CLS Physiotherapy & Nutrition

CLS Physiotherapy & Nutrition Providing Women's Health Physiotherapy & Nutrition Services in Canterbury, Kent & virtually.

🚨Pelvic health physios🚨 This is a relatively niche one, but I’d really like to use your collective brains as a sounding ...
16/08/2026

🚨Pelvic health physios🚨

This is a relatively niche one, but I’d really like to use your collective brains as a sounding board.

This post came from a conversation with a PT who had referred her asymptomatic pregnant client to a pelvic health physio, primarily to check that she was activating her pelvic floor correctly.

During the assessment, the client had a measurement taken of her perineum. I don’t know the exact specifics of what was measured, but the client understood from this measurement that she was at a higher risk of perineal tearing during birth and was subsequently advised to stop lifting weights during pregnancy because of this.

I’m acutely aware that this is second-hand information. We all know that what we communicate as clinicians and what a patient takes away from a consultation aren’t always the same thing, so there may well be more nuance to the original conversation.

Nonetheless, the client’s take-home message was that she was at high risk of tearing and that lifting weights could increase that risk. She left the appointment scared to lift.

I don’t routinely take perineal measurements as part of my antenatal pelvic floor assessments, so this sent me down a bit of a rabbit hole:

👉🏼What exactly are we measuring?
👉🏼How well does it predict perineal trauma?
👉🏼Does identifying someone as potentially “higher risk” actually change our management?
👉🏼And, importantly, what are the potential unintended consequences of communicating that risk?

As you’ll see from the carousel, I’m not presenting this as “this measurement is wrong and nobody should be doing it.” It’s really me hashing out my own thoughts after looking at the evidence and having conversations with other pelvic health physios.

So pelvic health physios, I’d genuinely love to hear your clinical reasoning.

Do you take perineal measurements antenatally? If so, what do you measure, how do you use that information, and does it change the advice you give?

And if you don’t measure — why not?

Would love a nerdy pelvic health discussion on this one 👇

Kinda chic x
02/08/2026

Kinda chic x

28/07/2026

I prescribe pelvic floor wands to some of my patients… but probably not for the reason you think.

I’m not convinced they “release trigger points.” Instead, I think they’re a valuable tool for graded exposure, desensitisation and helping an overprotective nervous system learn that vaginal touch can be safe again.

I think pelvic floor wands can work but should we questioning how they work.

What are your thoughts? 👇

Can we stop saying “deep core”?It’s a phrase I hear more and more in pregnancy, postpartum and pelvic health. But what d...
26/07/2026

Can we stop saying “deep core”?

It’s a phrase I hear more and more in pregnancy, postpartum and pelvic health. But what does it actually mean?

The more I looked into it, the more I realised that even the term “core” doesn’t have a universally accepted anatomical definition. So adding the word deep doesn’t necessarily make things any clearer.

The evidence also doesn’t support the idea that isolated transversus abdominis activation is superior to general exercise for improving diastasis recti or pelvic floor dysfunction. We also have recent RCTs showing that exercises like curl-ups can improve abdominal strength without worsening diastasis recti or pelvic floor symptoms.

What concerns me most is the message behind the phrase. It can imply that women need to reconnect with a hidden set of muscles before they can safely return to exercise.

In clinic, I regularly meet women who tell me they’ve been doing “deep core” workouts for months but don’t feel challenged. Quite often, they’re simply being underloaded.

Like every other muscle group, the abdominal wall adapts to progressive loading. If we become too cautious, we risk reinforcing the idea that women’s bodies are fragile rather than capable.

Perhaps instead of asking women to “find their deep core”, we should focus on helping them build strength, confidence and capacity.

I’d love to hear your thoughts.What does the term “deep core” actually mean to you?

This week I delivered a webinar on hormonal health across the female life course for , and one question that came up wa...
16/07/2026

This week I delivered a webinar on hormonal health across the female life course for , and one question that came up was:

“Why are my periods so much heavier after having a baby?”

I had a few ideas, but I didn’t know the evidence well enough to answer with confidence. As it’s a question I’ve now been asked several times in clinic and during teaching, I thought it was time to go away, do some reading, and find out what we actually know.

The reality is that there isn’t one single answer. It’s likely a combination of factors, including changes to the uterus during pregnancy, hormones and ovulation taking time to settle (particularly after breastfeeding), and the fact that the postpartum period often comes with sleep deprivation, stress, under-fuelling and reduced opportunities for exercise, all of which can influence menstrual health.

For many women, the first few periods after having a baby are heavier or more unpredictable. That can be completely normal.

However, if your periods are so heavy that you’re soaking through pads or tampons, passing large clots, feeling dizzy or exhausted, or they’re stopping you from living your life, it’s worth getting them checked.

A great place to start is the free Period Symptom Checker, which can help you understand whether your symptoms warrant further assessment and gives you information to take to your GP appointment.

As always, if something doesn’t feel right, trust your instincts. Heavy periods are common, but they don’t have to be something women simply put up with.

I’m increasingly seeing content from fitness influencers and coaches with clickbait hooks such as:“Training for birth”“T...
17/06/2026

I’m increasingly seeing content from fitness influencers and coaches with clickbait hooks such as:

“Training for birth”

“The exercises that made my birth easier”

“These workouts meant I had no pelvic floor issues after birth”

Whilst I’m fully supportive of encouraging exercise during pregnancy and sharing positive birth experiences, I think we need to be much more mindful of the language we use.

