Pregnancy Pelvic Floor Checks

When and Why Should I Get My Pelvic Floor Assessed During Pregnancy?

By Kathryn Melvin, APA Physiotherapist, Pilates Instructor and Total Physio’s Women’s Health Physiotherapist.

Initial Assessment: Week 13-25

This can occur at any time during your pregnancy, however we recommend coming in as soon as possible after your first trimester, ideally around 13 weeks. This may be the first time someone has checked your pelvic floor, movement patterns and strength, and it allows your women’s health physio to advise you on how much and what type of exercise, pelvic floor strengthening or relaxation you need to do. This is usually an external pelvic floor assessment that allows your physio to gage your baseline. They will use the measurements and outcomes taken in this session to compare to those after you have given birth. The second trimester is normally when individuals begin experiencing pelvic girdle pain, rib pain or pregnancy-related back pain. However, we still recommend you see a physio during this time, even if you do not have any symptoms.

Follow-up Assessment: Week 20 +

Between 18-22 weeks, most individuals will have a “morphology” scan. Following this, we recommend booking in to see your pelvic floor physiotherapist again. After this scan, you can usually have an internal pelvic floor assessment. During this assessment, your physio will see how your pelvic floor is functioning at the mid-point of your pregnancy, and also check in on the rest of your body to ensure we are minimising the risk of potential musculoskeletal dysfunction.

Your 20-week appointment will normally involve :

• Explanation of what the pelvic floor is, how it functions normally and how you can prepare it adequately for birth.

• Discussion of and preparation for your birth plan, if required.

• Any pelvic floor symptoms (leaking, urgency, “heaviness” felt around the vagina/pelvis), other aches and pains (e.g., lower back, ribs, pelvic girdle) and treatment to address these.

• Taking a baseline of pelvic floor tone, strength and muscle coordination.

• Screening for risk factors for longer second-stage labour/risk of prolapse or high degree perineal tears.

• Ensuring bladder, bowel and sexual function is all in line with normal pregnancy-related changes.

• Advice regarding safe exercise during pregnancy.

• DRAM (Diastasis Rectus Abdominus Muscle) Assessment.

• General assessment of and management for any other niggles, aches or pains. This is especially important, since the second half of pregnancy can place a greater load on your pelvic floor, hips, back and pelvis.

Birth Preparation: 34 weeks

• Discussion of birth plan and potential risks for your pelvic floor.

• Measurement & assessment of perineal tear or prolapse risk factors.

• Demonstration of perineal massage.

• Assessment of pushing technique, tone and function of pelvic floor.

• Discussion of labour positions..

• Early post-partum advice, pelvic floor and C-section advice.

• How to manage bowels and bladder in the early days.

• Measurements for abdominal and perineal compression shorts.

Kathryn is available for appointments at Total Physiotherapy on Monday, Tuesday, Wednesday and Friday.

Scoliosis

By Gabrielle Blomson, APA Physiotherapist at Total Physiotherapy

What is it?

Scoliosis is an abnormal lateral curvature of the spine. It is most often diagnosed in childhood or early adolescence, where there are growth spurts. It affects 2-4% of adolescents. There are two types of scoliosis: structural and functional. Structural scoliosis is where the spine has a physical curve. Functional scoliosis is when the spine appears to be curved, but the apparent curvature is actually the result of an irregularity elsewhere in the body (different leg lengths, muscle imbalance and posture). Scoliosis can be diagnosed by an X-ray of the spine to calculate the curve angle. If you have already been diagnosed with scoliosis, physiotherapy can help to improve your function, strength and reduce pain. 

Signs and symptoms

·      Shoulders are uneven – one or both shoulder blades may stick out

·      One or both hips are raised or unusually high

·      Rib cages are at different heights

·      Waist is uneven

·      Entire body leans to one side

·      Head is not centred directly above the pelvis

 Management

Management greatly depends on the extent of your curvature ranging from observation, bracing to surgery for more severe curves (you will be guided by GP and orthopaedic specialists). In most cases, there is an important role of exercise to maintain your general strength, mobility and function. From personal experience, Pilates as a form of ongoing management (in conjunction with medical treatment) has been highly effective in improving strength and reducing muscle imbalances. Pilates can greatly assist with increasing spinal range of motion, strengthening muscles to improve posture and reducing any muscular imbalances. For example, scapula winging is common for individuals with scoliosis, which can be reduced by specific strengthening exercises.

