Tag Archives: Pregnancy

An Indirect Path To A Smaller Bum!

21 May

By Jenny Burrell BSc (Hons), Founder of Burrell Education, Specialist For Pregnancy and Post Natal Fitness & Therapy Education, London, UK. 

www.burrelleducation.com

I’ve just spent 2 days teaching my Pregnancy and Post Natal Massage course at NLSSM and it proved to be a timely intervention.   It is without a doubt, extremely high on the list of my favourite things to do IN THE WHOLE WORLD!  No kidding.  You see, there was not a single person in that room (12 amazing women – below) who didn’t instinctively know that, to truly walk the path of  ‘showing up’ for your own life you’ve got to do AN INSIDE OUT JOB not visa versa! And that’s OK.

You see, I work mostly with fitness people and in my younger days, I too did my part to fortify the myth that looking good on the outside was a key to happiness.  Oh the folly of youth! I now consider this to be high class BS if your internal landscape looks like a bombsite, literally or spiritually.  Without a doubt, spending time in this awesome environment, got me ‘plugged back in’  to some key fundamentals of our human journey and the guiding principle that cultivating an awesome heart/head-space and a compassionate outlook for others and yourself is KING because it is actually a high self-regard that means you treat yourself well, slay your addiction and personality monsters (food, booze, co-dependence etc) and generally do no harm to others.  A high self- regard means that you instinctively steer clear of people, places and things that don’t keep you ‘in the light’.  A high self-regard means you can smell a rat at a hundred paces and head for the hills 🙂

If you’re not familiar with how much of this type of educatin is delivered, here’s a snapshot…..

  • During practically all of your education (in some cases, over the course of years) and on CPD’s you spend a lot of time undressed and physically exposed!
  • You make friends with a complete stranger, undress infront of them and the rest of the room without fear of judgement and allow them to get skin-to-skin with you.
  • You allow a perfect stranger to touch you intimatelyand to perform an  exchange of energy with you.
  • You allow someone you’ve never met before to to help you, to heal you, to perform an act caring and compassion for you and most of all, you instantly TRUST this complete stranger to do you no harm.

It’s only in this style of hands-on education that I ever truly see egalitarian interaction.  Everyone brings their take on the situation to the table and we all openly learn from and observe each other working, we’re happy to receive praise for great work and equally open to have someone guide us to a better solution.  In this environment,  interaction occurs without the GAME-FACE because we know that our bodies can’t lie to anyone, and what the ‘client and the therapist’ both feel as the treatment progresses is THE SIMPLE TRUTH.  So people get real, say real stuff, share rarely-voiced thoughts, ask questions easily and are happy when the answer is a shrug of the shoulders or some other ineffable or simply accept that ‘feeling a shift in energy or awareness’ IS the answer.  Love it!  But the hugest bonus is when the treatment is finished, your partner is up and dressed and you look each other in the eyes with gratitude and sincerity and you know that you JUST GOT RECONNECTED TO ANOTHER HUMAN SOUL AND TO THE BEST VERSION OF YOURSELF !  And isn’t that actually what we came here for?

Passionate About Pregnancy & Post Natal Health & Fitness Education FOREVER! 

Connect With Me on FACEBOOK and Twitter

www.burrelleducation.com

Why You Need to MOVE to Work Your Pelvic Floor!

16 May

By Jenny Burrell BSc (Hons), Founder of Burrell Education (www.burrelleducation.com)
Specialist Pregnancy and Post Natal Fitness & Therapy Education

BIG NEWS! The pelvic floor musculature does not exist and function in isolation! So……when we consider restoring it’s function and strength,  especially after birthing, MOVEMENT (the right amount at the right time) has to be part of our exercise prescription.  Eventually our prescription for the PF needs to be INTEGRATED, WHOLE BODY AND CHALLENGE THE ENTIRE MYOFASCIAL AND CONNECTIVE TISSUE SYSTEM.

