Tali Manne Physiotherapy + Acupuncture: Women's health

14/11/2021

All too often I'm hearing pregnant women being told their symptoms will pass after birth and to just "wait it out".

Whilst some of this may be true, and many symptoms will hopefully pass after the birth, pregnancy is a long period of time to be "waiting it out" (and suffering). And not all symptoms will just disappear post birth.

Whether you're experiencing pelvic pain, perineal heaviness and pulling, perineal swelling, lower back pain, rib discomfort, urinary issues, bowel issues and so on....it's worth getting checked out and asking your Gynecologist for a referral to a pelvic floor physiotherapist.

☝️These symptoms can often be helped!

So, whilst most the complaints are very common and considered 'normal', you may be able to find relief to help see you through, and even eliminate the issues.

For any more information, get talking to your health professionals! And feel free to PM me with questions😊

24/10/2021

After having this conversation with a few patients last week about different types of training and the fears associated with them, thought I'd write a post!

🏋️ Strength training is an integral part of an exercise routine. It's recommended by the ACSM specifically for women age 35 up as preparation for the menopausal period (changes in bone density etc).

Women will often tell me that they avoid weight lifting for fear of getting injured, or causing pelvic floor symptoms and so on.
Research, however, shows that it is not associated with high frequency of prolapse or urinary symptoms.
(In fact, running is associated with a greater risk of injury!)

As with most exercise, if the level is not suitable for the person or if the the progression is too quick, we may see symptoms showing up or injury occuring.

☝️That's where we all want to be conscious and aware of our bodies.
Can you do an exercise without breath holding? Do you feel symptoms such as heaviness or leakage during a specific activity? Are you pushing your abdominals outwards as you exert yourself?
Have you been examined by a professional in the area you experience symptoms?

Another thing to think about is what you're doing in your daily life. Are u lifting a 10kg baby multiple times a day? Sometimes with a stroller too?
Or carrying heavy shopping bags into and out of the car?
In that case you're going to want your exercise routine to reflect that and prepare you for correct and safe lifting.

In general, best to include a variety of exercise - aerobic, strength, stretching, relaxation.
And to listen to your body. There may be times you need to focus more on the relaxation, or times when you may want to decrease the load (during your period for example).

So those are just some points to ponder!
Make it fun- if you enjoy your exercise routine you'll likely stick to it better😊

27/02/2021

It's so great to see there is more open talk about pelvic floor issues. It helps to increase awareness and allows for such important conversation.
Sharing common symptoms can be encouraging, reassuring..but don't let it get in the way of treating symptoms that can and should be treated.
Just a couple of examples I see a lot in the clinic..

🎗️Urinary incontinence may be common during and post pregnancy..that does not make it normal or ok. Even if it's only occuring with jumping or sneezing (known as stress incontinence) it indicates a dysfunction that should be addressed.

🎗️Pain during in*******se may be something that many women will experience at some point in their lives..but it is NOT normal and is NOT something any woman has to just push through.
Possible causes of pain:
-scar tissue post birth or surgery
-low estrogen levels in pregnancy/breastfeeding/from the contraceptive pill
-overactive pelvic floor muscles
Just to name a few..
Again, it's not normal and you can get help to alleviate the pain.

Let's keep the conversation happening whilst encouraging treatment where needed🌸

25/01/2021

Such a great informative post on pelvic pain in pregnancy..

You don't need to "wait it out until after birth" like many women are advised.
See a Physiotherapist who's trained in this area for further advice and treatment.

נשים הרות רבות סובלות מכאבי אגן.
כאבים אלו יכולים לנבוע מכל מיני סיבות, ולכל כאב שם אחר וטיפול שונה.

כאב במפרק הסימפיזיס פוביס הוא אחד מכאבי האגן הנפוצים.
מפרק זה מחבר את שתי עצמות הערווה במרכז האגן מלפנים.
כאשר ישנה היפרדות של יותר מסנטימטר בין שני חלקי המפרק התופעה נקראת 'סימפיזיוליזיס'.

לא נמצא קשר בין גודל ההיפרדות לעוצמת הכאב והמוגבלות שהאישה חווה. כאשר יש כאב אך אין היפרדות המצב מכונה SPD (הפרעה בתפקוד בשל כאב במפרק).

נשים הרות עלולות לסבול מכאבי תופת גם כשאין פתיחה של המפרק כלל. הכאבים מושפעים מאוד מההורמונים המופרשים בהיריון.
הכאבים יכולים להתחיל בשלבים מוקדמים מאוד של ההיריון בלי קשר למשקל המתווסף.

ישנן נשים הסובלות מהכאב המדובר גם לאחר הלידה.
כאב שאינו מטופל עלול להפוך לכאב כרוני.

בעבר לא היו מתערבים טיפולית בכאבים אלו.
רופאי הנשים והאורתופדים היו ממליצים לנשים להשתמש בחגורת אגן על מנת לסייע בהקלת העומס, ולחכות עד לאחר הלידה.