Gabrielle is an APA Physiotherapist at Total Physiotherapy. She has a strong interest in the role of Physiotherapy and Pilates in the management of scoliosis. She is available for Physiotherapy consults, Clinical Pilates sessions and also takes small group Pilates classes.

The Pelvic Floor

Pelvic Floor & Pregnancy Series 

By Hannah Topp APA Physiotherapist – BSc Exercise Science (Sport Practice), Master of Physiotherapy, former elite international powerlifter

What is the pelvic floor? 

The pelvic floor is a layer of muscles covering the bottom of the pelvis that support the internal organs (bowel, bladder and uterus). The muscles run like a hammock from the pelvis to the tailbone and side to side. 

Pelvic floor muscles help with bladder and bowel control, passing urine and faeces, sexual function and support you through pregnancy and childbirth. 

What causes the pelvic floor muscles to become weak?

There are a few factors that contributes to making the pelvic floor muscles weak. These include pregnancy and childbirth, growing older and menopause, poor bowel habits which lead to chronic constipation and straining and people who have chronic conditions such as asthma. Weightlifters and cross fitters may experience some leaking when lifting weights or doing repetitive movement, this may be due to a weak pelvic floor however there are some other factors (breathing, strength and coordination of the pelvic floor muscles) 

Weak pelvic floor muscles can lead to urinary and or faecal incontinence, decreased sexual sensation or a feeling of a ‘bulge’ into the vagina (pelvic organ prolapse). 

Can you rehabilitate pelvic floor muscles?

Yes! It’s not normal to leak while running, sneezing or coughing but it’s very common! The pelvic floor muscles can be trained just like any other muscle in your body. A strong pelvic floor can prevent prolapse and stress incontinence.  Pelvic floor exercise is recommended for the treatment of incontinence, pelvic floor dysfunction and postnatally (Dumoulin et al. 2018). 

Stay tuned for our next post – pelvic floor in pregnancy.

If you have any concerns regarding your pelvic floor, book in to see our women’s health physiotherapist

Injury Prevention in Gaelic Games

With Sydney’s Irish contingent returning to preseason training and games over the last couple of weeks I thought it might be a good time to touch on some sport specific injury prevention advice for the season ahead.  

Injuries are unfortunately something that anyone who plays sport will likely have to deal with at some time or another. This is particularly true of contact sports like Gaelic Games. It would be great to say that there was a strategy that we could put in place that would be effective in preventing injuries from happening but given the wonderfully unpredictable nature of sport this is never going to be the case. While we can’t prevent injuries outright, there are things that we can do to reduce our risk of becoming injured. To look at some of these in more detail we’ll break down the injuries that are particularly common in Gaelic Football. 

A comprehensive study following 17 Gaelic Football teams over an 8-year period found that lower limb injuries account for 76% of all injuries sustained in the sport. The graph below shows the incidence of each specific injury. Unsurprisingly hamstring injuries are the most frequent issue, accounting for almost a quarter of all injuries seen. This data is comparable with similar sports such as AFL and is largely related to the sport specific demands of these sports, requiring a substantial volume of high-speed running and ground ball pick-ups while on the move, which place the hamstring in a more vulnerable position. These specific requirements mean that much of our focus in terms of injury reduction needs to be directed at the hip and knee – the two joints that the hamstring works around. Although the data below is from Gaelic Football, the similar movement patterns seen in hurling mean that the results can be extrapolated across codes to an extent.  

Data from Murphy et al 2012

Injuries can be broadly categorised as either acute (sudden onset type injuries) or chronic injuries. The majority of the injuries in the graph such as the muscle strains and joint/ligament sprains would come under the acute umbrella whereas chronic type injuries would include more of the overuse type issues such as tendinopathies (previously referred to as tendinitis). 

