By Anna Geraets, Pelvic Health Physio
There is this muscle we have that we typically don’t think about, until there is a problem (leaking, pain), or we’re considering vaginal childbirth.
So, first, what is this elusive muscle?
To make things as simple as possible, our pelvic floor has 2 layers. The superficial layer (closer to the surface), and the deep layer. They work together but also serve different functions.
Levator Ani, aka “Levators”: This is our deeper layer. It’s main action is to lift and lower. It is like a hammock that sits at the base of our perineum and works to support our pelvic floor organs. It is very important for placing pressure on the urethra during straining (cough, sneeze, lifting) to keep us continent.
Bulbocavernosus/Bulbospongiosus, aka “Bulbo”: This is the more superficial layer and has circular fibres which work in a similar way to pursing our lips. It is typically the muscle that receives the most stretch during vaginal deliveries, and typically the muscle that causes a sensation of blocking for women who experience vaginismus.
Both of these layers are important, and when you are doing “kegals” ideally you can identify both the squeeze (bulbo) and the lift (levators).
However, that doesn’t answer the question of this blog.
Kegals. AKA pelvic floor exercises. I think it’s important that every woman is able to identify their pelvic floor muscle and choose to activate and relax them at will. This coordination is important in order to use the pelvic floor to support the pelvic organs during a cough, sneeze, and activity. It is just as important that they relax when we are voiding, opening bowels, delivering a baby, or achieving penetration (such as using a moon cup, tampon, or intercourse).
Sometimes the pelvic floor is weak and needs to be stronger. These women may experience leaking.
Sometimes the pelvic floor is “hypertonic”, where it has become short and tight. These women may experience leaking.
See the difference?
Pelvic floor exercises will address a weak pelvic floor. It may not, however, address your leaking. To do this you need to have a specific diagnosis as to WHY you are leaking. Your pelvic floor muscles may be too weak to put pressure on the urethra to keep you continent (the urethra is the hose where urine leaves the body). Or, they may be compensating for an overactive bladder that is sporadically squeezing so hard that urine starts coming down the urethra, and the pelvic floor is working overtime to keep the urethra closed.
So, I encourage all women to learn where their pelvic floor is and how to turn it on and off. However; if you have leaking, and you have been doing pelvic floor exercises effectively and are still leaking, perhaps strength isn’t the problem.
A pelvic and womens health physio will help to teach pelvic floor exercises, check you are doing them correctly, and provide strengthening programs for weak pelvic floors. However, pelvic floor exercises are but one tool in a very extensive tool kit that we have to help women with pelvic floor dysfunction. Before we open the tool box, we need to get a good diagnosis so our treatment can be effective and relevant to your presenting concerns.
Leaking? See a pelvic health physio so you can address this effectively today.
ACC now covers birth injuries. Call us today to see if you are entitled to subsidised care under ACC.
Book an appointment HERE OR complimentary call with a Pelvic Physio HERE
Sports massage is a term often discussed and often comes with some misconceptions. It is not just for athletes but is for anyone who is active to any degree. It is often referred to as being painful, but this is not necessarily the case. So, the following are some answers to four common questions about sports massage.
What is sports massage?
Sports massage is the use of a range of massage techniques applied to your muscles that are used in a specific sport or activity. Whether you are training for a specific event, regularly exercising or getting back into an activity a focused sports massage can be of benefit. For those of you training for a specific event, or series of events, a sports massage will take into account the phases of your training whether you are in preparation, pre-competition, competition or transition. The sports massage would be modified to suit each phase.
Isn’t sports massage really painful?
This is a misconception and a sports massage does not have to be really painful. If you have muscular tension or a previous injury that restricts movement there may be an element of discomfort – this is however, entirely within your control as your feedback to the massage therapist should always determine the depth and intensity of any massage, sports included.
Why is sports massage good for me?
