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…..and not a Kegel in Sight! MODERN Pelvic Floor Exercise

16 May

By:  Jenny Burrell BSc (Hons), Pre/Post Natal Exercise Specialist & Founder of Burrell Education (www.burrelleducation.com).

OK ,the gig is finally up on ONLY performing Kegels to re-activate and  re-condition the Pelvic Floor!  Don’t get me wrong, after giving birth when the musculature, nerve and blood supply, fascia and ligaments of the Pelvic Floor and Pelvic Basin have undergone significant trauma or at the very least, have been stretched by carrying the weight of a growing baby,  Kegels are a vital tool.  In the every early days after vaginal birthing and C-Section, performing Kegels can provide a lifeline to knowing that you are still in one piece!  Also, performing Kegels for both the anterior, mid and posterior muscles of the PF assist with healing, bringing nutrient –rich blood and healing agents to wounded tissue.   And still after the acute trauma phase has passed these muscle contractions can still help to recondition the PF and restore function.  But there comes a point when Kegels are not really ‘functional’ – ie., preparing the mom for real life, after all…..afterall, who pees themselves when they are stood still?  It’s usually during movement and an increase in intra-abdominal pressure that the PF fails and urinary incontinence is experienced.  So, introducing  MODERN MOVEMENT-BASED PELVIC FLOOR EXERCISE, spearheaded by forward-thinkers such as Eric Franklin and many other specialists in this field across the pond.

Any Pre/Post Health & Fitness Specialist worth his/her salt now knows that the PF muscles respond much more to a host of functional movements such as squatting, lunging, hopping, moving in multiple planes, gravity and vibration.  Here are some tested functional movements and the microvolt reading (electrical potential of the PF muscles as contraction occurs) versus Kegels.  (These were measured using a vaginal probe).   I think you’ll find them pretty impressive!  NB these exercises were performed without adding either conscious TVA activation or a Kegel contraction!

Kegel vs Movement – EMG Testing Summary

Exercise Name

Maximum uV

Kegel

75.1

Wide squat

168.1

Transverse step into squat off a low platform

180.2

Low Level Jumping

117.6

Supine bridge with resisted abduction (resistance band around knees)

169.2

Wide stance sumo deadlifts with resistance band

107.5


Table 1: (Reproduced with Permission) :  Kegels vs Functional Exercise EMG Study
–  Jenny Burrell, Louise Dear, Stephen Powell, Phil Nourse,  2011.

So,  in short, the Pelvic Floor LOVES MOVEMENT!  When the time is right and your mommy is out of her acute phase (and been given the goahead by her HCP to exercise – she must have had her 6 week check!) You need to get her squatting, lunging and moving in multiple planes – where appropriate.  You need to get her working her PF against gravity (start with mini hops on an empty bladder), introduce her to vibration (Power Plate or Flexi-Bars are both awesome tools for whole body vibration that includes the Pelvic Floor) and give simple adduction, abduction and pelvic tilting exercises as homework (great for when watching her favourite soap).

So Trainers!!!!  Let’s get those mommies moving for real-life solution to a real-life problem.  They’ll thank you forever.  Remember, it’s all about more laughs and less leaks!  Incidentally if your client base includes the post menopausal woman, this information is just as applicable!

Remember, keep it passionate, mediocrity is a sin!

Want to find out more about MODERN MOVEMENT BASED PELVIC FLOOR EXERCISE, attend the Burrell Education Modern Post Natal Assessment and Exercise Prescription  Course
worth 16 REPs CPD points

Visit: www.burrelleducation.com  for full details.

Why/How Vibration Training Works for the Post Natal Client

6 Apr

By Jenny Burrell BSc (Hons) – Founder of Burrell Education, London, UK , REPs Endorsed
Modern Pregnancy & Post Natal Fitness Education

Just over a week to go til the UK’s Top Fitness Convention, here’s a taster of one of my presentations in partnership with Power Plate International UK. 

As a fitness professional and educator with over a decade of experience providing fitness and therapy solutions for the Pregnant and Post Natal client and my peers, I think I can safely say that the world of fitness education and training principles for the Post Natal client has finally caught up the rest of the game-changing developments occurring in fitness right now.  And just as well, because even if we aren’t parents ourselves, we all have some insight into just how tough being a mom can be on both body and soul and these women need safe, sound and highly effective fitness strategies to get them back into their grooves.

Mothering a new baby is a tough job, requiring the constant lifting and carrying of an ever-increasing weight (the weight of a newborn is averaged at 3.5kg and rising) not to mention the countless squats, lunges, pulls, pushes, rotations and bends-to-extends performed throughout an extremely long ‘working day’ – I also hear that the pay’s not so great either!

