By Liz Brookes, Pilates Instructor
As a busy Mum taking time out for yourself with a regular movement practice is so important when you’re constantly taking care of others and are constantly on the go. When things get a little overwhelming during your day take a few minutes to restore your nervous system with some abdominal breathing and release of your surrounding tissues.
Abdominal Breathing Exercise
Begin resting on your back with your knees up and feet flat on the floor a little way apart. Focus your attention into your belly. You might want to put your hands there to feel the pressure shifting in and out of the belly region to create relaxation. Try to breathe so that your belly, pelvic floor, waist and lower back feel expansive on the inhale and deflated on the exhale. Feel the distance tissues travel as you deliberately focus on breathing into them. Repeat for 10 breaths.
Roll onto your side with your knees bent and a support under your head. Use a prop of a rolled up mat or towel supporting your waist between your ribs and your hips. Begin breathing by inhaling intentionally into the prop under your waist to make it expand while your top waist side contracts.
Hold your breath for a moment and then contract all the muscles below the diaphragm (lower ribs), hold the contraction for three seconds and then exhale. Allow the prop to enter your side as tissues become more pliable. Repeat this breathing 5-7 more times. Then switch sides and repeat the same process on the other side.
If it is comfortable, lie face down and rest your abdomen on top of the prop slightly below your belly button.
Start breathing by inhaling intentionally into the prop. Hold your breath for a moment and then contract all the muscles below the diaphragm (lower ribs). Hold the contraction for three seconds and then exhale. Allow the prop to release into your belly as your tissues become more pliable. Repeat this contract and relax breathing 5-7 more times and then return onto your back into the starting rest position.
Practice this breathing technique when things get a little overwhelming and you need to push your reset button.
Now you are ready to give yourself some ‘me time’ with a regular movement practice with Pilates classes in our new Collective Loft Space at Auckland Physiotherapy.
Invigorate and energise yourself with one of our Essential or Intermediate Reformer classes. Or if you need a bit more specialised care we have Private one-on-one or Studio classes available where the focus is on just you as you are. Our team of expert instructors are equipped with the skills to modify any of the exercises to accommodate for injuries, pregnancies and any other life’s discomforts. Pilates is great for anyone whether they have practiced Pilates before or not. If you have any concerns with any existing or old injuries you can always have a 1-1 first with one of our highly trained Physiotherapists who will ensure you get the best advice and guidance before you join in a regular class.
Haven't done Pilates before? Pilates was founded in the 1920s by Joseph Pilates, a German physical trainer who developed this progression-based fitness method that gives you a workout that is both effective & safe, suitable for all ages, gender and fitness levels.
It’s a method of exercise consisting of low impact exercises that focuses on the whole body, targeting strength, flexibility, stability, postural awareness, spinal mobility and body-mind connection.
You can’t think of anything else except focusing on your own self-care when you are practicing Pilates, so it is a great way to regain energy, strength and focus before you enter back into being a busy Mum again!
Happy Mother’s Day!
By Renée Malyon
It is known to be one of the hardest things you will ever do in your life…do you ever feel completely ready for it?…many women say no. Motherhood is a ‘rite of passage’ as some call it; a truly life changing event. Here at Auckland Physiotherapy, we want to acknowledge all of the women out there that have embraced this journey and salute you this Mother’s Day.
Working in the Women’s & Pelvic Health field for the last 16 years has taught me so much. The resilience, willpower and emotional strength women have is such an understatement… it is a testament. I am incredibly passionate about supporting women and work in a very holistic way to ensure you feel seen, heard, and nurtured.
We have a Women’s Health team along with other niche services and products to support you throughout this journey. No matter what stage you are - be it pregnant, early postnatal, or even ‘years gone by’, a ‘WOF’ session with Anna or myself can assist you in treatment, prevention and upscaling your daily function and wellbeing.
What treatments do we offer?