For acute injuries there are a number of exercise interventions that have been proven to be effective in reducing injury incidence. At the top of the list in terms of effectiveness is strengthening exercise. Proprioception work (balance, movement practice, landing mechanics etc) tends to have a positive impact, particularly when it comes to ankle sprains. Although this will come as a surprise to many, stretching programmes have not been shown to have any meaningful impact on injury prevention. Does this mean that you shouldn’t stretch? Well, if stretching is something that you already do and you enjoy it or feel better after it then there is no harm in continuing but if you are sacrificing strength training because you are spending your limited time stretching then you might want to re-evaluate. Strengthening exercises (particularly eccentric biased exercises) give you the best bang for your buck in terms of increasing both muscle strength and length (flexibility) and reducing injury risk.  

A lot of the evidence for eccentric strengthening has come from research around the hamstrings – making it highly applicable for a sport where hamstring strains are such a massive issue. One exercise which has gained a lot of notoriety in recent years is the Nordic hamstring curl, and for good reason – it’s exercise requiring little equipment that is really effective in reducing the risk of hamstring strains. If there was just one new exercise you started to implement for injury prevention this season it should be the Nordic curl. While it’s not the easiest exercise to master there are a number of simple progressions we can use. Some examples are shown in the videos below. 

While overuse injuries also benefit from strength training to promote resilience in the relevant muscle groups, these types of injuries are largely attributable to training errors and thus largely preventable through maintenance of appropriate training loads. Often the training error is a simple case of too much too soon in relation to increasing volume, intensity or frequency. Other factors such as lack of recovery +/- external fatigue factors, nutrition, change in training type, terrain, footwear etc can also have an impact. In team situations training load is not something that is directly in your control but given that a sharp spike in running load at the start of the season (or following an in season break in training) is the primary cause of these overuse type injuries you can prepare your body (prevent the spike) by gradually introducing similar patterns of running within your training in the lead up to your return to play. 

GPS data gives us a good insight into the type of running that we need to do to prepare for the loading we undergo during games. One study involving intercounty players identified the following: 

• Average distance covered: Male: 11.7km, Female: 9.6km 

• 1731m covered at high speed >20kmph 

• Distributed across 44 sprint actions. >50% multidirectional 

• Players completed 184 accelerations 

It’s important to remember that these figures are based on elite athletes in 70-minute games so at least 15-20% could be taken off each when applying the numbers to club players. Even so, what should be clear from this data is that just running steady state 5kms in the off season isn’t going to condition your body for what you will be asking it to do in games. Yes, these types of runs are certainly worthwhile but prior to returning to training your individual running ideally should include drills which will mimic the types of runs made in games. Some simple additions to the longer runs would be: 

• Sprinting up to 20m 

• Higher speed runs of between 40-100m 

• Change of direction and fast deceleration elements in 50% of the above runs 

• Ball interaction within high-speed running drills e.g. pick-ups, solos etc 

Finally, just a note on warm ups. The GAA have developed a really nice standardised warm-up programme called GAA 15 which encompasses a lot of the principles covered in this blog. It’s available for free online and it’s a very handy resource for coaches and players as a means of putting the latest research into practice prior to training and games. If you are looking for advice or programming related specifically to you and your injury history, we can complete a thorough physical assessment along with a detailed discussion of your previous history to allow us to create an injury prevention programme that is tailored to the areas where you may be a little bit weaker or at greater risk of injury.  

GAA 15 Link

By Paul Keating, APA Physiotherapist

Fear avoidance behaviour and how it may be slowing down your recovery:

Quick Summary for those who don’t have the time to read:

• Check out the image below it explains the basics of the theory of fear-avoidance behaviour and how it can affect your recovery.

• Fear can be affecting your behaviour in small ways which could be hindering/slowing your recovery.

• Self-awareness of your own understanding of pain and how you deal with is important to reflect on to be able to alter it.

• Talk to your physio for any concerns throughout your entire rehab not just in the first appointment- rehab concerns, time frames, normal pain ranges or just to check your understanding of pain and how it works (hint: it’s complicated).