There are a range of reported benefits from receiving a sports massage and these include:
- May improve flexibility and joint range of motion
- May decrease muscular and fascial tension
- May improve recovery times
- May assist with injury prevention and rehab
- May help to alleviate stress from everyday life to enable better rest and allow for more focused training.
How often should I get a Sports massage?
There are a lot of variables to consider including your budget, your phase of training, if you are experiencing muscular issues during your training, if you are more injury prone, and even how massage normally affects you and what benefits you gain from it short and long term.
If you have not included sports massage in your training programme before than starting a series of massage in the preparation phase would be best – you can then assess how you feel post massage, what worked, what you might like to modify with massage and how often you would benefit in relation to your training.
Auckland Physiotherapy offers massage packages and you can purchase these to assist with your sports massage scheduling – and save some money as well.
With the marathon season upon us, the change in seasons that brings a change in sporting events and codes, and just generally being more active as we come out of winter, now is the time to book in a sports massage.
Book a Sports Massage with Bryce
Physiotherapist and Health Coach Kirsten Rose suggests a yummy breakfast idea that is great, especially if you are trying to build muscle mass. Good news is that it is quick to make and the whole family will love it.
Serves 1, Prep time 5 minutes, Cook time 10 minutes
What you need;
1/4 cup egg whites (around 4
eggs)
1 scoop (25g) of vanilla whey
powder
1/2 banana, mashed
almond milk, if needed
1/4 cup (25g) fresh or frozen
blueberries
½ tsp. coconut oil
What you need to do;
Whisk together the egg whites and protein powder.
Stir in the mashed banana and add the blueberries. If the pancake
mixture seems too thick, add a splash of almond milk to thin it.
Heat the coconut oil in a pan to low-medium. Pour in the pancake
mixture and cook until little bubbles form (about 5 minutes).
Make sure the pancake has set enough before you try flipping it,
then flip over. Cook the pancake for another
2-3 minutes.
You can also make 3 small pancakes instead of 1 large.
Serve with your favourite toppings.
Physiotherapist and Health Coach Kirsten Rose gives us one of her favourite mid-week meal ideas.
Serves 4. Prep time 5 minutes. Cook time 20 minutes
What you need;
4 eggs
4 egg whites
2 tbsp. almond milk
1 tsp. coconut oil
1 small onion, chopped
450g minced chicken
2 tsp. oregano
1 tsp. cumin
2 cups (60g) spinach,
chopped
4 red medium capsicums
½ cup (50g) cheese (dairy or
plant-based)
parsley, chopped to serve
What you need to do;
Heat oven to 200C.
Beat the eggs, egg whites and milk, then set aside.
Heat the coconut oil in a pan over medium heat. Add the onion and
cook for 3 mins until softened and browned.
Add in the chicken, oregano and cumin, season with salt and pepper.
Cook until meat is cooked through, about 5 mins. Then add the spinach
and mix until it wilts about 2 mins.
Increase the heat and add in the eggs. Pull the eggs across the skillet
with a spatula. Repeat for about 3 mins until eggs are cooked. Then set
aside.
Cut the capsicums horizontally and remove the seeds, then stuff with the
scrambled eggs and chicken.
Place the capsicums in a baking dish and sprinkle them with grated
cheese.
Bake in the oven for 15 mins, until cheese has melted and the edges
have browned.
To serve, sprinkle with chopped parsley.
What is the ACL?
Knee injuries, in addition to ankle injuries, are among the most prevalent sports injuries. The anterior cruciate ligament is one of the knee’s primary stabilisers and performs a key role in reducing rotational forces on the knee joint. It also acts to reduce anterior (forwards) movement of the tibia (shin bone) in relation to the femur (thigh bone). It also has a role in proprioception of the knee, which is the body's ability to send mechanical information to the brain without looking at the knee through structures called mechanoreceptors.
So how is it injured?