Pregnancy, birth, and postpartum recovery are influenced by multiple factors, many of which are completely outside of our control. Exercise can absolutely be beneficial, but when we suggest that a particular workout, training programme, or set of behaviours caused a low-risk pregnancy, straightforward birth, or symptom-free recovery, we’re oversimplifying an incredibly complex process.

These narratives often attribute positive outcomes solely to individual behaviours, whilst overlooking the roles of genetics, physiology, healthcare access, socioeconomic factors, environment, and, sometimes, simple luck.

The unintended consequence is that women who exercised, prepared, followed the advice, and still experienced complications can be left feeling as though they somehow failed or didn’t do enough.

We can promote exercise in pregnancy without suggesting it guarantees a particular outcome.

If you’re looking for more balanced and nuanced conversations around pregnancy, birth, and exercise, I’d highly recommend listening to on the podcast. It’s an excellent discussion that acknowledges both the benefits of exercise and the complexity of pregnancy and birth outcome.

The reality is that there is no single right answer. Factors such as your symptoms, recovery, investigations, previous b...
15/06/2026

The reality is that there is no single right answer. Factors such as your symptoms, recovery, investigations, previous birth circumstances, and future plans all play a role. But above all, the deciding factor should be informed maternal choice.

Women should have access to balanced information, appropriate investigations where indicated, and support from healthcare professionals who can help them understand their options and make the decision that feels right for them.

If you have experienced a severe perineal tear, one organisation I highly recommend is I’ve had the privilege of working alongside MASIC and they provide invaluable support, education, and advocacy for women recovering from birth injuries.

And if you have a question you’d like me to answer, keep an eye out for my anonymous question boxes. I try to pop one up at least once a week, and they often inspire posts like this one. Chances are if you’re wondering it, someone else is too.

If you’re a pelvic health physiotherapist, obstetrician, midwife, or another professional supporting women after OASI, I’d love to hear your perspective.

👇 What factors do you think are most important when counselling women about birth choices after a 3rd or 4th degree tear?

Apparently the Price of Women’s Health Advocacy Is £4,000. And I regret to inform you that my NHS salary combined with m...
12/05/2026

Apparently the Price of Women’s Health Advocacy Is £4,000.

And I regret to inform you that my NHS salary combined with my PhD stipend won’t stretch that far.

🎓 Thousands graduate. Only a handful get jobs.Inspired by a post from and speaking in parliament about physiotherapy, ...
06/05/2026

🎓 Thousands graduate. Only a handful get jobs.

Inspired by a post from and speaking in parliament about physiotherapy, I tried to investigate the state of physiotherapy for new graduates.

The only figure I could obtain was that there are around 3,000 new graduates per year. Although this is not from an official source, it aligns with statistics showing there are around 85–90 courses across the UK, each with about 30–35 students per intake.

When I checked NHS Jobs on 5th May, I counted six Band 5 jobs (new graduate level) advertised.

Despite soaring demand in the NHS and record numbers of new healthcare graduates, entry-level roles are vanishing. Recruitment freezes, delayed hiring, and unfilled vacancies are leaving skilled clinicians on the sidelines—while patients wait longer for care and overworked staff shoulder the blame for system-wide issues.

This isn’t just a physio problem. Midwifery, nursing, medicine, and paramedicine are all feeling the strain. The real shortage isn’t talent or willingness to work—it’s funded posts, sustainable workforce planning, and long-term investment in our healthcare system.

We can’t fix the NHS by training more professionals alone. The system needs to employ and retain them, too.

Last week, M Powered and I recorded a podcast about pelvic floor dysfunction and exercise (out next week). It reminded m...
30/04/2026

Last week, M Powered and I recorded a podcast about pelvic floor dysfunction and exercise (out next week). It reminded me how often women share stories of misguided advice from healthcare providers when managing prolapse, prompting me to revisit the findings of the narrative review I wrote for my MSc dissertation.

Too many women are told to avoid lifting and impact, or to “just do pelvic floor exercise.” But the evidence doesn’t support these blanket restrictions. There’s no consistent proof that resistance training or high-impact movement worsens prolapse—or that it doesn’t. That means recommendations should be individualised. The best approach is to collaborate with each woman, testing different exercises and adjusting based on her symptoms—modifying, not banning, movement.

Current research doesn’t support blanket restrictions. Instead, symptom-guided exposure is key: gradually increase strength and tolerance over time. Avoidance actually reduces capacity and does not protect women long term.

Pelvic floor muscle training is important, with gold-standard evidence supporting its effectiveness—even if the anti-Kegel movement disagrees. But pelvic floor exercises shouldn’t happen in isolation. Clinicians should integrate pelvic floor function into whole-body movement, because the pelvic floor doesn’t work alone in real life, and rehab shouldn’t either.

Another issue is generic, unsupervised advice. Too many women are given leaflets or told to “do their exercises” with no plan for progression. But like any muscle, the pelvic floor needs overload, progression, and individualisation to actually improve.

Dismissive language has real consequences. Women often describe feeling dismissed, fearful, or limited by the advice they receive, which leads to reduced activity and confidence.

What women really need is specialist, supportive care, care that builds confidence in movement and recognises that strength training and impact can be part of the solution, not the problem.

Effective prolapse management keeps women active and confident.

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St Lawrence Clinic, Spitfire Ground Street Lawrence
Canterbury
CT13NZ

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Monday 4pm - 8pm
Saturday 8am - 4pm

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