The fear avoidance model was first created to explain why patients who initially presented with typical lower back pain developed chronic back pain and the associated disability of such a condition. However the theory can be applied to every injury and is useful to keep in mind when facing your own recovery. 

As seen above, the theory is fairly simple. Two patients who face the same injury and who have the same “pain experience” have different fear-related mindsets regarding their injury. One is “fearful” and one has “no fear.” Realistically no fear and absolute fear don’t really capture the spectrum of the human condition, however thinking more as a see-saw scale, if fear outweighs the non-fear behaviour then that patent will be more likely to take the “pain catastrophising" pathway. From here, "pain-related fear” and “avoidance/hypervigilace” all contribute in part to the patient’s poor recovery, leading to “disuse, depression, disability.” 

In contrast, the patient who has “no fear” (realistically reduced fear), confronts the injury and recovers. Now this model sounds in all honesty a little depressing and has a stark black and whiteness to it, not visibly taking into account the multitude of other factors that contribute to fearful behaviour as well as the recovery process. However understanding the fear avoidance model in perhaps reduced starkness may be the key to a thriving recovery. 

Now what does this model, in its reduced-starkness look like with typical injury? Theoretically, say you injure your shoulder, you’ve started physiotherapy and you’re doing your exercises for the most part but it still hurts to do some simple everyday tasks, such as wiping the surfaces at home. Because it hurts you use your other arm to wipe the surfaces and maybe you do your exercises every other day instead because even though you’re doing them its still sore so maybe they’re doing more damage, but you’re not really sure.

Because you’re not doing the exercises as diligently and because you’re favouring your other arm your shoulder loses some of the endurance that it was building with the exercises and everyday exposure to load. Now you’re aware of the injury it every time you go to do a task that requires your shoulder, maybe you even call one your “bad shoulder” nonchalantly in passing, not realising the connotations that bad/good categorisation hold. 

Now this doesn’t always have to lead to “disuse, depression and disability” but it can lead to extended periods of pain, reduced adherence to exercises, reduced exposure to normal every day load (which is what you want to get it back to) and therefore a longer period of recovery. 

Now what do you do with this information?

Just keeping an awareness of the different tendencies that people can have towards injury/pain and the different (generalised) consequences of these during your own recovery can be enough to steer things in a more positive direction. A great tip for an optimal recovery can be just to keep in touch with your physio! Don’t be afraid to ask all the questions and don’t leave them to be answered by your own assumptions or your friends experiences with a similar injury. A simple explanation from your physio can be enough to put your mind at ease and keep you on the right track for a healthy recovery. 

If you have an old injury that still “niggles” at you, don’t be afraid to get in touch with us (or your own physio), there’s always something that can be done to improve things whether that be a better understanding or strengthening things up after all confrontation is key! 

By Claire Crawford

Bsc Sport and Exercise Science

Current Masters of Physiotherapy Student

The Muscle Tension Conspiracy - Don’t always believe what they’re telling you

Why is stretching not relieving my tight muscles? 

Well first, we have to ask what we mean by tight. Is there an actual limitation in range of movement associated with reduced muscle length? Or do we have this feeling of tension despite our range of movement being really good? Think being able to easily touch the floor despite your hamstrings feeling tighter than that friend who never buys a drink on a night out. A feeling of tightness doesn’t always mean that the muscle length is inadequate. It is very common for people to experience this feeling of tension when in fact their muscle length is just fine. In these cases, even hours of stretching will be ineffective in making lasting change in the symptoms. 

Why is stretching not relieving my tight muscles? 

Well first, we have to ask what we mean by tight. Is there an actual limitation in range of movement associated with reduced muscle length? Or do we have this feeling of tension despite our range of movement being really good? Think being able to easily touch the floor despite your hamstrings feeling tighter than that friend who never buys a drink on a night out. A feeling of tightness doesn’t always mean that the muscle length is inadequate. It is very common for people to experience this feeling of tension when in fact their muscle length is just fine. In these cases, even hours of stretching will be ineffective in making lasting change in the symptoms. 