We can provide manual therapy and rehabilitation for spinal & pelvic pain (PGP/SPD)/sciatica/sprains/strains, dry needling, Clinical Pilates, preparation for labour, abdominal re-training following C-section or Rectus Abdominis Diastasis, pelvic floor re-training, urinary and bowel dysfunction, prolapse management, bladder retraining for overactive bladder, internal manual therapy, and rehabilitation post prolapse repair, hysterectomy and other pelvic floor surgery. Guidance for return to sport and exercise is also included within this, along side our other physiotherapy colleagues, running assessment and strength and conditioning / Pilates team. Mindfulness and Somatic Trauma Therapy may also be something you may want to explore with me – check out the website for more information.
Furthermore, our Women’s Health and Pregnancy Support shop on our website includes products such as belts, pelvic floor devices, SRC shorts (for pre and post natal pelvic/abdominal support), Pilates and exercise equipment, period underwear and more. We advise that you contact the team for a call if you have questions about one of these products and have not yet been assessed.
What exercise can you do during pregnancy?
Pregnancy can feel like a marathon at times so the fitter you are before pregnancy, the better you may generally feel during pregnancy and afterwards. There are many forms of exercise you can do before and during pregnancy to help prevent and treat musculoskeletal pain, and pelvic floor dysfunction. Firstly, Pilates-based exercise, continuing cardiovascular activity and specific strength exercise that your body is used to is advised. It is important that you listen to your lead maternity care professional as some exercise is not indicated for particular issues.
There are sound guidelines that support exercise during pregnancy (e.g. The Royal College of Obstetricians and Gynaecologists and Sports Medicine Australia). Women must ensure they have been cleared to exercise, and a physiotherapist or trainer with specific qualifications in exercise in pregnancy can help guide you.
Looking after your pelvic floor muscles is essential to help prevent leakage from the bladder and bowel ante and postnatal, to help safeguard from prolapse and may improve your sexual function. It is quite important to know that you are doing these correctly and that they are actually appropriate for you.
What forms of exercise do we recommend post-partum (and what to avoid)?
The first thing to understand postpartum is what your body has been through. Hormones and the growth of your baby has affected a lot of the soft tissues and therefore how your joints function. This can have a significant effect on the stability system of the body.
For the first 6 weeks, take it easy, let your body heal, and the soft tissue recoil without overloading it. Avoid heavy lifting (apart from your baby) for the first 6 weeks and wait until you have been cleared to do so. Learning to isolate the pelvic floor and transversus abdominis muscles with your breath in different positions is a nice starting point. Walking for cardio with gentle progressions then moving onto other non-impact cardio e.g cycling, cross trainer from 6-8 weeks. No other abdominal exercises should be performed until you have a good deep transversus abdominis activation and proper breathing technique.
Rectus abdominis diastasis can occur in up to 80% of women in the third trimester. It is therefore very important to avoid sit-ups, planks and heavy loaded exercise or running/impact work until it is almost closed. Research has shown that there is a strong correlation between abdominal muscle weakness, rectus abdominis diastasis and pelvic floor dysfunction/incontinence.
Return to impact exercise is often the most common topic women are concerned about. Some of the hormones that influence soft tissue laxity during pregnancy can remain in the body until 6 months after you stop breastfeeding. Therefore, the effects and vulnerability to the pelvic floor can continue up until this point. Research is now saying to avoid any impact exercise for the first 6 months at least post-partum, but this in individualised to each person and their health and exercise history.
Still have questions? Give our team a call!
If you are experiencing symptoms that you are concerned about and you are not sure what to do, we are here to help you. Book a complimentary consult in with Anna or myself, or book in for an initial first appointment women’s health consultation for when suits you. We also offer telehealth video call appointments to get you started.
It’s Just a Headache
Written by Robyn Atkinson
Headache is considered one of the most common disorders globally, however most headache sufferers do not seek treatment. Instead, they rely on over the counter medication to ease their pain - sometimes for many years without end. Unfortunately pain medication only masks the pain, with the underlying cause ready to trigger the head pain again. This merry-go-round of numbing the pain with pills is a widely accepted solution for headache pain…but should it be?