מאחר שהבעיה אינה מסכנת את חיי האם והעובר, לעיתים קרובות נשים אינן זכאיות לשמירת היריון בשל הכאבים הללו ונדרשות להמשיך לעבוד.

בשנים האחרונות הגיעה לארץ הכשרה חדשנית לפיזיותרפיסטיות שנתנה כלים להקלה בטיפול בכאבי אגן סביב הריון ולידה.
לפני שרצים לבקש צילומים והדמיות כדאי להגיע לאבחון פיזיותרפי אצל פיזיותרפיסטית שהוכשרה לטיפול בתחום.

שלב האיבחון הראשוני יהיה שלילה של פתולוגיות אחרות שיכולות לגרום לכאבים דומים. לאחר מכן מנתחים ומבודדים את מרכיבי התנועה והכאב, ואז בונים תוכנית התערבות לפי צרכיה של המטופלת. למטופלות שונות מתאימים כיווני עבודה שונים, ויש צורך באבחון מדויק על מנת לתת פתרון מיטבי.

לפעמים יומלץ על שימוש בחגורות מסוימות ליצירת לחץ ויציבות באגן, לפעמים ממש לא. תלוי.

קל יותר לטפל בכאב חדש מלטפל בכאב ישן (אם כי גם כאב ישן דורש טיפול). כדאי לטפל בכאב כבר במהלך ההריון.

יש מקום לחכות לשיפור ספונטני לאחר הלידה, אך נשים הסובלות מכאבים חריפים צריכות לגשת לטיפול פיזיותרפי כבר שבוע (!) אחרי הלידה, ולא לחכות עד תום משכב הלידה . אם יש כאבים גם 12 שבועות אחרי הלידה סביר להניח שהכאב לא יעבור לבד.

בשורה התחתונה: אם את סובלת מכאבי אגן בהיריון, גשי לטיפול מייד. אל תחכי עד אחרי הלידה, אל תסתפקי בשימוש בחגורה שלא בהכרח מתאימה להקלה על כאבייך. אל תחכי שהכאב יהפוך כרוני. קל יותר לטפל בכאב טרי.

התקופה הזאת היא אחת החשובות בחייך.
אל תיתני לכאב מיותר להאפיל עליה.
גשי לטיפול.
פנו לפיזיותרפיסט/ית

נכתב על פי דבריה של:
Adi Amit David
https://www.facebook.com/adi.amitdavid
על ידי:

Avital Beej Etz
https://www.facebook.com/avital.beej
תודה על הייעוץ ל:
Hadas Gabbay Ashush
https://www.facebook.com/hadas.gabay.9

20/12/2020

🚻 Do you find yourself looking for the bathroom every place you visit? (I used to!)

🚻 Do you avoid drinking before leaving the house or going on a long journey (I did!)

🚻 Do you find that as you put the key in the door your urgency skyrockets? (Didn't have this one but it's an issue for many people!)

The average bladder can hold between 400-600 ml of fluid.
Its job is to store fluid until we decide to empty it (usually when it's about 3/4 full).
So if you're going to the bathroom every hour or waking up in the night to p*e, you may want to think about doing some bladder retraining.

💪 You can take control and change this! I did😉

Bladder retraining involves behavioural and cognitive changes.

Learning about the process, about urge control techniques, improving bladder capacity as well as avoiding foods/drink irritants can be very helpful.

A common mistake is to avoid drinking much at all. But when the body is dehydrated, it can actually increase the feeling of urge and needing to urinate!

If this is something that you're dealing with, you CAN take control of your bladder and stop letting it control you..

15/12/2020

No, bending down from your back to pick something up from the floor is not bad for everyone. Nor does it need to be avoided at all costs!
And no, crunches are not a bad exercise for all pregnant/post partum women!

We're often told that certain movements are to be avoided full stop. But there aren't movements that are inherently wrong or bad.
It's true that in certain situations when movement causes pain, it's often best to avoid it while addressing the core of the issue. The idea is not to avoid a specific motion or exercise forever.

Our bodies are designed to move! And our backs are designed to be able to bend forwards as well backwards, sideways and twisting.

It's also important to get to know your own body. To learn when a movement feels right and when a exercise feels like its too much at a given stage.

So, with bending down from your back..this is a movement that our backs are supposed to do without pain - in fact you get a nice hamstring stretch as you do it!
But sometimes we find ourselves bending our backs most the day (whether it's sitting for long periods, doing dishes, picking things up from the floor) and we don't balance it out with other back movements like extension for example. A nice way to balance out the bending would be to do exercises like the one in the pic - Cobra.

The idea is to have a variety of movement in our daily routine..
So try out a movement or position that you don't find yourself in too often and see how it goes!

Thank you מרים דיאמנט פיזיותרפיה- שיקום רצפת אגן, שיקום אורטופדי, פילאטיס for the post inspiration!

29/11/2020

It struck me last week that the most common complaint I was seeing at work was pain in the pelvic area. And all of the women had all been suffering for a couple of years!
It had taken that long for them to get referred to pelvic floor physio🙄
So I wanted to share a little on the subject to try and get women the care they need earlier!