New moms have the work-rate of high level athletes but unfortunately, in the wake of childbirth, many find themselves severely lacking in the energy, vitality and functional strength (especially with regards to their core and pelvic floor) to perform well in their ‘sport’.

What do moms returning to exercise want/need?  In my experience and in no particular order a typical checklist during an Initial Consultation usually looks like this:

  1. More energy and to feel good again!
  2. A solution for a ‘leaky’ pelvic floor
  3. Core strength restoration and a better looking mid-section
  4. FAT LOSS!  ( Actually, this is usually No. 1)
  5. A metabolism/hormonal re-boot
  6. Improved muscle strength and tone
  7. Functional fitness for their demanding day
  8. A ‘bang-for-buck’ workout – as short as possible and highly effective without leaving them drained

So how can the Power Plate serve the Post Natal client?  If you are new to the concept of Whole Body Vibration Training (WBV) – in basic terms – when WBV is incorporated into an exercise session, both target and non-target musculature is stimulated unconsciously by the multi-directional vibrating plate and the vibration is absorbed at hugely increased speeds of between 30-50 times per second. This leads to a highly significant rise in muscle contraction and fitness gains without the traditional increase in loading (ie., lifting a progressively heavier weights).  This major factor creates the potential for a shorter workout compared with traditional land-based training.

So, let’s start with the leaky Pelvic Floor – the very act of carrying the ever-increasing weight of growing baby let alone the process of a vaginal birth means that practically all women are in need of focussed work and strategies to firstly reconnect them to their pelvic floor musculature before improving its strength and function.  Enter……Whole Body Vibration.  In the simplest terms, WBV also includes the musculature of the Pelvic Floor and the simple act of standing on a vibrating platform has the same effect on Pelvic Floor muscles as it does the rest of the body.  In tests, both the baseline activity level (just standing on the Plate without performing Kegels) of Pelvic Floor muscles were significantly increased as well as the strength of Kegel muscle contractions when performed on the Plate.  Clients also reported and increased ablility to ‘connect’ with their Pelvic Floor muscles – a huge and vital accomplishment for many.  This is due to the stimulus provided by WBV to the nerves serving the Pelvic Floor musculature and its outlets,  predominantly the Pudendal nerve.  The vital work that can be achieved with the Power Plate to help clients re-establish contact with their Pelvic Floor and the rest of their core shouldn’t be underestimated.  For many clients this period of post birth incontinence can be extremely distressing and for many a formal, easy-to-do exercise programme that is adhered to can provide the solution to an embarrassing problem.  The take-home here, is just get the client onto the Plate and the magic will begin even without performing Kegels!

Next up, core strength restoration and a better-looking mid-section.  If you already use the Plate, you probably have a repertoire of core strength exercises that are suitable for the general client population, so how do you create similar solutions for the Post Natal client with stretched and (in the case of the C-Section client) severely traumatized musculature, ligaments and fascia.  There are a few key principles to follow:

First the clients’ core strength needs to be fully assessed.  This involves a verbal screening for post birth changes in sensation and function and if possible (for early returners to exercise) viewing the C-Section scar to ensure full external healing.  The client then needs to be checked for Rectus Diastasis (Distension).  For all pregnancies, it’s a totally natural phenomenon, the mid-line of the abdominals with the Linea Alba at the surface has to stretch to accommodate the growing baby and after birth, its return to normal strength, tension and function takes time.  In the case of the C-Section birth, the midline has been cut and separated in order to gain access to the uterus to allow birthing.  After the uterus is sutured, THE MIDLINE TISSUES ARE NOT and only the outer layer of skin and underlying soft tissue is sutured.  The key point here is that during the early days of healing (until at least 6 months Post Natal) care has to be taken to avoid performing inappropriate abdominal and whole body exercises that increase intra-abdominal pressure and consequently pressure to an already weakened and healing midline.  Inappropriate activity at this time can lead to lingering issues with core strength due to an obstinate separation of the Rectus Abdominis and other underlying abdominal muscles and back/pelvic pain later down the line.  So, what does core training look like on the Plate?

After categorising the clients’ core strength according to level of any Diastasis found, the exercises below were created to provide stimulus for superficial and deep muscles of the core including Pelvic Floor and the lumbar muscles and associated fascia.


Resistance Band Deadlifts

In the flexed-hip, neutral spine position, the client is asked to contract TVA.   The abdominals are challenged by a combination of factors: resisting gravity, TVA activation and unconscious stimulation via WBV.  The vibration also provides unconscious work for the Pelvic Floor muscles.  Additionally, the resisted bend-to-extend pattern of the ‘Deadlift’, fires the core by providing work specifically for the Lumbar Multifidus, Erector Spinae muscles and Thoracic Fascia.

