to be stronger.

Ageing can also take a toll on your pelvic floor like it does with all your muscles, so too with constipation, chronic cough and being overweight.

As you can see the odds are against us women, but the dairy helps monitor all aspects of the bladder routine and can hopefully help show the effects of exercise and work out what needs to be changed.

If you are suffering from incontinence and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com. I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Useful tips after birth

Now many of you may think that this topic is not physiotherapy-related, but the job of a women’s health physio sometimes involves treating patients within hours of them giving birth. In these cases, we provide general advice on advisable body positions, as well as treating the patient for the uncommon discomforts post-labour.

My number one tip of the day would be to keep drinking water, and lots of it. You may quite often hear many of the different medical professionals say this, but this is because it affects so many systems in the body that it is an all round good substance for the body. Many might recall the soreness down below when urinating. Now the water can change the pH of your urine making it sting less. If you find it very painful when you urinate then you can pour water on yourself, down the toilet whilst urinating. I might also add that doing your pelvic floor exercise can also increase the healing time as it increases blood flow. (There is just no escaping those pelvic floor exercises).

While on the topic of soreness, some patients have told me they have difficulties in sitting on a hard chair. So here is another piece of DIY make it yourself equipment advice. Take a towel and roll it up into a sausage shape. Then place the towel in a horse shoe shape on the chair and sit on the chair, thus relieving you of putting pressure on the pain. 

While you are not in company or even if you are you can put some ice on the sore area. The recommended method would be to use a bag of frozen peas wrapped in a tea towel. It is best to do this 10 minutes at a time, giving yourself a 10 minute brake before repeating. 

One of the less talked about problems that can follow is constipation. Whilst on the toilet, put a foot stool (mind the pun) under your feet to raise your legs, knees bent hips flexed above 90. This creates a smoother route for the stool to exit your body.  

I don’t talk about it much, as physiotherapists are very much advocates for exercise, but do remember to rest after giving birth. Birth is a wonderful and traumatic event on your body and rest will help improve healing times.

If you suffer from any type of muscle pain during or after pregnancy and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com.  I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.

Exercise During Pregnancy: The Correct Formula

You may have heard the saying from your doctor or midwife that it is fine to carry on with exercise during pregnancy but don’t take on any new activities. You may have also heard the advice that pregnancy exercise classes are great and that general exercise and keeping fit is a great way to prepare your body for labour. So what happens when these two pieces of advice contradict each other?  

As a general rule, exercise that you were doing before pregnancy is usually safe during pregnancy – except of course for extreme sports and other dangerous activities such as horse riding. 

The benefits of exercise during pregnancy

Exercise is important during pregnancy, and has a number of benefits for you and your body:

• It increases your energy levels  
• It can help you sleep better (very important before the baby comes)
• It reduces those pregnancy discomforts: As your bump gets bigger it pulls your body into a different posture, meaning that you are relying on different muscles from normal while carrying out your daily activities. Exercise helps stretch and strengthen your muscles, making them easier to use and therefore helping you cope better with the aches and pains.
• Exercise helps prepare your body for labour; the better shape you’re in, the stronger your body will be when it comes to labour and delivery. Giving birth requires stamina, determination and focus, all skills used and practised while exercising.
• There are medical articles that say that exercise makes for an easier labour and a shorter one too
• Exercise can improve stress levels by increasing levels of serotonin, a chemical linked to mood; stress levels can often increase during pregnancy for many reasons
• It can also improve your self-image and make it easier to get your body back into shape after giving birth  

Striking the right balance

Even if you don’t exercise regularly pre-pregnancy, taking on new classes specific to pregnancy or low impact exercises (e.g. regular walking or swimming) are not only going to do you no harm, but will do you the world of good, provided that you are not suffering with any specific pain and are having no complications. Pregnancy exercise classes are normally very good because they focus on core stability exercises related to the muscles that are put under extra stress with the change of posture that takes place during pregnancy. Walking and swimming also have many benefits, such as help your aerobic activity and stretching and strengthening your muscles. However, it is not advisable to take on high-impact or over-strenuous exercise, such as training for a marathon.

 If you are suffering from any type of pain during pregnancy and are not sure if it’s safe to exercise and would like to book an appointment, please contact me on 0544485086 or by email to tamaramay.physio@gmail.com.  I can arrange to see you in Bishvilaych Women's Comprehensive Medical Centre in Givat Shaul, Jerusalem or a home visit if you live in Gush Etzion.