Rowan

Physiotherapy for Pelvic Organ Prolapse (POP) - advice

Pelvic organ prolapse is extremely common and one in two women are actually likely to experience this condition.

Having a prolapse means that one or more of your pelvic organs - your bladder, rectum or uterus – descend into your vagina. You may have the sensation of ‘a bulge’ or ‘heaviness’ in the vagina, which may or may not be visible.

It’s not life threatening and for many women it doesn’t cause any problem at all. However, for some women prolapse can cause bladder, bowel or even sexual difficulties.

Prolapse is especially common if you’ve had children for two main reasons. Firstly, as your baby grows there is an increase in pressure down onto your pelvic organs. Secondly any injury to the pelvic floor muscles, like a tear, increases the chance of prolapse especially if active labour has been prolonged or if you required forceps or an episiotomy to assist your baby’s delivery.

How to prevent and treat prolapse

If you are in the first six weeks after having a baby, allow your body rest and recover as much as possible to encourage your body to heal. Take the help that is offered, eat nutritious protein packed food and stay well hydrated.

Prolapse tends to worsen towards the end of the day especially if you’ve been on your feet all day. Try resting on your back with a pillow under your hips to take the pressure off your pelvic organs and relieve your symptoms:

Best position for using the toilet to avoid prolapse

Avoid bearing down or straining to open your bowels. Many women are constipated immediately post-partum and it may be helpful to take a gentle laxative for the first few weeks to soften your stool and make it easier to pass. Make sure you are sitting on the toilet in a relaxed position with both feet on the floor and your knees slightly higher than your hips. Lean forward and rest your elbows on your thighs. Apply a gentle pressure downwards as you exhale. Do not hold your breath or brace your abdominals.

How to lift safely to prevent prolapse

It can be difficult for mums to avoid heavy lifting, squatting or running but try these tips for lifting more safely:

Inhale to prepare, exhale and gently draw in your pelvic floor muscles as you bend your hips and knees, keeping your back straight. Breathe out to tighten your pelvic floor muscles again and return to standing.

Pelvic floor muscle and gentle core strengthening exercises are absolutely vital but avoid abdominal crunches as they will increase the pressure on your pelvic organs. We recommend a safe, targeted programme of exercises prescribed by a specialist women’s health physiotherapist to help you reach your fitness goals.

As always feel free to contact us if you have any questions,

The Physiofit Team!

Physiotherapy advice and exercises for Whiplash

Most people are familiar with the term ‘whiplash’, an injury that occurs when your spine is suddenly and forcefully overstretched.

We tend to think of whiplash as something that happens when you’ve been in a car accident but you can actually develop it in a number of other ways too. For example during sports or after a fall.

Most people don’t have symptoms immediately but experience a gradual increase in pain and stiffness in the spine, commonly the neck, within a few hours or the next day after an incident. Dizziness and headaches are also common.

Whiplash symptoms may actually worsen for several days and how you take care of yourself during this phase can make all the difference to the speed of your recovery.

Advice for the early stages of whiplash

Pain relief – your GP may prescribe painkillers, antiinflammatories or even muscle relaxants to relieve your symptoms. Take a regular dose to reduce some of your pain, this will help you regain movement in your spine more quickly.
Keep moving – move your neck within a comfortable range, in all directions, regularly throughout the day. This may be a little sore to begin with but it won’t cause damage. Don’t push through pain or do all your exercises in one go … little and often is the key.
Continue normal activities – you can keep up any of your normal daily activities if they feel comfortable. Modify those activities that feel a bit much in the short term. You’ll find you can do a bit more each day as you recover.
Heat – you can try using a wheat bag or hot water bottle to relax tight muscles. If you are struggling with your movements, try putting some heat on the area for 10 minutes before doing your exercises.
Gentle massage – it’s safe to massage or ask someone to massage the muscles around your neck and shoulders gently.

Exercises for neck whiplash

Neck bend

Move your chin down to your chest and back to the middle again.

Neck turn

Sit upright and turn your head to look over one shoulder (imagine drawing a line on the horizon with your nose). Turn to the opposite side.

Neck side bend

Sit upright and tip your ear towards one shoulder. Now tilt to the opposite side.