 

 

Isometric Handle Pushes

An entry-level exercises for the early PN client.  While maintaining a neutral spine and TVA activation, isometric double-handed presses are coached while the client maintains optimal breathing (exhale – TVA activated – PF lifted).  This simple move provide great stimulation for the whole hoop of the core (including the Pelvic Floor).  Reducing stability by performing this exercise on one leg, also increase challenge.  The simplicity of these exercises allows space for the client to ‘reconnect’ with her whole core and the trainer to coach the finer points of a reconnection strategy.

 

Ab-Scooping, Pelvic Tilts and Kegels

This move combines the core muscles resisting the effects of gravity in the prone position, the synergist relationship between TVA activation and Pelvic Floor and  the ‘switching on’ of Pelvic floor through pelvic tilting whilst adding a simultaneous Kegel contraction.  Sound a little complicated but with great coaching the client will be successful and feel incredibly connected to her whole core.  As the pelvis is moved into the neutral position and the client usually reports pelvic floor activation (heightened by vibration), she is also coached to perform a simultaneous Kegel contraction. If this last part of the exercise isn’t possible, no worry as the PF muscles still receive great stimulation via the vibration.  This exercise is not suitable for clients with a Diastasis or those who are unable to maintain ‘scooped abdominals’ in this prone position…remember, any bulging – stop – the client is not strong enough yet.

 

Plate Crunch and Kick-Back

A crunch but not as you know it!  Here we are performing Rectus Abdominis flexion and extension in the prone kneeling position.  The client is coached to activate TVA throughout and the trainer helps the client truly visualise the concentric and eccentric phases of the exercise as the knee is brought in and then the leg is extended out.  Again, vibration creates extra stimulation to the whole core and greatly accelerates the benefits and results of this exercise.  The version shows extra resistance being added via the cable.  An entry level client would work without added resistance.  This exercise is not suitable for clients with a Diastasis or those who are unable to maintain ‘scooped abdominals’ in this prone position…remember, any bulging – stop – the client is not strong enough.  Also fabulous work for reconditioning the glutes – vital for promoting pelvic stabily and optimal posture.

 


 

The ‘Campbell Crunch’

This static four point floating box position can be regressed back to six points by adding a step platform close the plate onto which the knees rest in between work periods.  The client is coached to contract TVA (working the prone core against gravity). When performing the entry level version of this exercise, the client is coached to lift and lower the knees (each move being held for approximately 2 seconds).  This exercise can easily be progressed by asking the client to hold the elevated position for longer or by also incorporating palm lifts or leg extensions to reduce stability and increase challenge.

Kneeling Resisted Scapular Retraction

Fabulous move for improving core and thoracic strength.  In the hip flexed position, the client is coached to maintain TVA activiation with an optimal breathing strategy (see above).  She is then asked to draw the band apart creating work for typically deconditioned thoracic mommy muscles.  Not as easy as it looks!

In the arena of promoting fat loss, a metabolic/hormonal re-boot, improved muscle strength and tone and time-efficient fitness the Plate really comes into it’s own:

‘Following acute exposure to WBV training, there are several positive dynamic responses in the body’s endocrine system.  These hormonal responses constitute a powerful benefit to all types of exercise programmes.  Research has documented that subsequent to acceleration training, anabolic hormones are enhanced:  human growth hormone is multiplied, free testosterone rises, Serotonin levels increase and Cortisol is reduced.  Strength gains are amplified and the sense of wellbeing is enhanced and subjects achieve results more efficiently than with many forms of conventional training.  The endocrine responses from acceleration training promote balance in the autonomic nervous system, and beneficially impact growth, recovery and regeneration, creating the environment for positive change.’  (Adapted from Handbook of Acceleration Training, Science, Principles and Benefits).

The typical Post Natal client presents initially for exercise with lingering hormonal imbalance (heavy on the Oestrogens that are ‘fat increasing’) low on the lean muscle-building hormones.  Exercising at the optimal thresholds (ie., rest-based anaerobic training) can be extremely valuable in helping to normalize this imbalance alongside the positive effect of WBV.  Cortisol over-production is also another huge factor in the Post Natal clients’ fat storage issue (especially in the abdominal area) and her ability to metabolise fat as a source of energy.  With naturally elevated levels of Cortisol during Pregnancy still lingering into the Post Natal period caused by random sleep patterns and the possible stress of managing a newborn infant, any exercise modality that helps to reduce rather than raise Cortisol levels is obviously a huge bonus.  The brevity of exercise sessions 20-30 mins is also a huge bonus in the war against elevating Cortisol too.