Tension, like pain is a sensation that the brain provides to us in order to alert us to something. To tell us to change something perhaps. So what would the feeling of tension be trying to alert us in these cases? Quite often it is a sign of excessive workload and thus fatigue in a certain muscle group or possibly a lack of blood flow to certain muscles. 

This makes a bit more sense when we take a common example that most people will have experienced at some time in their lives. The trapezius muscles which lie between shoulder and neck are much maligned for the feelings of stiffness they produce, particularly after a long and stressful day. Quite often however, despite these symptoms the person will have full neck range of movement and the feeling of stiffness persists despite stretching to the point of near decapitation. If episodes like this are a common occurrence, we need to look at what else might be going on that the brain is trying to alert us to.  

When we are sat at a desk for hours on end without taking adequate breaks and or positional/postural changes we are placing quite a bit of load on the same structures. Certain muscles are placed under a load that exceeds their capacity (meaning they become fatigued). Further, if they are not allowed to relax and move through range they can be deprived of adequate blood flow. That discomfort or feeling of tightness is often trying to draw our attention to one, or both of these issues.  

So what can we do? 

When someone’s aggravating activities are work related (such as long hours behind a desk), reducing this load can be difficult because there is a certain obligation of working hours to be met. On top of this we’re all addicted to our smartphones and best of luck reducing your scrolling time, I certainly don’t have the answer for that. Ultimately even with regular breaks and appropriate desk station set up, the way we live our lives right now is pretty taxing on certain muscles (particularly in the neck and shoulders) and the best way to prevent them from being a pain is to make them strong enough to manage the load we place on them. Thankfully we know some simple exercises that are really effective at increasing the strength of these muscles and reducing neck pain.  

A 2018 study carried out on Brisbane office workers found that those who completed the three exercises shown below reported a significant reduction in neck pain at work compared with those who did not. You might remember seeing some news articles about it too – it’s about as box office as physio gets:  

https://www.abc.net.au/news/2018-01-02/simple-exercises-to-reduce-neck-pain-for-office-workers/9283044  

(We’ve added a link above to the exercises demonstrated by our physio Paul. )

It is recommended that you complete between 10 and 15 repetitions and 3 sets of each exercise 3-4 times a week. To notice real benefits you’ll have to continue this for at least 10 weeks, as unfortunately strengthening doesn’t happen overnight. You should also steadily progress the load. This can be done by increasing the weight of the dumbbell or grade of resistance band, increasing repetitions or reducing rest periods between sets.  

Although there has been a strong focus here on the neck, this principle is no different throughout the rest of body. If you’re struggling to shake that tense feeling, getting yourself a bit stronger in the right areas is a good place to start. If your symptoms have been persistent for a long time, or if you are concerned about anything, it’s a good idea to get in to see your physiotherapist so that they can rule out other sources of symptoms and identify the specific areas you need to work on and give you the appropriate treatment and exercises to address your needs.  

By APA Physiotherapist Paul Keating

Improving your squat

There are many reasons to squat – to get stronger, to help increase muscle mass, athletic performance or to just keep moving functionally. The squat is one of the most beneficial exercises and you squat throughout your life stages, from playing when you’re a baby to when you sit on the toilet at age 99!

When looking at the squat, I find the most important components to look at are: Foot and toe position, breathing and bracing, beginning the squat, the bottom of the squat and standing up in the squat. In this blog, I break down these components which will hopefully help you improve some aspects of your squat. Also note that every individual is different and technique will vary due to leg length, hip mechanics, ankle mobility etc. If you would like a squat assessment or experience pain when squatting, book in with your physiotherapist who can assess and address technique deficits and weaknesses. 

Toes and feet position

When setting up for the squat, it’s important to find a good starting foot position. Depending on your individual anatomical differences, your starting position will be different to the person next to you at the gym. A general rule of thumb is to place your feet from hip to shoulder width with your toes facing out slightly. You want to place your feet in a position so you can reach a full squat depth and still feel comfortable.