First up….The Abdominal Aponeuroses

The Abdominal Aponeuroses are sheets of tendon that cover and connect the abdominal muscles to the pelvic girdle.  In terms of it’s relationship to the pelvic floor muscles (especially the anterior musculature), concentric and eccentric movement of not only the abdominal muscles but connecting aponeuroses and fascia ALL HAVE A SYNERGISTIC AND POSITIVE EFFECT ON THE PELVIC FLOOR ie., lift both of your arms into the air at the same time so they end  up just past your ears and ‘listen’ to what your pelvic floor has to say…..can you feel a change in its tension and a tightening?  Yes?  That’s the relationship between the muscles, fascia and tendons stretching from your pubis to your sternum talking to you!

Next up, the Anterior Longditudinal Ligament (ALL) and Posterior Longditudinal Ligaments (PLL).  When I first discovered these two ligaments, it was a major lightbulb moment, gee whizz! So to keep this simple,  I’ll focus on the ALL, this continuum of ligament runs alongside the spinal column from the cervical region to the sacrum where there are fascial links to…..guess where?  THE PELVIC FLOOR MUSCLES.  So what does that mean in exercise terms?  Flex and extend the spine ie., BEND OVER AND RETURN and you also work your Pelvic Floor!

Now onto the adductors of the femur.  Just take a look at where the proximal attachments fasten – extremely close to the PF!  And guess what?  Thanks to fascia, everytime your adductors are fired the PF muscles are too!

The deep lateral rotators of the femur, namely the Gemellus and Obturator muscles facilitate abduction of the femur.  They are all intimately posititioned within the pelvic basis proximal to the PF muscles and thanks to the fascia factor, firing these muscles also fire the PF  muscles.

Ok, so now onto the rest of your ‘CORE’

In the most basic terms, the components of the  ‘CORE’ can be defined as the pelvic floor muscles, the TVA, the diaphragm and the lumbar muscles and fascia.  These 4 components all work reciprocally and are synergized by respiration.  Point in case:

  • Breathe out throught pursed lips and simultaneously pull your belly button in towards your spine, can you eventually feel your pelvic floor muscles lifting and tightening?  That’s the synergistic relationship between your PF, diaphragm and your TVA.
  • Do this again and this time take your attention toward the muscles of your low back this time, now can you also feel these muscles tensioning too?

So, in summary…..

  • Squat or take your legs apart (abduction) – the pelvic floor is active.
  • Squeeze your knees together especially against resistance (a pilates ball or ring) – the pelvic floor is active.
  • Perform flexion to extension (bend over) – the pelvic floor is active.
  • Breathe in and out – the pelvic floor is active.
  • Move into throacic extension – the pelvic floor is active.

The pelvic floor also loves…..

  • Whole Body Vibration – yes, the vibration works on those muscles too!  From a Powerplate to a Flexibar, it’s all good.
  • Working against gravity, and snappy movement – from hopping foot to foot to full blown plomentric jumping
  • A neutral pelvis and beautifully aligned posture
  • A global myofascial system free of tension and restriction

I hope that’s helped you to reconsider what you consider to be PELVIC FLOOR EXERCISE and if you liked this blog, and would like to know more about my modern, inspiring education, check out the Burrell Education website: www.burrelleducation.com.

My June 15th Modern Post Natal Assesment  & Exercise Prescription CPD has SOLD OUT! So I’ve decided to add another date on Friday 22nd June.  If you’d like to attend, please book sharpish as 4 places have already gone.

Visit the website for more details and booking: www.burrelleducation.com

Passionate About Pregnancy & Post Natal Health & Fitness Education FOREVER! 

Connect With Me on FACEBOOK and Twitter

Core And Pillar Strength for the Pregnant Client

8 May

By Jenny Burrell BSc (Hons), Founder of Burrell Education (www.burrelleducation.com)
Specialist Pregnancy and Post Natal Fitness & Therapy Education

 
This information is intended for use by the specialist Pre/Post Natal Health and Fitness Professional.  If you are a mom, please seek advice and guidance from a qualified professional.  If you are a qualified professional, the following exercises are suitable for the LOW RISK PREGNANCIES ONLY.