✨Pelvic girdle pain or PGP refers to pain in the pelvis or lower abdomen lasting longer than 3 months

✨It's common and often not addressed or treated until way down the line.

✨Symptoms can vary- some women able to continue their daily functions and others where it impacts every part of their day including affecting their quality of sleep.

✨PGP includes pain in the coccyx, groin, ge***al area, vulvar/perineum, pain with in*******se, as well as pain in the sacroiliac joint and p***c symphysis- more common during pregnancy (the list goes on....)

✨Getting the correct advice and early treatment can help ease the suffering.
There's a lot that can be done, and if symptoms are during pregnancy, most women do NOT have to just wait it out until after birth!!

If you suffer from PGP or have any questions feel free to PM me. Go get checked by your Gynecologist and pelvic floor physio :)

Have a great week x

16/11/2020

Going to the bathroom, whether to p**p or p*e, involves RELAXATION of your pelvic floor muscles.

Straining with constipation, or just pushing out of habit, can lead to downward pressure on your pelvic organs and weakening of your pelvic floor muscles (and potential risk factor for prolapse)

Incomplete relaxation can also be the cause of urinary retention and the feeling of incomplete emptying of the bladder.

There's A LOT that you can do to improve these functions!! A pelvic floor physio is the place to go!
Feel free to get in touch with any queries..

10/10/2020

RELAX! and let your tummy release.

Sucking in and clenching your abs will limit your ability to take a good deep breath. This can disrupt the communication between your diaphragm (main breathing muscle) and your pelvic floor.

It can also put pressure on your pelvic floor and organs which can lead to symptoms such as heaviness or leakage.

So every so often, check in and place a hand on your belly and feel it expand freely as you breathe in....and just let go...

06/10/2020

Following on from my last post, here are some pointers on DRA management.

There is no one size fits all approach to treating DRA, no perfect exercise or protocol. Your exercise program should ideally be individualized to take into account what stage of rehab you are in, what YOUR goals and what activities YOU want to get back to doing. It takes time and gradual progression get to where you want to be, but don’t let frightening statements like “you’ll never do a crunch again” prevent you from reaching your rehab goals.

🌸If you’re able to start rehab early, that is going to be optimal- to coincide with the spontaneous recovery that occurs after birth.

🌸You want to be aware of what changes are occurring in your body-to know and feel how your abdomen is working in different functional activities and exercises. To also be aware of your BREATHING and your pelvic floor, and to understand when a function or activity is too hard AT A GIVEN POINT IN TIME (your rehab is not static and nor should your exercise routine be). If you can’t do an exercise without holding your breath-it’s probably too hard for you right now. If you can’t do an exercise without bulging in the midline, it’s probably not suitable for you at this stage. On the other hand, you do not need to fear seeing that bulge here and there.

🌸We want to look at improving posture if necessary- that will impact on the way the abdomen looks and functions.

🌸Rehab should include strengthening your abdominals in all directions- We don’t want to be avoiding trunk flexion in the post-partum period. The rotator muscles are important too! We also want to stretch these muscles to keep them at their optimal length.

🌸It’s important to note that rehab is not just about “Narrowing the Gap”. We do measure and monitor the gap in treatment, but we also want to know what’s happening within that gap, what the tension is like in the tissue. Is the tissue very soft and ‘smushy’? Or does it feel firm? Are the muscles ‘communicating’ well with each other.

👆If you feel your body image, daily functions or fitness is impacted by DRA, or you are unsure what rehab you should be doing, go get a check-up!

04/10/2020

This is a BIG topic that gets loads of attention around post natal rehab. I'm hoping to share some info on the subject and some management tips!

Diastesis Re**us Abdominis or DRA is the separation or thinning of the tissue between the Re**us Abdominis muscle (known as the Linea Alba), and is measured by having a gap over 2cm.

There’s a lot of conflicting information on the internet, much of which induces fear and can discourage women from doing activities and exercise that they would actually be benefiting from. Many women CAN go back to doing all the activities that they were before pregnancy.
The research still has unanswered questions, but here are some thing we do know-

♣️ Approx 30% of women have DRA
♣️ Up to 100% of women will have DRA by the end of the third trimester!! This implies that its NORMAL and physiological in pregnancy- which makes sense because our abdominal muscles need to stretch to accommodate a growing belly
♣️ There is spontaneous recovery after birth-most apparent in the first 3.5 months post-partum. A third of women will still have DRA a year after birth
♣️ DRA can lead to lowered body image and self-esteem. It is not just aesthetic. It's connected to reduced abdominal strength and compromise of trunk stability and synergy of the abdominal muscles. So in rehab we’re looking at how well the two sides of the abdomen can communicate with each other and transfer force
♣️ Physical activity during pregnancy, including abdominal exercises, can decrease DRA by 35%, so its important to be active and include ab work in your routine, suited to your stage of pregnancy.

Some people have a gap prior to their first pregnancy (they just never measured it). When it comes to rehab, goals need to be realistic, so for example, if you had a gap before your first pregnancy, your goal is not going to be to close the gap beyond where you started.
*Stay tuned for my next post on management and treatment!