Upper back twist

Sit upright and turn your upper body to one side. Now turn the other way.

Try not to worry … most people make a good recovery from whiplash but if you still have significant symptoms or you’re not back to doing most of your usual activities after 6 weeks, make an appointment to see your GP.

A few precautions …

If you experience any combination of dizziness, double vision, difficulty speaking, difficulty swallowing, fainting or collapse, significant nausea, numbness around your mouth or lips, a metallic taste in your mouth or difficulty controlling your legs the urgent medical advice is required. Go straight to your local A&E department.

Give us a call if you have any questions,

The Physiofit Team!

Physiotherapy exercises and advice for hip pain and bursitis

If you are experiencing pain on the outside of your hip, you may have been told that you are suffering from ‘bursitis’.

This is the term given to pain caused by irritation of the bursa, a fluid filled sac that sits on the outside of your hip between the tendons of your buttock muscles and the place where they attached to your thigh bone:

Traditionally pain felt over the outer hip is often diagnosed as ‘bursitis’ but it’s actually far more common for the pain to be coming from tendons of the buttock muscle themselves.

This is a condition called gluteal tendinopathy, where accumulative strain builds up overtime in the tendons until the outer hip becomes painful.

If you are experiencing discomfort on the outside of your hip that has come on over time and causes pain on walking, climbing stairs, standing, siting with your legs crossed or sleeping on your side then it’s likely that you have gluteal tendinopathy. That said, it’s possible to experience both tendinopathy and bursitis of the hip at the same time. Fortunately the advice and exercises are the same for both conditions.

Advice for hip pain from gluteal tendinopathy or bursitis

Avoid sitting with your legs crossed or sitting with your knees higher than your hips.
Try to stand with equal weight going through both legs, rather than leaning on one side.
Sleep on your unaffected side with one or two cushions under your top leg to stop it dropping forwards.
Do not try to stretch your hip, this will make your symptoms worse.

Exercises for hip pain from gluteal tendinopathy or bursitis

1. Isometric Clam

Lie on your side with your knees slightly bent and a pillow between your knees.
Gently relieve the pressure of your top leg from the pillow – imagine you are about to lift your leg up but do not actually lift it fully, your leg should remain in contact with the pillow. Hold for 10 – 30 seconds. Relax. Repeat a sufficient number of times to reach 2 minutes in total.

2. Isometric hip press

Lie on your back with a couple of pillows under your knees, legs hip width apart. Tie a belt around your knees. Hold for 10 – 30 seconds. Relax. Repeat a sufficient number of times to reach 2 minutes in total.

3. Standing isometric buttock squeeze

Stand with your legs slightly apart, feet pointing forwards. Push the ground away trying to push out through your heels, you should not actually move your feet. Hold for 10 – 30 seconds. Relax. Repeat a sufficient number of times to reach 2 minutes in total.

Repeat Exercises 1-3 at frequent intervals during the day to relieve pain.

4. Bridge

Breathe out and scoop your tailbone upwards, flattening your lower back into the floor. Continue to lift your hips, peeling your spine, bone by bone, up off the mat.
Breathe in to hold the bridge and breathe out to lower your spine again like a string of pearls.

A few precautions …

There are other conditions that can also cause pain on the outside of your hip including arthritis, stress fracture and piriformis syndrome.

A comprehensive examination can rule out these conditions and look for any underlying cases such as difference in the length of your legs, unusual walking patterns or muscles weakness to make sure your symptoms get better and stay that way.

If you think we can help you, please get in touch.

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How to measure up a walking stick correctly

Using the wrong type of walking aid or one that hasn’t been properly adjusted causes discomfort but more importantly it won't offer enough support and this can contribute to a fall.

Here's how we take the correct measurement:

* Stand in a comfortable, upright posture with your usual shoes on

* Allow your arm to hang down by your side, with a slight bend (no more than 15 degrees)

* Ask a friend or family member to measure from the floor to the base of your wrist

If your walking stick has a rubber stopper at the bottom, check at least once a month that it doesn’t look too worn.

When to move to a more supportive walking aid

If you notice that you have started to rely on support from furniture or walls for balance as well as your stick, then it might be time to consider a more supportive walking aid like a frame or a wheeled walker.