During sports which involve a lot of sprinting, cutting, change of direction and lateral movements occasionally the external forces may exceed the ligament's ability to cope. This may lead to a ligament injury or rupture. Soccer, netball and basketball are among the sports with the highest injury prevalence. The most common mechanism of injury for an ACL rupture is twisting or turning during a change of direction with the weight bearing leg planted in the ground. More commonly these are actually non-contact injuries, although not exclusively. Players usually present with immediate swelling of the knee and usually cannot continue to play. Others on the field may even hear an audible noise “POP” during the injury. Of course ACL injuries don’t occur exclusively in sports. You may trip/fall and twist your knee on hike or slip on the floor leading to an ACL injury.
How is an ACL injury managed?
So, what does an ACL injury mean for me? Well, patients can get very scared when told they’ve ruptured their ACL. High profile stories in the media of professional athletes from their favourite sports teams can create fear and worry over returning to an active lifestyle and sport. Well the good news is that with the correct management patients normally do very well. Management options are either non-operative or operative and the decision on which to choose will be down to a variety of factors including age, level of activity and degree of knee instability. Despite prior thinking there is evidence that the ACL can actually heal spontaneously without the knee for surgery although further research is needed on this topic.
Whichever option you choose there is a long recovery. Patients should aim for at least 6 months of rehab if treated non-operatively and 12 months if treated operatively.
How does physiotherapy help?
Physiotherapy is key for ACL injuries. The research supports that pre-operatively (prehab) patients have improved outcomes if they have better movement and strength prior to surgery. Post injury or surgery, physiotherapy goals will include regaining full knee movement ,lower limb muscle strength, balance and returning to sport or usual activities. The evidence suggests that any deficit in muscle strength, balance and landing mechanics may predispose you to a higher risk of re-injury. So you and your Physio will become good friends for the next year!.
Finally, the great news is ACC are now funding a pathway called Careway which more often than not will cover all costs for new ACL injuries. We at Auckland physiotherapy are a Careway provider, so if you have injured your knee come in and see us for an assessment to see if you are eligible. If you would like more information, book a complimentary call with one of our Physiotherapists.
Kirsten is one of our Masters Physiotherapists, a certified Health Coach, Crossfit coach and mum of 2 girls. In this blog she’ll take you through some of the considerations for returning to running or high intensity exercise after having a baby….
Getting back to or even just starting a new exercise routine after having a baby can be one of the best things we can do for ourselves as mums. There are loads of reasons why we want to do this and each of us will have our own priorities - physical health, mental health, body composition, social connection and even just feeling a little but like your “old self” are all things I hear often and can certainly relate to with my own journey into motherhood. Unfortunately there is also a mind boggling amount of information out there about what you should or shouldn’t be doing - add in sleep deprivation, hormonal fluctuations and the general adjustment to life with a baby - it's all too easy to feel overwhelmed.
So in this blog I’m really hoping to simplify that and give you some guidance around what choices you could be making for yourself when it comes to returning to exercise, particularly higher impact exercise like running, F45, gym classes or sport.
Firstly, It’s really important to take the time to connect with why you want to do it. I really want you to separate this from why you think you “should'' do it. Yes there are a few things that are really important to do when we’re recovering from birth, but in my experience, as a new mum, we’re already struggling to keep up on the escalator of expectations moving at double speed - some of these are our own expectations and then there’s those of society and people around us. Ask yourself if you really want to go back to running/gym/sport now or are you’re doing it because you think you should be at that point by now?
Before having kids I would definitely have told you that my exercise was for physical health, body aesthetics, and keeping up with how I thought I “should” look and how fit I “should” be, especially given that I was a Physio and a CrossFit coach. Since the addition of my 2 girls to my life over the past 5 years, I’ve realised that I placed an extraordinary amount of pressure on myself to get back to all that. Not that those reasons were wrong in any way but more that I could have been kinder to myself over time and given myself some credit for what I was actually achieving. Also know that your reasons for exercising can change over time and that’s absolutely fine too. These days I find that the benefits I get for my mental wellbeing from exercise far outweigh anything else.