1.  Resistance Band Deadlifts – Deadlifts….. but not as you know them! This version is still highly effective with a strong band and much more appropriate for the pregnant client that a 20kg barbell!  Ensure your band has a good level of tension before starting by wrapping it around the fist.  Good form protocols still apply – work with a ‘strong back’ and ‘drive through the heels and exhale as you rise’.  Really great work for the glutes, hamstrings, working the bend-to-extend pattern and fascia/musculature of the lumbar and thoracic back.  Great for off-setting upper body postural changes that typically occur during pregnancy.

2.  Flexi-Bar Plie Squats

The Pelvic Floor LOVES functional movement including wide-legged squats.  Add the extra challenge of gentle vibration via the Flexi-Bar to the WHOLE CORE.  Amazing work for the thighs, glutes, core including the all important Pelvic Floor and of course a wicked workout for the arms and shoulder….supersized multi-tasking – excellent for time-poor mommies.  Take care to coach regular breathing while the client is working.  There’s sometimes a tendency to hold the breath while concentrating on getting the movement right with the Flexi-Bar.  NB:  Not suitable for clients suffering SPD or any other type of Pelvic Pain Syndrome.

3.  Single Leg Sits to Chair/Bench

For my moneyand I hope yours too, the ‘Core’ includes the GLUTES TOO!  This single leg work targets both Glute Max and Med and looks so simple but is really challenging and highly effective (especially as the clients’ bump grows).  Keeping the glutes strong can help offset the drop into an anteriorly tilted pelvis, which is bad news for the lumbar spine and turns off the Pelvic Floor!!!

4.  ‘Draw The Swords’

The pregnant client is prone to developing Upper Crossed Syndrome due to changes in her centre of gravity caused by boob and belly growth.  Incorporating strength work for her Thoracic area to promote better posture is essential.  Use an appropriate weight, a cable machine or a strong dynaband both work well.

 

5.  Resistance Band Scap Retraction into Chest Opener

A great 2 in 1 exercise to give as homework.  Drawing the band wide at the front of the chest causes scapular retraction, strengthening those upper back posture muscles and then taking the band overhead opens up and stretches the often tight and shortenend pecs, anterior delts and biceps.  Brilliant use of time and highly effective!  PS just as valuable in the post natal period when moms spend lots of time in the feeding position.

Need to modernize your exercise prescription for your Pregnant clients?

The next Burrell Education ‘Modern Pregnancy Exercise’ REPs Endorsed CPD Workshop in London, UK.

 Friday 13th July, 2012 – Only 3 Places Left!

Visit www.burrelleducation.com for more details and securing your place.


Passionate About Pregnancy & Post Natal Health & Fitness Education FOREVER! 

Connect With Me on FACEBOOK and Twitter


How to Create an Awesome Pregnancy and Post Natal Massage Service

3 May

By Jenny Burrell BSc (Hons), Founder of Burrell Education, Specialist For Pregnancy and Post Natal Fitness & Therapy, London, UK.

  

www.burrelleducation.com

I began my massage journey nearly a decade ago studying for the ITEC Holistic Massage Certification and as soon as I began my studies, something just clicked.  For me, the skin-to-skin element of using massage and other hands-on bodywork techniques to connect with and help my Pre/Post clients seemed to be the perfect way to compliment the physical expenditure of one-to-one fitness training.

As a Pregnancy and Post Natal Fitness Specialist, my goal was always to progress onto deeper levels of study that would specifically empower me to help my Pre/Post clients and after embarking on  further study at  North London School of Sports Massage and other top London massage schools, I finally had the skills that could be honed into helping my own niche client base.

Fast forward 7 years and thanks to the support of Susan and the team at NLSSM, I created and now tutor their 2-Day CPD offering.

Next 2 Day CPD Course Date: Saturday/Sunday 19th & 20th May, 2012.

If you are a certified Massage Therapist wanting to extend your offerings to help the Pre/Post Natal client or a fitness professional with Pre/Post Natal clients and a massage qualification, this weekend CPD course will give you a ready-to-go, entire skill-set to help you create a stand-out service that will keep clients coming back time-after-time and keep them referring for you.