There are advantages to both ... a walking frame allows you to support a greater amount of your body weight through your arms. So it’s worth thinking of a frame if you experience a lot of knee or hip pain. Three or four wheeled walkers allow for smoother, faster walking than a frame but most models also have a seat if you need to sit down quickly.

As always, give us a call if you need any advice.

The Physiofit Team

Best physiotherapy exercises for Carpal Tunnel Syndrome

If you’re experiencing a tingling, numbness or pain in one or both hands you may have a condition called Carpal Tunnel Syndrome.

Carpal Tunnel Syndrome is quite common during pregnancy but it can affect anyone, at any age. It’s caused by compression of one of the nerves in your wrist and one of the key features is that your symptoms will have a clear ‘edge and aspect’. This means that symptoms will be located in a very specific part of your hand. So specific, in fact, that you could draw an imaginary line around it like this:

It’s also likely that your symptoms are worse at night. You may wake up with a dead sensation in your hand or intense pins and needles and often hanging your arm over the edge of your bed and shaking it brings back the normal feeling. Activities that involve gripping may also trigger your symptoms and as time progresses you may find that your hand feels a bit weaker or clumsier during intricate tasks.

Self-test for Carpal Tunnel Syndrome

Bend your wrists and stay in this position for 3 minutes.

If this test brings on your symptoms within 1-2 minutes, then it’s likely that you have Carpal Tunnel Syndrome.

How to relieve Carpal Tunnel Syndrome

Here are our four top tips for relieving the symptoms of Carpal Tunnel Syndrome:

1. Stretch out your wrist muscles:

With your elbow straight, bend your wrist back and use your other hand to gently help stretch.

Hold for 15 – 30 seconds and repeat 3 times.

2. Stretch your thumb muscles:

With your elbow straight, take hold of your thumb and gently draw it back to increase the stretch.

Hold for 15 – 30 seconds and repeat 3 times.

3. Glide the nerve as it travels from your neck to your wrist:

Make a fist and bend your wrist towards your shoulder on your bad side, side bend your head away. Then press your palm away and bend your head towards the bad side. Move within a comfort zone and repeat 15 times.

Tips: you might want to start with a slightly smaller range of movement and build up.

4. Wear a wrist splint at night:

Put your splint on before you go to bed and wear it through the night for 2 weeks. It can also be worn during the day for short periods if you are unable to avoid doing an activity that normally brings on your symptoms. Look for a splint which contains a shaped metal bar sitting along the palm side of your hand and forearm.

Other treatment options for Carpal Tunnel Syndrome

Your GP might recommend a steroid injection to reduce swelling and relieve compression on the nerve. It can give good short term relief of your symptoms but it’s vital that any underlying causes are addressed to prevent the condition from coming back.

If treatment hasn’t been effective, your GP can refer you for tests to see how fast your nerves are able to send electricals signal from one part to another (nerve conduction testing). If these tests show that your nerves are not working quickly enough you may be offered surgery to release the pressure at your wrist.

Although it is possible to have carpal tunnel in both hands at the same time it’s unusual. If you are experiencing your symptoms in both hands the problem may actually be coming from your neck. Either way we’d recommend a physical assessment with your GP or a physiotherapist.

If you think you might be suffering from Carpal Tunnel Syndrome and you’d like to speak to someone about your symptoms, please don’t hesitate to give us a call.

If you think we can help you, please get in touch.

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Best advice for neck pain

Neck pain is really common and most people will experience at least one episode at some point in their life.

It’s often something really simple that triggers the pain like carrying something heavy, sleeping awkwardly or spending your day driving or hunched over a computer.

Your neck muscles are also frequently affected by the way you are feeling. Periods of stress and anxiety cause muscle tension, which in turn can lead to pain.

Most of the time, neck pain is not a sign of any serious injury and it generally gets better in a matter of weeks.

First aid for neck pain

Keep your neck on the move - gentle movement helps your body heal and prevents other joints and muscles around the painful part of your neck from becoming weak, stiff and painful too. Stay within a comfort zone and move your neck in all directions, little and often. If you work at a desk, get up and move around frequently during the day. Don’t wait until your neck feels uncomfortable before stretching, it’s far less effective this way.