On the topic of expectations let’s take a quick look at the reality of what many women are experiencing in the pregnancy and postpartum period. There are many things that are more common than we think:
Now whilst those stats aren’t exactly sunshine and rainbows the good news is that there are simple steps we can take to improve them with a huge component being the advice and support a mother has during this time. Luckily for you that’s a massive part of what we do at AP, so let’s take a look at some of that advice..
So it’s time to consider if you are ready to return to exercise at the level you’re aiming for. There are a few key factors that come into this decision and whilst some health providers might say that you’re cleared for exercise from 6 weeks postpartum this doesn’t mean you can jump straight back in. In reality the healing process continues long past this time. When we consider other musculoskeletal injuries or post surgical rehab protocols (like a knee or shoulder for example) we are often working with clients for several months prior to them returning to exercise and sport so we need to be thinking the same way after having a baby.
Ideally we would love it if every new mum had access to a postnatal check with a qualified Pelvic Health Physiotherapist so if you can afford it then this really is your best first step.
Let’s take a look at the key screening questions you want to ask yourself about your pelvic health:
If you answered “yes” to any of the above, we would really encourage you to book an appointment with one of our Women's Health team to ensure you get the appropriate assessment and treatment before progressing on your exercise journey.
If you answered “no” then that’s great. A few other things you might want to consider:
So if you’ve got to a place where you can honestly say that you have no pelvic symptoms, you’ve been building up your walking gradually, you’ve done the boring basic strength work and you think you’re eating and sleeping well enough, then congrats you’re likely ready to ramp things up to the next level with your exercise! Continue to build up gradually and allow yourself the chance to rest and recover as you move through the different phases of your child’s first few years! If at anytime you experience symptoms or need advice then we’re here.
If you feel like you have more questions than answers….or you may be wondering how some of these factors apply to you individually then we’re here to help and we have a range of services available:
Book in for a complimentary phone consultation to have quick chat with one of our team about your situation.
If you’re experiencing any pelvic symptoms - book in for a consultation with one of our Womens Health physiotherapists.
If you’re not experiencing any symptoms and are looking for strengthening advice and testing for return to sport readiness then book in for a Post Natal Return to running assessment with Kirsten.
How are you really feeling today?
Do you ever ‘check in’ with your body?
What sensations can you feel in your body that may be related to stress?
Did you know that there is a direct relationship between our thoughts, our emotions, and therefore the reactions that happen internally in our bodies?
We live in a society full of pressure, judgement, stress, deadlines, overwhelm, anxiety and trauma. It is normal to go through ups and downs in life. It is how we grow learn, and develop coping mechanisms and resilience as humans. However it is vital we choose tools that are positive to our recovery during these times.
My name is Renée Malyon and I am a Senior Physiotherapist at Auckland Physiotherapy, with a holistic and multidisciplinary approach to patient care. I am very passionate about mental wellness with my own life experience, and having the realisation that the mind is so interconnected with what I do helping people as a Physiotherapist.
I have a special interest in women’s and pelvic health Physiotherapy, clinical Pilates, and health promotion – including corporate health, ergonomics, sleep, and mental wellbeing. I am a qualified Mindfulness teacher through the Holistic Therapies Institute in the UK, and I am also trained in some forms of Somatic Trauma Release therapy.
My Top 10 Tips for Mental Wellbeing:
1) Provide a safe and secure environment to those who share with you. We all want to feel this when being vulnerable and opening up. When you learn to do that for others, you will find the value in receiving that yourself.
2) Practice mindful breath work and meditation – daily. You can do it anywhere, anytime. Find stillness as frequently as you can to instil focus, a sense of grounding, and increase your sense of calm. Learn these life changing skills...they are not just for hippies I promise.
3) Stress is real and you shouldn’t ignore its ability to affect your body. Many symptoms’ people go to the GP for a due to stress. Did you know that calming down your nervous system regularly through the day using breath awareness meditation, visualisation, mindful movement, and many other tools, can reduce the effects of stress on your body?