Think of pain as your body’s way of telling you that something isn’t right. Whether it’s repeated headache attacks, constant daily headaches or migraine, taking the time to investigate the cause of your headache can save you from future pain (and pills). Pain medication can be a quick and easy solution, but without addressing the root cause of the pain - your headache is likely to always return. Not to mention, most pain medication can exacerbate your headaches over the long-term (also known as medication overuse headache).
Headaches are classified as either primary or secondary. Primary headaches, such as migraine and tension-type headache have no known cause. Headaches from a known cause such as neck dysfunction or from pain medication overuse are classified as secondary headaches. With approximately 300 different types of headache however, it may be difficult to decide where to start looking for non-pharmaceutical relief. Luckily, there is a common feature between most headache types:
a sensitised trigemino-cervical nucleus (TCN)
- also known as the lower brainstem.
The lower brainstem extends into the spinal canal (down to the 3rd bone of the spine). Joint or muscle dysfunction in those top 3 levels of the neck will sensitise the TCN/lower brain stem causing pain to refer into the head, giving you a headache or migraine. Over time, sensitisation of the lower brain stem can lower the body’s threshold to hormones, stress, fatigue, wine, cheese etc. giving these factors the potential to cause a headache. But these triggers may not be the cause of your headache - your sensitised brainstem likely is!
Fortunately, physiotherapy can help headache sufferers. I, Robyn Atkinson, have been trained in the Watson HeadacheⓇ Approach. This method is an internationally renowned and researched method of examination and treatment for headaches. Its’ accuracy is unparalleled: specific tests can confirm upper neck disorders responsible for headache and migraine and isolate the specific joint/structure involved. The Watson HeadacheⓇ Approach utilises small amplitude techniques (no cracking or manipulation) to confirm involvement of the neck through reproduction and resolution of your usual head pain.
This targeted and gentle treatment to the upper neck, reduces sensitisation of the lower brainstem, leading to long-term resolution of your headaches, ability to return to what you love to do (and eat and drink!) without getting a headache or migraine. No more pills, no more avoiding the things that you love.
How do I know if my headache is coming from my neck or a sensitised brainstem?
Your headache may be caused by neck dysfunction if you experience any of the following:
Still not sure if the root of the problem could be within your TCN/brainstem? Consider these 4 headache myths:
Actually, you do not need to have neck pain in order to have a headache that is caused by neck dysfunction. Impairments in the neck joints, muscles or discs can sensitise the TCN/brainstem causing headache without causing neck pain. The best way to determine if your headache is coming from your neck is to receive a physiotherapy assessment. Your physiotherapist will confirm involvement of your neck through reproduction of your headache followed by alleviation of the pain by sustained pressure over the structures in the upper neck. Reproduction of pain followed by amelioration indicates neck dysfunction and an underlying sensitised TCN.
Associated symptoms such as nausea and dizziness have been found to improve with hands-on therapy in cases where the sensitised brainstem is responsible for triggering those symptoms. Furthermore, it is common for headaches to present with an overlap of headache type symptoms (i.e. migrainous and tension-type). Determining underlying neck dysfunction, regardless of the predominant headache classification or diagnosis, is crucial in the effective management of your headache.
Many headache sufferers that I see have been suffering from headaches for a decade or more. They may get them everyday or a couple times a month. Eventually, when they decide enough is enough - they seek help. Medicating for a headache seems harmless at the time, but how long would you be willing to employ this strategy? It is curious how pills have become synonymous with headache management (several different commercials come immediately to mind for me). We wouldn’t be satisfied with long-term pain relief for an injured ankle, but covering up headache symptoms has somehow become status quo. Is it possible that we have been conditioned to accept headache pain, when similar pain in other parts of the body would trigger us to find the cause rather than a temporary band-aid solution?
Relief from strategies such as massage, may only be part of the solution. If the headaches keep coming back, chances are the root cause has not been addressed. With the potential for multiple contributing factors, headache management should be individualised. In addition to hands-on therapy for the neck, physiotherapy can also provide relief from head pain through postural correction; advice on positioning when asleep or at your desk; strengthening exercises for the neck and shoulders; and self-management pain relieving strategies.
Should I consider other causes before booking a physiotherapy appointment?