Heat pack– placing a wheat bag or hot water bottle around your neck for 10- 15 minutes wil relax tight, sore muscles. This usually gives some temporary relief from pain, so afterwards it’s the ideal time to work on your neck movements.

Painkillers and anti-inflammatories – taking regular medication will allow you to move your neck more normally. This will help to speed up your recovery and prevent other areas of your body from compensating. Have a chat with your GP or pharmacist if you have any questions about which medication would work best for you.

Shaped pillow – If your sleep is affected by your neck pain, try rolling up a hand towel lengthways and place it in a pair of tights to hold the shape. Slide the roll into your pillow case along the bottom edge so that when you place your head on the pillow the rolled towel supports your neck.

Breathing exercises – if stress or anxiety are triggers for your neck pain then breathing exercises are a great way to relieve neck symptoms:

Lie down somewhere comfortable and quiet.
Place one hand on your abdomen and one hand on your breastbone.
Inhale and imagine your abdomen filling with air like a balloon. Your lower hand should rise while your top hand remains still.
Make a smooth transition to the next breath without pausing.
Allow the breath to exit your body without effort - imagine your lower hand sinking through your body towards the floor. This will help you exhale fully.
Count to keep to each breathe long and even – 5 seconds in and 5 seconds out.

Tips: If you can breathe in through your nose as this adds greater resistance and slows the breath down. Practice twice a day for 5 mins.

Better posture – draw your shoulders back gently and imagine an invisible cord pulling you up from the crown of your skull, so the back of your neck lengthens and your chin drops in slightly towards your throat. An ergonomic assessment might be helpful to support better posture at work.

Gentle massage – gently working into the muscles around your neck and upper shoulders can also help to warm up and relax your muscles before trying to get your neck moving.

We offer a range of treatments for neck pain and send out all our exercise programmes with video links so you can be confident you’re doing them correctly.

If you think we might be able to help, don’t hesitate to get in touch.

The Physiofit Team!

Exercises for relieving sciatic pain from piriformis syndrome

Sciatica or Piriformis Syndrome?

So you think you’ve got sciatica (trapped nerves)? If you’ve got pain in one of your buttocks, down the back of your thigh and maybe even symptoms into your calf or foot then this might well be the case.

The sciatic nerve is formed by lots of smaller nerves coming together from your spine and travelling in a bundle down the back of your leg.

Sciatica’ is the term given to pain caused by compression or irritation of this nerve. In most cases this is due to a problem with one of the discs in your lower back but there also are two small muscles in your pelvis called the piriformis muscles and if one of them is tight, strained or goes into spasm then this can also compress the sciatic nerve. The symptoms of this ‘piriformis syndrome’ are so similar to a trapped nerve in your back that it’s actually called a false sciatica.

The Piriformis muscles help to control the hip joint during movement of the legs and sometimes they can become overworked when other muscles (such as the gluteals) are weak. Sitting, walking upstairs or an incline or stretching the buttock (pulling your knee into your chest) might become gradually more painful if you have piriformis syndrome. While these activities can also be problematic if you have ‘true’ sciatica, there are a couple of distinguishing features. If your pain increases when you cough, sneeze or strain then it is likely the problem is coming from your lower back; but if coughing doesn’t affect you, then it could be piriformis syndrome. You could try these two tests which are usually painful with this specific condition:

Test 1: Lie on your side and bend your hip to just below 90 degrees. Let your knee drop down and press gently with your hand.

Test 2: Sit in a chair with a band tied around your knees and press your knees outwards into the band.

If either of these tests are painful, you might have Piriformis Syndrome.

Self help for piriformis pain

Avoid sitting on hard surfaces or with your legs crossed and get up to move every 20 minutes.
Heat can be helpful – try lying on your front with a hot water bottle on your buttock.
Release your piriformis muscles with a massage ball:

Roll for up to 1 minute and if you find a sore spot, hold for 10 seconds until you feel it relax. Start with light pressure and build up as it feels more and more comfortable. It’s not pain-free but shouldn’t be an endurance test either.