4) Journaling or simply putting pen to paper, can be a great way to name the emotions you are feeling, and therefore understand your thoughts. This in turn will affect how you feel mentally but then how your body feels physically i.e. pain, tension etc.
5) Gratitude practice can trigger certain reactions in the brain to immediately change your mood. You can practice this in written form, in meditation, or even in front of a mirror. It can be beneficial to do before bed to help improve sleep.
6) Eat healthy fresh food, reduce or eliminate alcohol consumption, and focus on quality sleep routine methods. Keep your lights low at night, and use dark modes on all of your technology. There is software you can even download now on to your computers.
7) Exercise, especially in nature, can help improve your mood and energy. Stop and really SEE the beauty around you.
8) 'Acceptance' is a big one. We simply cannot control everything in life. The things we can control are: exercise, food intake, sleep, choosing healthy coping tools, what you are saying to yourself and others, controlling your media observation, boundaries of your energy and people, expectations of yourself and others, and mindfulness practice – choosing how you want to respond to situations and conflict. Acceptance also to others, situations, yourself, the past etc.
9) 'Letting go' and forgiveness. These relate to acceptance also. Learn to forgive and let go of situations, conflict, even your thoughts and beliefs that may be holding you back from living a truly fulfilled and happy life.
10) Practice compassion and kindness…it seems simple but having an open mind with true empathy and understanding for others seems to be lost in today’s society. Treat others as you would like to be treated. Respect yourself, respect others, respect the environment.
There are lots of amazing resources and contact details for helplines on mentalhealth.org.nz.
If you are interested in learning more about what Renée has to offer, and what would be right for you, please feel free to contact her on [email protected] for a free phone consultation.
Ankle sprain is one of the most common musculoskeletal injuries. A recent analysis of the research has shown that females are at a higher risk of sustaining an ankle sprain compared with males and children compared with adolescents and adults. Indoor and court sports are the highest risk activity but ankle sprains don’t only occur as a result of sport. They can also be caused by stepping awkwardly on an uneven surface, or even wearing high heels. Any action that throws off your balance and shifts your centre of gravity, could result in a painful sprain. Lateral ankle sprains are by far the most common. If not managed well, some people may go on to having recurrent issues.
The ankle joint is made up of three bones: the talus (ankle bone), the tibia (shin bone), and the fibula (the smaller leg bone). A series of ligaments running in different directions connect the bones and provide stability and support to the joint.
There are three lateral (outer) ligaments that help to stabilise the ankle joint, preventing it from moving too much. The anterior talo-fibular ligament, or ATFL is one of them. It is a short ligament that attaches the fibula to the talus. The ATFL is the weakest outer ligament and the most injured.
Sports and activities that involve running, jumping, and sudden changes in direction put pressure on the ankle and may cause it to abruptly roll outwards. When this results in overstretching and tearing of the outside ligaments, it is known as a lateral ankle sprain.
If you’ve sprained your ankle you may experience the following symptoms: swelling (immediately or over a few hours); localised tenderness or bruising around the joint; pain when trying to walk, or when you put weight on it.
Lateral ankle sprains are graded depending on severity:
RICER protocol is suggested for treatment of a sprained ankle:
You should also avoid HARM – Heat, Alcohol, Running/exercise and Massage, in the first 48 hours to keep any swelling to a minimum. You should also call your physiotherapist at your earliest convenience.
Physiotherapy can help with rehabilitation as you recover from an ankle sprain. Your physio will work with you to develop an exercise program focused on improving the mobility of the joint and regain movement. Evidence shows that commencing rehabilitation exercises within a week of a sprain speeds up recovery.
Auckland Physiotherapy has been asked to be part of an exciting new pilot study with ACC, orthopaedic surgeons, and radiology providers. This is a fully funded pathway (no surcharge) for those patients that are appropriate so please give us a call to see whether we think you may be appropriate.
Our physiotherapists will also help you to strengthen the surrounding muscles to aid your recovery. This is particularly important to prevent the injury from reoccurring. Stabilising the ankle using tape or a brace will allow the ATFL to rest and heal. Your physio can recommend a support or brace as appropriate and teach you the correct technique to ensure the best recovery.