You may consider seeing your optometrist if you haven’t had your vision checked recently or believe your headaches may be due to eye strain. On a more serious note, a very small percentage of headaches will have a more sinister cause that requires emergency care: if your headache is severe or came on suddenly without cause (within seconds), has been worsening or is unlike any other headache you’ve ever experienced - seek medical attention. If you’re not sure however, your physiotherapist will be able to guide you in the appropriate management of your head pain.
Effective treatment is available for the following headache types through The Headache Clinic:
To enquire or book an appointment, please call our friendly reception team on (09) 366 4480 and ask about The Headache Clinic or book online HERE.
Movement Therapy by Mira Boeyens
Should I be doing yoga or pilates, is one superior over the other… and what is actually the difference between the two?
Firstly, both yoga and pilates is for everyone, from complete beginners to advanced gurus. However, there are some differences that’s noteworthy, especially if you are recovering from an injury.
Pilates is powerful as it caters to all levels, including those after injury/surgery. Pilates is often my “go to” when reintroducing exercise/starting rehabilitation after injury. The benefit with pilates, is that you can more easily focus on activating, recruiting and strengthening specific localised muscles.
You can perform certain exercises on the equipment available, such as the reformer, which you otherwise would not have been able to do without it. The equipment allows us to start with exercises, activating and recruiting the correct muscles- without pain, that would not have been possible otherwise.
As you progress, you strengthen and heal, your programme is progressively advanced to challenge you, molding you into a fitter, stronger version of yourself that will support a body that is less likely to reinjure.
You can think of yoga as an exercise for both your mind and body. It will challenge your mind-body connection, flexibility, strength and balance through a specifically designed class, where postures/exercises are sequenced to flow together at varying tempo’s.
Some classes are slow, involving sustained stretches to improve muscle length and postural imbalances, while other classes flow through a variety of movements that challenge balance, strength and endurance.
Yoga focuses on the entire body; deep body strengthening and conditioning, stretching, mind and breath work. Which is incorporated through the classes to calm the mind and find a deeper awareness and connection with your body and movement.
Yoga may not be ideal if you have an acute injury where pain levels are above 4/10. If you are a client at Auckland Physiotherapy, where Mira leads the yoga class, that can be accommodated with her supervision, but it is definitely not recommended in a generic class outside of Auckland Physiotherapy.
An initial one on one consultation with one of our physiotherapists is required prior to enrolling into classes, this is vitally important. During this appointment, a comprehensive assessment is completed, which includes assessing and recording any muscle imbalances/weaknesses, problematic and painful areas. Based on this information, we can guide you and advise which would be the best movement therapy to start with.
We will establish your goals, and plan an evidence based treatment plan to achieve them!
Book an appointment with Mira HERE
In line with this month's recipe, I want to give an important mention to optimising our protein intake. Much of our body is made of proteins, especially bones and muscles so when we're recovering from an injury I think this is one of the key nutrition changes we can make. The majority of people eat well below the minimum daily recommended amount of protein (0.8g per kg of your bodyweight). This amount really only covers our usual cell turnover, it doesn't allow us to cope with extra repair needs, building muscle mass or coping with the depletion of daily stress. Ideally we want to eat around 1.5g of protein per kilogram of bodyweight per day. Yes, when you do the maths for yourself it will seem like a lot, trust me it's worth it! Ideally you'll break that into blocks of 30g at a time from plant and/or animal sources. A highly quality protein supplement can be a good addition too. If you'd like to read more about this and calculate your own ideal intake then I'd recommend this website https://examine.com/guides/protein-intake/ or book in for a complimentary health coaching call and I'll walk you through what suits your lifestyle and goals.
Book a Health Coaching appointment HERE
Omelette wraps; serves 4, prep 15 mins, cook 10 mins
Ingredients;
200g cottage cheese
4 handfuls watercress
1 lemon, peel only
6 eggs
¼ cup milk (dairy or
plant-based)
1 tsp mixed herbs
4 tsp coconut oil
100g smoked salmon,
chopped
Method;
Place the cottage cheese, watercress and lemon peel in a high bowl
and puree with the hand blender (or food processor) until smooth
paste forms.