Stretch your hips:

Start on all fours and move your knee towards your hands. Slide your heel across until it’s under the opposite thigh. Finally slide your other leg back along the floor and lean over the top to stretch your hips. Hold for 30 seconds and repeat 3 times

Check the position of your pelvis and lower back in a mirror. If you have a deep inward curve of your lower back this means that your buttock muscles can’t work properly and your piriformis muscles are also overstretched.

Correct your posture by pulling your tailbone right underneath (tilting your pelvis backwards to flatten your lower back), then press it out behind you (tilting your pelvis forwards to arch your lower back). Find the halfway point and hold this ‘neutral’ position. It might feel a bit odd to begin with as your muscles and joints aren’t used to this new position but keep practising and your body will soon develop its muscle memory!

Strengthen your buttock muscles. While you still have symptoms in your buttock you’ll need to increase the number of repetitions gradually – try 5 repetitions of each and build up to 15:

Squats

Hinge through your hips – start the movement by moving your tailbone behind you.
Keep your trunk upright and your shoulder blades drawing down and backwards.
Hold your knees in line with your toes and keep your weight in your heels.
Your gaze should remain forward but lower slightly as you squat so you keep the length through the back of your neck.
Lower and rise at a constant pace.

Bridge

Breathe out and scoop your tailbone upwards, flattening your lower back into the floor. Continue to lift your hips, peeling your spine, bone by bone, up off the mat.
Breathe in to hold the bridge and breathe out to lower your spine again like a string of pearls.

Swimming

Start on all fours. Press the floor away with your hands and tuck your tailbone in slightly.
Breathe out and slide one leg out behind you and reach away through your toe.
Breathe in to lower again and repeat on the opposite side

Tips: keep your abdominals gently drawn in and your back as still as you can throughout.

A few precautions …

If you’ve had a heavy fall onto your side or bottom in the last month since your symptoms started then it’s worth arranging a checkup with your GP or a physiotherapist as this type of accident can cause an injury to one of the pelvic joints (sacroiliac).

If you have tingling or numbness down one leg it’s important to see your GP to rule out a trapped nerve in your back before starting any treatment plan.

If you’ve had any recent changes in your normal bladder or bowel habits, tingling or numbness in both legs or around your groin or a feeling that your legs aren’t under ‘normal control’ then urgent medical attention is required. Call for an ambulance or go straight to your local A&E department.

Prevention is definitely better than cure and no-one likes to be overworked, so strengthen your buttock muscles and make sure they’re taking their fair share of the load!

If you think we can help you, please get in touch.

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Best treatment for tennis elbow

It may be called ‘tennis elbow’ but playing tennis isn’t the most common cause of this painful condition affecting the tendon on the outside of your elbow. Repetitive activities, such as gripping or typing, are actually far more likely to cause the kind of accumulative tendon strain that becomes painful over time.

Tennis elbow is sometimes misdiagnosed when the pain is actually referred from your neck or caused by a trapped nerve at your elbow. These conditions, however, are far less frequent and if your elbow pain is largely related to movements of your hands and wrist, rather than persistent pain exacerbated by changes in your posture, then it’s likely you have tennis elbow.

Tennis elbow first aid

Pain control – apply an ice pack for up to 10 minutes, twice a day and take painkillers or anti-inflammatories as advised by your GP or a pharmacist. This will help you continue to use your arm for light activities and to keep your elbow moving, encouraging blood flow and preventing weakness from developing while your tendon heals

Rest – the most important thing you can do is to modify or stop doing activities that strain the tendon.

Try to identify a cause – have you started a new job or taken up a new sport? Has there been a sudden increase in your workload or working hours? New computer set-up? Consider how you can modify your activity and home or work to reduce stress on the tendon in a sustainable way for at least 3 to 6 months.

Start gentle stretching – straighten your elbow, palm down and bend your wrist. Use your other hand to press gently on the back of your hand to increase the stretch. Hold for 30 seconds, three times and repeat this regularly during the day.

Strengthen up – you can start strengthening exercises as soon as pain allows. Stay within your comfort zone, the exercises shouldn’t stir up your pain significantly at the time or affect your ability to use your hand for other general activity. Start by holding a 0.5kg weight, palm downwards with your forearm and hand on a table. Lift the weight 10 times, rest for 30 seconds and repeat. Increase the number of repetitions to 15 (as pain allows) and complete 3 sets with rest breaks. You can make this exercise a bit harder by putting your hand over the edge of the table to lift and lower the weight. Allow the pain to guide you … doing too much too soon may delay healing.