If you have any knowledge at all of the rigours of Pregnancy,  you’ll know that the myofascial and skeletal system is put under immense duress and undergoes a complete transformation in terms of function.  This dysfunction usually leads to soft tissue discomfort and pain, most of which can be alleviated by massage therapy and bodywork.  You’ll find that Pre/Post Natal clients will be some of your most grateful customers.

Typical Pregnancy Into Post Natal Period Posture (Client at 17 Weeks Post Birth)


The Top 20 Areas Where The Pregnant/ Post Natal Client May Have Pain and Discomfort & Why?

  1. QL’s – the anterior tilted pelvis causes shortening
  2. Lats – the anterior tilted pelvis causes shortening and scapular abduction causes length tension
  3. Intercostals – breathing patterns change as the ever-growing baby demands more space causing further rib flaring
  4. ITB (Origin and Insertion) – changes to posture and biomechanics may cause pain
  5. Quads – tightness in attachments at both the hip and knee
  6. Calves – changes in plantarfascia reflected further up the myofascial chain
  7. Plantar Fascia  – changes to tension due to dramatic increase in weight biomechanics
  8. Biceps – creeping scapular abduction closing down anterior musculature – breastfeeding and ADLs all contribute
  9. Anterior Delts – creeping scapular abduction closing down anterior musculature – breastfeeding and ADLs all contribute
  10. Pectorals – creeping scapular abduction closing down anterior musculature – breastfeeding and ADLs all contribute
  11. Rhomboids – creeping scapular abduction causing length tension – breastfeeding and ADLs all contribute
  12. Upper Traps – forward head posture due to change in weight/size and centre of gravity causes forward head posture and associated changes in tension of neck and shoulder musculature
  13. Levator Scapulae – forward head posture draws origin away from insertion causing length tension
  14. Sub Occipital Region – see above
  15. Platsyma –forward head posture causes length tension in the anterior neck
  16. Erector Spinae & Lumbar Region – increased lumbar lordosis and lack of exercise in this area causes shortening and dysfunction
  17. C- Section Scar Tissue –  Valuable work can be done to educate and instruct client to self-administer gentle massage to help avoid the build-up of restrictive scar tissue
  18. Tibialis Anterior – change in posture and biomechanics of the foot can be reflected in the anterior aspect of the lower leg
  19. Carpal Tunnel – fluid retention affects passage of nerve impulses through Carpal Tunnel, massage can aid dispersion of fluid build-up.
  20. Piriformis Pain – anterior tilted pelvis, everted foot fall and weakening of anterior Pelvic Floor muscles all contribute to increased tension and shortening.

Techniques You’ll Learn Over the Weekend

  1. How to address ALL  of the above areas and issues! Applying a suitable strategy specific to client’s needs.
  2. How to position and massage the Pregnant client – elevated supine, side-lying supported by bolsters.
  3. How to position and massage the Post Natal client – especially after C-Section.
  4. How to use a sheet for draping the client instead of towels.
  5. How to modify the traditional massage strokes, when the client is in the side-lying position.
  6. You’ll learn or polish your Soft Tissue Release (STR) skills.  (Shorten, LOCK target tissue, move to lengthen away from the direction of the LOCK’).  STR is so flexible that is can be used on all of the 20 listed areas above.
  7. Appropriate Contract/Relax Methods
  8. Therapist applied Myofascial Release using small foam rollers
  9. Simple Acupressure for the Post Natal Period
  10. Learning and teaching C-Section scar massage to the Post Natal client
  11. Which massage mediums are safest and most effective during the Pre/Post periods
  12. How to create a welcoming and nurturing environment for your clients
  13. How to Attract, Retain and Gain Referrals
  14. How to offer a polished, second-to-none STAND-OUT service – EVERYTIME!

What You Take Home

1.  A 2-day, paradigm-shifting educational experience that will help you hone your instinctive skills to serve a brand new additional client group
2.  A 100+ page fully illustrated and referenced manual
3.  Bonus client information on Pelvic Floor exercise and Pre/Post Natal Specific Mobilization and Stretching

4.  The skills to start your brand new business venture
5.  My personal business blueprint for creating an awesome service that will ensure you ATTRACT, SERVE AND RETAIN happy clients for years and years to come.