Beat the eggs with the milk and herbs in a separate bowl.
Heat 1 tsp of oil in the medium size frying pan and fry 1/4 of the
egg over medium heat for 2 minutes until the egg solidifies, then
turn around. Bake the other side for ½ minute.
Remove the omelette from the pan and set aside. Fry the other
omelettes with the rest of the oil.
To serve, spread the cottage cheese paste over the omelettes and
top with smoked salmon. Roll up the omelette as a wrap and cut in
half.
Makes: 7 cups
Prep: 20 mins
Cook: 2 hrs
What you need;
1 cup (165g) pineapple,
cubed
5 Medjool dates, pitted and
roughly chopped
Orange, 2 tbsp. juice
1 tbsp. vanilla extract
1 tsp. ground cinnamon
¼ cup (60ml) coconut oil,
melted
3 cups (400g) almonds,
roughly chopped
1 cup (150g) cashew nuts,
roughly chopped
3 cups (90g) unsweetened
coconut flakes
½ cup (70g) sunflower seeds
½ tsp. salt
What you need to do;
Pre-heat oven to 250F (120C) and prepare 2 racks lined with baking
sheets.
In a food processor or high-speed blender, add the pineapple, dates,
orange juice, vanilla extract and cinnamon. Blend until smooth. Next
add in the coconut oil and blend again. Set aside until required.
Chop up the almonds and cashew nuts and transfer into a large bowl.
Add the coconut flakes, sunflower seeds, salt and mix well.
Fold in the pineapple mix into the nuts and mix well until combined.
Divide the wet granola between the two earlier prepared baking sheets
and spread into a thin layer.
Place into the oven and bake for around 2 hours. Give the granola a
mix every 20 mins and rotate the trays after 60 mins of baking.
In the last 30 mins keep a close eye on the granola to prevent burning.
Finish baking as granola turns golden brown. Cool to room
temperature and transfer into airtight containers.
The granola will keep for a couple of weeks.
Calf muscle strains are one of the most common lower limb muscle injuries in addition to hamstring and groin strains. They occur commonly in sports which involve high-speed running or high volumes of running and acceleration and deceleration forces, although they can also occur in the general population with less intense activity. It is unsurprising that the calf gets injured when you consider 3-6 times your bodyweight goes through it when you run! The classic presentation will be a sudden feeling of pain like someone hitting them in the back of the lower leg, sometimes associated with an audible noise.
Like all acute soft tissue injuries there will be a subsequent inflammatory reaction to start the healing process, which may last up to approximately 12 weeks, without any complications. These injuries are graded from 1-3, with 1 indicating that less muscle fibres have been damaged and 3 meaning significantly more muscle fibres and fascia (connective tissue) have been damaged during the injury. This will have direct implications for your prognosis and how long you should expect the injury to resolve and have to go back doing all your normal activities and sports.
Treatment will involve an initial period of rest, and reduced activity whilst your body repairs, and then a graded increase in load on the muscle over months as the healing continues to achieve full function. A recent systematic review identified the main risk factors for a calf injury being increasing age and previous calf injury. This makes sense, as a process called sarcopenia reduces muscle mass as we age and therefore strength and force output of our muscles. In addition to this if a previous muscle injury is not rehabilitated optimally there may be remaining strength deficits, which could be responsible for further injury once the person attempts to get back to their full activities as the calf cannot cope with the forces applied to the muscle.
Anecdotally from personal experience people often feel fine to go back to the sports field when they can walk normally without a limp. The trouble is the forces required to run, jump, walk uphill and sprint are significantly more than required to walk. Therefore, patients often come back in after re-injuring the calf on return to activity. To safely return to normal activities and sports the strength needs to be approximately the same as the other side. Also, strength is only one part of the rehab. Once the strength is optimal we need to work on power, the ability of the calf to produce force quickly, which is what's needed in explosive sports. Hence what seems like a “simple” calf injury will need to be screened fully by a physiotherapist and given the sign off to return to sports to reduce the risk of recurrence.