Move your arms and neck and upper back – often if the elbow hurts we don't use the hand and shoulder as normal on that side either. This can lead to tightness down the arm of either soft tissues or neural tissues. Try these two stretches to keep everything moving normally:

Mid back mobiliser: slowly relax backwards over the back of your chair as far as you can move comfortably. Keep your elbows together and try not to arch your lower back. Repeat 5 times.

Spinal rotation: turn your upper body to one side and use the back of your chair to gently increase the stretch. Repeat 3 times each side.

Should I use a tennis elbow clasp?

A clasp can be helpful to change the amount of stress that falls on the tendon at the elbow. When you are wearing it you’ll know straight away whether it’s going to be helpful or not as the tendon pain should immediately reduce when using your hand. I tend to recommend using a clasp only for specific activities that can’t be avoided or modified in your work or home life.

My GP has suggested that I could have a steroid injection?

Opinions vary but it’s thought that an injection might work best within 2-3 months of the pain starting. However having a steroid injection on its own has been shown to be less effective than having physiotherapy treatment.

If your symptoms don’t settle or they improve but you have difficulty returning to your usual activities, it might be time to consider an assessment with a health professional who specialises in ergonomics and overuse injuries.

Please get in touch if you think we can help,

The Physiofit Team

Rowing - how to prevent back pain

With only a month to go until the 2016 Oxford Cambridge boat race, here are our training tips to keep your back strong and flexible, to prevent injury and to keep you out on the water!

The risk factors for back pain in rowers

Insufficient hamstring flexibility, core strength and general fitness
Sudden increases in training time on an ergometer with high load and low stroke rate
Inadequate warm up
Ignoring niggling aches and pains and continuing to train
Poor technique/rigging
Inexperience
Previous history of back injury

How to prevent back pain

Hamstring flexibility – The leading cause of low back pain in rowers is due to tight hamstrings. If your hamstrings are tight the amount of flexibility in your hip joints is reduced and your lower back compensates by bending more than it should … causing back pain. You need to hold your hamstring stretches for at least 30 seconds, 5 times each side, with a short rest in between, several times per day to be effective.
Core strength – You may be aware that the muscles in our body work in pairs. Each has a buddy and as one muscle tightens the other relaxes to produce a synchronized and controlled movement. The abdominals and lower back muscles work together like this but if you have weak abdominals (strength or endurance) then you may find your lower back muscles working a bit harder than they should be while you’re rowing. This may be noticed at first as a bit of lower back tightness in the morning – don’t wait for it to develop into a back problem … speak to your coach about some core exercises or try a pilates class.

General Fitness – Try to combine your rowing training with other aerobic exercise, such as cycling or running. Variety in activity is the best way to prevent overuse injuries, while allowing you to train frequently enough to build fitness. Even twice a week for 20-30 mins and you will notice a big change. Feeling fitter while you row will reduce fatigue during training and thus reduce your risk of injury.
Gradual build up – it’s vital that you build up the miles gradually and rest days are important. Over training is a huge cause of low back pain, as well as many overuse injuries. If a muscle is fatigued the risk of injury is much greater. Ask a more experienced rower for a programme, or get advice from a coach if you’re just starting out.
Warm up – Before getting on the ergometer or into the boat, get moving to warm up your muscles. Even 10 minutes will significantly reduce the risk of injury. Try a fast walk, into a light jog, then some drills like high knees and butt kicks. This gets your heart rate up, pumping fresh nutrients into all the muscles, ready for the training ahead.
Early assessment – If you feel a niggle in your back, stop training until you’ve spoken to your coach, an experienced rower or a physiotherapist. You may need to change your training programme (load size, intervals, frequency) or your set-up in the boat but if you keep training through low back pain your symptoms could get worse and this could increase the rest time you need to recover. You can call for some advice from one of our physiotherapists, without charge: 07721 085511.

Good luck Cambridge!

Hope to see the rest of you out on the water – the Physiofit team!

If you think we can help you, please get in touch.

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