The Plate also lends itself perfectly to performing rest-based interval training – the optimal tool for promoting Post Natal fat loss especially for the time poor.  A 20-25 minute workout is the foundation of this system of training.  If performed with the optimal exercise combinations most clients will feel more than sufficiently challenged by a workout of this length.  Also, levels of Serotonin, one of our feel-good hormones is also increased leading to a feeling of well-being which is surely the ultimate aim for both trainer and client.  We all want clients to return for sessions because the last one made them feel goooooood!

The cherry on the cake comes in ability of the trainer to utilise the Plate to train the full range of functional movement patterns that will serve a mother in her daily life.  Training in movement patterns as opposed to isolated muscle groups provides greater ‘real-life’ strength gains for the whole body including the core but most interestingly on the Pelvic Floor muscles!  In tests carried out  (using a vaginal EMG probe),  Pelvic Floor muscle activation was measured when performing standard and multi-planar functional lower body movements and the results were extremely impressive.  In summary it was found that leg adduction, abduction, squatting, jumping, lunging in multiple planes (especially frontal and transverse) all produced greater EMG readings than then humble Kegel!  THE PELVIC FLOOR THRIVES ON MOVEMENT!  The relationship between the deep adductors and abductors and both the fascia and musculature of the Pelvic Floor and pelvic basin all contribute to this increase activity alongside the creation of a stretch reflex during wide-legged movements such as squatting.  Other factors such as a neutral pelvic position and the synergistic relationship of Pelvic Floor muscles with TVA also have a role to play in accentuating muscular activation and the ability for the Post Natal client to re-connect to her PF muscles.

So in summary, let’s briefly return to that Post Natal Initial Consultation checklist:

  1. More energy and to feel good again! CHECK
  2. A solution for a ‘leaky’ pelvic floor – CHECK
  3. Core strength restoration and a better looking mid-section – CHECK
  4. FAT LOSS!  ( Actually, this is usually No. 1) – CHECK
  5. A metabolism/hormonal re-boot – CHECK
  6. Improved muscle strength and tone – CHECK
  7. Functional fitness for their demanding day – CHECK
  8. A ‘bang-for-buck’ workout – as short as possible and highly effective without leaving them drained – CHECK

All in all, I hope this article has given you some insight into the wide-ranging benefits of incorporating WBV into your training programmes for the Post Natal client.  It’s positive aspects are pretty impressive and it delivers huge bang-for-buck every time and on every level for both the trainer and the clients. Never forget, we’re in the results game and successful clients are the bed-rock of successful businesses.

References, Further Reading & Education Resources

  1. Handbook of Acceleration Training – Science, Principles & Benefits, G Van der Meer, E Zeinstra, J Tempelaars, S Hopson, Power Plate International, 2007.
  2. Post Natal Assessment and Exercise Prescription, REPs Endorsed, 1 – Day CPD Workshop, J Burrell, Burrell Education, 2007. (Available via PtontheNet Box Office)
  3. Power Plate Post Natal Assessment and Exercise Prescription, 1-Day CPD Workshop, J Burrell, Burrell Education & Power Plate International, 2009. (Available via PtontheNet Box Office)
  4. Therapeutic Exercise for Lumbopelvic Stabilization, C Richardson, P Hodges, J Hides, 2ndEdition, Churchill Livingstone, 2004.
    1. Functional Digest Series, Volume 3.3, The Pelvic Floor, Gary Gray, 2003.
    2. Fitness for the Pelvic Floor, Beate Carriere, Thieme, 2002.
    3. Pelvic Power, E Franklin, Elysian Editions, Princeton Book Company. 2002.
    4. The Crunchless Core DVD, www.crunchlesscore.com, 2010.

Caveat

Before considering any exercise session with the Post Natal client using a vibration platform, the fitness professional should be both certified as a Pre/Post Natal specialist and have undergone a foundation level of education for the use of vibration platforms with this and the general population.  Fitness professionals are also advised to carry out a full pre-exercise assessment specific to this client group before commencing any physical activity in order to create safe and bespoke exercise prescription specific to the clients’ needs.

Jenny Burrell is founder of Burrell Education (www.burrelleducation.com), a REPs Licensed Education Provider based in London.  Burrell Education specializes in Pre/Post Natal Fitness and Massage Therapy Education.  Jenny also runs her own Pre/Post Natal fitness and therapy practice in West London.  Jenny is the author of the Power Plate Post Natal Certification and lectures at the UK Academy in London – Please check www.burrelleducation.com for dates of Power Plate Post Natal Certification Courses.

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