So if you’re suffering from a new or recurrent calf injury, or any other muscle strain, book an appointment to see one of our physiotherapists to get you back doing what you enjoy.
The new year often brings optimism and motivation to do things differently. Many of us are keen to set big goals and kickstart our health. I have 2 favourite quotes that I always find useful at this time of year. The first is by James Clear, author of Atomic Habits (which is an excellent read when it comes to making changes to your health and lifestyle), he says "You don't rise to the level of your goals, you fall to the level of your systems". The takeaway for me is that the goal is not the key to our success, the magic is in creating habits that actually work. It's the small, repeated actions we take and how well we maintain them that matter the most.
Which brings me to my next favourite by Charlie Munger who says "Take a simple idea and take it seriously". No one likes a complex system, it's too hard to maintain. Living a healthy lifestyle isn't rocket science, the simple things work. What is hard is the mindset and patience to keep doing those simple things. So when you're deciding on the changes you want to make to your health this year, try to choose an action that is really simple, something you almost can't fail at. Whilst in the beginning it's likely this won't feel like "enough", trust me, consistency wins over intensity everytime!
If you've got some health goals for the year and want some guidance on fine tuning your systems then book in for our 30 minute complimentary health coaching call. I'd love to get you off to a great start in 2023.
SPINACH SHAKSHUKA
WHAT YOU NEED;
1 tbsp. coconut oil
1 large onion, chopped
2 garlic cloves, crushed
4 cups (300g) mushrooms,
sliced
2 cups (450g) leaf spinach
4 eggs
handful parsley, chopped
WHAT YOU NEED TO DO;
Heat the oil in a large pan over medium heat. Add the onion and
garlic and cook for 2-3 minutes until soft. Next, add the
mushrooms and cook for another 3-4 minutes. Season with salt
& pepper.
Now start adding the spinach to the pan, you will likely have to
do this in batches. Cover the pan with a lid and let it wilt, repeat
this step until all the spinach is in the pan. Stir well and taste for
seasoning.
Make 4 indentations (‘wells’) in the spinach and break an egg in
each. Cook for 5-6 minutes covered with a lid until egg whites
are set.
Dress in fresh parsley and serve.
A Healthy festive option for Christmas
Pav is back on the menu thanks to this quick and simple, fail-proof low-carb recipe.
Decorate your low-carb pavlova with whipped cream (sweetened with your choice of LCHF sweetener if you like), seasonal berries and fresh mint. Or if you’re feeling creative, bake and decorate mini individual pavlovas so you don’t have to share. Delish!
Ingredients;
6 egg whites
1⁄2 teaspoon of cream of tartar (meringue stabiliser)
1⁄3 cup of Natvia granules
1 cup whipping cream (unsweetened)
1 teaspoon vanilla extract 1⁄2 cup
(75g) fresh strawberries, chopped 1⁄2 cup
(75g) fresh blueberries
Handful of fresh mint leaves
Method;
Pre-heat oven to between 120o–150oC.
Whisk the 6 egg whites until thick and frothy, then mix in the 1⁄2 teaspoon of cream of tartar – this is a meringue stabiliser, so it is important not to forget this.
Once stiff peaks have formed (this means that when the beaters are lifted from the mix, the peaks stands straight up), add 1⁄3 cup of Natvia granules slowly to the egg whites while the mixer is on. Allow the eggs to continue whipping until white, shiny and glossy.
Once mix looks nice and glossy, turn mixer off and rub a little of the mix between your fingers. If it’s silky smooth, it’s whipped enough. If you can feel any grain or granules, keep whipping! When ready, dot a little of the mix on baking paper to stick to your baking pan to help keep the paper in place on the tray. Spoon mix out onto baking tray and arrange however you like – the mixture should yield one 20cm round, or you can spoon individually onto the tray for mini pavlovas instead.
Bake at 120o–150oC for 1.5 hours for a large pavlova. It will brown a little. After 1.5 hours, turn the oven off and allow the pavlova to remain in the oven for another hour to dry out (or, if you have time, overnight!).