Breathing and Bracing

When squatting (especially under heavy loads), it’s crucial to have adequate intra-abdominal pressure ie ‘bracing’ (engaging the core). What I teach my clients is to take a deep breath into your stomach, bring your ribs down to pelvis, belly button towards spine, tuck in your tailbone and squeeze the tummy muscles. Using correct technique will help prevent lower back injuries when squatting.

Beginning the squat

To begin the squat, think about pushing your hips back followed by bending the knees. Pushing your hips back first will help engage the hamstrings and glutes. Squat to a depth where your mobility allows you to go.

If you struggle getting to a good depth or feel like you are just bending yourself in half at the hips, a good cue I use to encourage you to bend the knees is using a box or bench and aim to squat to that (pictured on the right). 

The bottom of the squat
At the bottom of the squat you should feel well balanced and comfortable. Your weight should be evenly distributed your feet.

Ascending and finishing the squat

When standing up from the squat, you want to push your hips up and back while pulling your knees back (visualise making your shins vertical). Using your hips to push up and back will avoid placing excess load into the knees.

By Hannah Topp Physiotherapist - Bsc Exercise Science (Sport Practice), Master of Physiotherapy, former elite international powerlifter

‼️ The biomechanics of posture-related neck pain‼️

With a significant increase in our time spent at home, our screen time, for some people, can almost be unbroken. So what does this mean for our necks? Well, as you see in the image below, our neck position whilst using our phones or computers differs significantly from our normal standing posture. Our skulls are actually quite heavy and our neck flexor and extensor muscles aren’t that large (smaller muscles fatigue faster). When smaller muscles fatigue, they often recruit larger muscles, which can take more load, typically in these flexed neck postures, this will be your upper back muscles like traps and rhomboids. However, with this rounded neck and upper back posture, we usually aren’t able to properly set our scapula and other joints in their intended position, resulting in poor musculoskeletal biomechanics, increasing the load on these joints even more, hence mid back or thoracic stiffness. 

Now keeping this in mind, if you look at your screen time reports for your phones and computers it can be up to 12 hours! Which means 12 hours of offloading forces through this fatiguing cycle, increasing your risk of neck and thoracic stiffness and injuries? This issue is only compounded by the fact that we aren’t taking as many much needed breaks during the day or having the same mileage to take them -lunch break to a cafe, bathroom breaks on the other side of the floor etc, it all adds up! 

So where do we come in? Our physiotherapists have years of clinical experience and knowledge around neck, thoracic and spinal issues and are here to help. They will perform a thorough assessment to find the specific structures within your neck and spine that your body has been overloading forces to, reduce some of the tension that’s been building over these recent months, educate you on your individual factors that have been causing your injury, and provide you with an personalised exercise program that fits in with your daily life to reduce the reoccurrence of this injury. 

Book Now

Contact us at (02)83223898

Or

Book online via the link on our website home page

By Claire Crawford - Bsc Sport and Exercise Science, current Master of Physiotherapy student

Health Alert: We’re Flattening the Wrong Curve

During my time as a Physio I have seen a huge increase in the number of people presenting with neck related issues. This has accelerated recently with the changes occurring due to our lovely friend - COVID-19. This includes:

• Working from home resulting in increased screen time, use of mobile phone and virtual meetings. These extended periods in front of a screen and reduction in physical interactions in the workplace mean we do not move our neck as much on a daily basis.

• Increased use of mobile phones and tablets - this was already occurring but I believe has accelerated as we turn to these devices for news, social interactions and to fill in time.

• Stress and anxiety - in many people this results in neck and shoulder tension, further reducing mobility.

• Reduced strength - closure of gyms and a change in our normal strengthening routines leave us more vulnerable to neck issues. 

The result is a loss of our normal cervical (neck) lordotic curve (refer to picture) and a flat cervical spine. This can lead to: 

• Neck, shoulder and/or upper back pain and tension

• Headaches

• Restricted neck mobility

Let’s ‘Bring Back the Curve’! Here’s what I suggest:

1. Move, Move, Move! Bring movement back in to your work day and take regular breaks from the screen.

2. If movement is difficult or you are concerned due to the symptoms above then get in to your physio. We can reduce the muscle tension, get those joints moving again and point you to the right movements and management strategies for your situation. Generally your symptoms will be under control within 1-2 sessions.