When you return to your favourite sport/activity, you may need to brace or tape the ankle for extra support. Your physiotherapist will provide advice on whether this is necessary and when.
Get in touch with us now if you have had an ankle sprain over the past year that just doesn’t seem to be coming right!
Massage – it is something many is us think about but fewer actually do on a regular basis. There are many reasons people have for not getting regular massages from – “I don’t have time” through to “Is it really worth doing?” and “I don’t know if will be of any benefit”.
Over the years I have introduced people of all ages to massage – the oldest being 94 – and a common thread from conversation post-massage is “Why didn’t I try this earlier?”. That particular question doesn’t come with a standard answer as each person’s reasons are different for why they do, or don’t, access massage more often.
So, if you have been wondering about whether massage is for you here are some of the benefits….
There are many different types of massage out there to choose from. Here are some of them…
This is based on the symptoms of biomechanical dysfunction or injury and then the relevant treatment for the presenting condition. It is generally more focused on the area of dysfunction rather than a “full body” approach. The aim is to assist you in a return to normal function and health.
Also known as 'Western' or 'Swedish' massage. A popular form of massage that aims to encourage relaxation and improve blood circulation – can be light to firmer pressure, it depends on your preference.
This is quite a different type of massage from what you may expect. It is a light and gentle technique that stimulates your lymphatic system to encourage improvements in clearing excess fluid in the tissues, whether from injury/surgery or a more chronic condition. It can also benefit your immune system.
This is not so much a specific style of massage but more the application of massage techniques. This takes into account stages of training, any past or current injuries and any other factors you present with. It is aimed at muscle recovery, injury prevention and performance enhancement.
No two people are the same and no two massages should be the same. Each massage should be specific to you and what you need on the day – something you discuss and agree with your therapist. If you have any questions regarding massage please feel free to contact me at Auckland Physiotherapy.
It’s very likely that at some point you’ve heard about, been told about, or known someone that’s struggled with adhesive capsulitis, more commonly known as frozen shoulder.
A frozen shoulder is not simply a stiff shoulder, but an inflammatory condition that affects the capsule of the shoulder joint. The capsule becomes inflamed, dehydrated and stiff, which in turn causes varying levels of pain and stiffness in your shoulder joint itself.
The cause is still not fully understood, however, we do know that certain individuals are more susceptible. Women and those who have had a traumatic shoulder injury, as well as individuals with thyroid problems, diabetes and/or cardiac issues have a higher incidence of developing it than others.
Frozen shoulder runs through three phases until it resolves. The first is the “freezing” phase, where the shoulder is not yet that stiff, but one has developed substantial pain. The second is the “frozen phase”, where there is pain present and the shoulder becomes very stiff. Daily activities become challenging and outward rotation of the arm becomes noticeably reduced. The “thawing” phase is the last, where the pain is much reduced but lingering stiffness remains. The good news is that it does resolve, however, it can, unfortunately, take up to 18 months.
The role we play as physiotherapists at Auckland Physiotherapy is multifaceted. Frozen shoulders are unfortunately often misdiagnosed which leads to mismanagement. We will ensure you are correctly diagnosed, we will consult you to obtain a comprehensive history, perform special physical tests and potentially order x-rays and an ultrasound to exclude any other potential issues.
Once the diagnosis is confirmed, we may advise a joint injection to manage severe pain, especially if the pain is pronounced during the night (the effects of the injection last for around 3 months). Additionally, we perform and implement physiotherapy techniques, including hands-on joint mobilisations and carefully prescribed home exercise programmes to restore your movement, strength and function. We strive to ensure optimal outcomes are reached.
Frozen shoulders may take a prolonged time to heal, but our team will guide and support you to ensure your optimal recovery!
If you think you might be experiencing a frozen shoulder, book in with our physiotherapists so that we can help you on your road to recovery.
