Q&A! Meet Jess, the Women's Health Physio at APPI Wimbledon.
This is the fantastic Jess. Jess is the Women’s Health Physio at APPI in Wimbledon. She specialises in pelvic floor rehabilitation and teaches the pre and postnatal pilates classes. An absolute expert in her field, Jess spends her time outside of the Wimbledon clinic educating healthcare professionals and mums alike on the importance of a strong pelvic floor and postpartum recovery.
For me, recovering properly after Nella was hugely important and knowing how to exercise safely was paramount. I know this is one of the biggest issues for other mums who want to know what they can and can’t do; no-one wants to end up with a distended tummy or suffer from continence issues. In France every mother gets to see a women’s health physio after birth but this isn’t something that’s offered here in the UK. At my 6 week check-up post Nella, I felt fobbed off and I had to ask my GP to check my stomach for diastasis recti, if I hadn’t known what to ask for, they wouldn’t have checked. Seeing Jess for a specialist opinion and having that dedicated time to me and my body really helped in my recovery.
As part of bringing more awareness to postpartum issues and helping mums, I’ve asked Jess a few questions and wanted to share her expertise here:
1) What is the best exercise for pregnant women to do? And is there a type of exercise they should avoid?
Exercise in pregnancy is highly beneficial for both the mother and baby. The more fit and active a mother is during her pregnancy, the easier it will be to manage labour, cope with the demands of motherhood and recover postnatal. There is also evidence of reduced complications in pregnancy (preeclampsia, pelvic pain, lower back pain, incontinence and tummy separation to name a few!) and enhanced physical and mental health. I think exercising for mental wellbeing is really important however it is quite often overlooked.
Obviously I am biased because I think the best form of exercise to participate in during pregnancy is Pilates! I love the way classes can be tailored to target different things such as strength, mobility, and an aerobic workout all in one. The classes can also specifically target pelvic floor and tummy strength, as well as preventing common pregnancy issues such as pelvic girdle and lower back pain.
Other great options during pregnancy are cycling, swimming, walking, the cross trainer, light weights and pregnancy yoga. If a mother has already been running this it is okay to continue as long as she feels comfortable. It is advised to steer clear of contact sports such as netball, skiing and tennis due to risks to the baby as it emerges from the pelvis. As a rule of thumb, for all exercise forms, you should be able to hold a conversation whilst exercising, otherwise you may be exerting too strenuously.
2) What do you check for in the postpartum assessments and why are they so important?
The body undergoes many changes during pregnancy and continues to change postnatal. Consequently the pelvic floor and pelvic region can become dysfunctional and women may experience issues related to this. 1 in 3 women experience urinary incontinence in the UK, 1 in 2 develop a pelvic organ prolapse after childbirth, and 60% of women will have a tummy separation at 6 weeks postnatal. The incidence of pelvic floor issues is alarmingly high yet mothers are not questioned about this in their 6-week check, unless it is brought up! And even if they do, waitlists for specialists are long so it can take months to receive help.
At APPI we provide a specialised postnatal MOT that I highly recommend to all new (and old!) mothers. We assess the pelvis and lumbar spine, which takes a lot of stress in pregnancy, and the tummy muscles and pelvic floor. Real time ultrasound can be used to assess the abdominal wall and pelvic floor, as well as an internal pelvic floor examination to assess muscle function and injury. Following this comprehensive assessment an individualised recovery plan is discussed.
3)What is the biggest problem you treat mums for post birth? And is it rectifiable?
Urinary incontinence is definitely the biggest issue that I treat post delivery. However I also see a lot of women with asymptomatic prolapses and tummy separations as well. Evidence shows that all these issues are linked because of their association with the ‘core canister’. Imagine your torso as a canister. The top is the diaphragm, the bottom is your pelvic floor, the front is your deep tummy muscles and the back is deep back muscles. As you can imagine, any flaws in any part of this system can affect each other, which is why I usually see these issues coexisting. There is lots of evidence that pelvic floor physiotherapy helps with urinary incontinence and I see many women resolve their symptoms through different forms of physiotherapy.
4) When can mums safely return to exercise and what’s best to start with?
During the postnatal period the body undergoes a number of changes. Generally speaking, the guidelines for return to exercise are derived from tissue healing timeframes. It takes approximately 6 to 8 weeks for tissue healing and this is one of the reasons for a 6-week check with a GP. Throw in an array of hormones, sleep deprivation and a shock to the system in terms of life adjustment, and this period of time can vary wildly.
Directly after the birth I normally advise to commence pelvic floor and lower tummy squeezes within a day or two (as pain allows and after the catheter is removed). Then mothers can slowly progress their pelvic floor muscle training and add in a graded walking program and functional exercises. After all most mothers are carrying a 3-5kg baby strapped to them most of the day so they may as well practice how to do it properly!
At 6-8 weeks, after a postnatal assessment, individualised advice is given for return to low to moderate intensity exercise such as walking, cycling, cross trainer, swimming, light weights, Pilates, yoga. Spin classes and swimming are a great way to increase the heart rate without putting strain on the pelvic floor. I recommend Pilates because it teaches stability through movement and correct posture. Pregnancy places lots of strain on the body so clinical Pilates can be used a as a tool to rehabilitate the pelvic floor, back issues and tummy muscles after your delivery. Weights should be kept around the weight of your baby and progressed slowly.
At 12-16 weeks (and some recent evidence argues up to 6 months) dependent on each individual’s symptoms and assessment they can return to higher intensity exercise such as running, HIIT training, heavier weights.
It is important that each form of exercise is begun slowly and gradually progressed to avoid injury and allow for tissue remodelling and tolerance. Following guidelines also helps reduce risk of pelvic floor issues such as leakage and prolapse.
5)When can mums start running again?
Almost every mother asks me about returning to running (even if they’ve never run before!) and there seems to be lots of conflicting advice available. Just because a mother hits 12-16 weeks as per the guidelines, doesn’t mean she can go out and run 5km that day. Like all exercise it needs to be returned to gradually to allow your tissues to adapt. A great easy way to return to running is using the ‘couch to 5k’ phone app. It is an app that guides you through 3 runs per week (20-30mins), over 9 weeks to a steady 5km run. Otherwise I treat ladies in clinic and give them individualised advice with a home program alongside their bespoke program.
For more information or to book to see Jess, do contact APPI: https://www.appihealthgroup.com/Clinics/Wimbledon