3. Get strong - strong shoulders and upper back help reduce the strain on your neck.

4. Ensure your home workstation is well set up to reduce the loads on your body. Although this alone is not enough - you still need to MOVE!

If you can relate to this and would like to get on top of your neck pain get in touch - our physio’s would like nothing more than to help make this challenging time a little more comfortable for you!

Contact us at : (02) 8322 3898

Or book online via the “book Now” link on our homepage

Avoiding Musculoskeletal Injuries After Isolation

Understanding load management when returning to the gym or playing sport

COVID19 has presented challenges to many aspects of life - and for the active population, some of those challenges directly impact our ability to exercise and play sport. With restrictions, it has been difficult for people to continue their current fitness programs due to; working from home, lack of access to gyms or equipments, time or a lack of motivation. You might have been creative in ways to stay fit, but most people will have struggled to maintain or improve their fitness. 

With easing of current restrictions expected soon, it is key to consider ‘load’ when resuming gym programs or playing sport, as poorly managed load can lead to a spike in injuries. There is an increased risk of overload injuries such as tendinopathies or muscle strains if you return to the gym where you left off, without a consideration for a possible de-conditioning period. Even in professional sports, musculoskeletal injuries can increase by two-fold following an extended period of time out of sport - so changes to load can affect anyone!! 

But what is managing load?

‘Load’ is related to the variables of time, weight, distance, repetitions, sets and intensity. Overload is an increase in one or more load variable which leads to injury risk. A simple way of thinking about how much to increase your load by when returning to activity is to increase one variable by 10% per week.

This means if you were running 20km/week on average, you would increase your risk of musculoskeletal injury if you suddenly increased to 40km/week. However, if you increased by 10% to 22km/week, you have a lower chance of injury. 

What types of injuries could poor load management cause? 

Tendinopathies are injuries occurring in the tendon after taking a break from exercise (hint: tendons hate taking a holiday) or after a sudden change in load. So what does this mean for your return to exercise management? A sudden spike in load with heavy weights in the gym after more than a month off significantly increases your risk of muscle strain or tendinopathies. If you haven’t been lifting your usual weights, running normal km/week or training for sport for more than month, easing back into activities is recommended. 

Key Messages when Restrictions Lift:

• Do not expect to be able to pick up where you left off if you were not able to maintain your regime. Don’t go too hard straight away!

• If your exercise decreased and intake of food/drinking increased, be mindful of extra weight that you may now be carrying as this can factor into your load

Marney Staniforth is an APA physiotherapist practicing at Total Physiotherapy. She has a special interest in both Women's Health and Sport and musculoskeletal physiotherapy, with experience in both recreational and elite sporting populations.

What does being ‘cleared’ at a 6-week postnatal check really mean?

Have you heard of the 6-week postnatal check? It can be often seen as the most important marker for some new mums, whether to return to heavier lifting, exercise, to drive or to return to sex. 

In Australia, this quick check is often performed by a GP, midwife or Obstetrician; they could assess anything from wound healing to mental health, baby growth to lactation and everything in between. These short appointments cover all the important medical requirements but are often not adequate to assess everything for a postnatal women - especially for a clearance to run (which is far too early at 6-weeks!). A physiotherapist with Women’s health experience will physically assess a postnatal mother and identify areas to work on, before they become a problem. 

At Total Physiotherapy, Marney will spend an hour listening to your birth history in detail and recording your symptoms, listen to your goals with returning to exercise and answer any questions you have before undertaking an assessment. 

A Women’s Health consultation may include an external and/or internal vaginal assessment of your pelvic floor function, prolapse risk, abdominal muscle function, scar tissue and tear recovery; as well as, a musculoskeletal screen of your body. Following this process, Marney will be able to guide you through to returning to your goals or activity (whether it is exercise or intimacy-based).

Marney Staniforth

APA Physiotherapist

Movember Chat with Stu

Stu, owner of Total Physiotherapy shares his thoughts on Men’s Health and why Men should get on the front foot early to help ensure an active and rewarding life.