How to Reserve Your Place!

Contact Cassandra at NLSSM to book your place ( class size is limited to 10 participants, so be quick!)


www.burrelleducation.com

Passionate About Pregnancy & Post Natal Health & Fitness Education FOREVER! 

Connect With Me on FACEBOOK and Twitter

Why Fat Loss May Be Harder For Your Breastfeeding Clients

2 Apr

By Jenny Burrell BSc (Hons), Founder of Burrell Education, Specialist REPs Endorsed Pregnancy and Post Natal Fitness& Therapy Education, London, UK. http://www.burrelleducation.com



What do women want on their return to exercise after having their babies?

  • Fatloss?
  • Energy?
  • A better looking  & functioning belly?
  • A non-leaky pelvic floor?
  • Rest?

With over a decade of experience working with this client population, the tools and strategies to tackle all of these areas have never been more effective, plentiful and easy to implement.

1.  Let’s start with post baby fat loss.  A bit of a tricky subject if you’re not able to get with the science.  There are a few key factors why post baby clients hold fat:

  • The heightened Cortisol during pregnancy, remains high after birth and this situation is not helped by the added stressors of the early post birth period, poor sleep patterns and for some, the hormonal influence on fat stores perpetuated by on-going breast feeding.  It’s a complexed subject but here Jade Teta of the Metabolic effect succinctly explains one of the mysteries of why many women DO NOT lose fat when they breastfeed unless perhaps you are Victoria Beckham or Abbey Clancey :-)!
  • The next key area of the post baby fat loss conundrum is EXERCISE INTENSITY.  I could write forever on this but basically, the magic bullet for blitzing fat stores is INTENSITY NOT TIME!  Unfortunately, most people don’t like to get uncomfortable (literally and metaphorically) so rarely go there!  Unfortunately, discomfort is a vital key to effective exercising in shorter sessions that have huge fat burning/hormonal shifting potential for HOURS AFTER YOUR ACTUAL EXERCISE SESSION!   Here are the generally accepted key elements of a metabolism boosting, fat busting session:

a)       It’s short 20-30 mins maximum

b)      Contains compound, integrated, functional movement – no individual ‘body-part’ exercising here! OK, may just bi’s and tri’s 😉 firm arms mean the world to us girls!

c)       The exercise makes you sweat

d)      The exercise makes your muscles burn

e)      You get out of breath

f)       You get hot

g)      You push yourself ie., get a little uncomfortable

h)      You don’t over-rest within the training period

The third component of successful post baby fat loss is Optimum Re-Nutrition.  Pregnancy, birthing through to the early post birth period is a time of depletion for the mother.  When the dust has settled, a key consideration is to re-nourish the body, replenishing depleted stores of essential vitamins and minerals that ensure her system regains balance and functions optimally.  Many clients have no idea of the positive nutritional potency of many everyday foodstuffs and conversely how harmful to health many  foods in their current diet are too – mainly those that come in packets!  These days it really seems that we’ve finally nailed it!  We have a long-term formula that actually works in terms of health, wellbeing, offsetting later life disease and helping us to consistently shed and keep fat off.  Basically it boils down to:  Get rid of, or at the very least CONSISTENTLY LIMIT the C.R.A.P  in our diets– starchy carbohydrates and grains,  refined foods and to be honest any sugar, alcohol and processed/packaged foods.  Following these protocols will have a transformational effect on your clients’ energy, wellbeing and fat loss potential.  Insulin is the master hormone for fat loss and once you get out of the sugar-trap, the results are amazing but for a lot of people a diet consisting mainly of restricted quantities of carbohydrates, protein, vegetables and selected fruit is challenging….that is, until they see the fat falling away.  Based on my own personal and client experience, I created a cut and paste Post Baby Fat Loss manual that you can plug into your business almost automatically to establish your own system for POST BABY FAT LOSS THROUGH OPTIMUM NUTRTION.

  Check out the contents here:

http://www.burrelleducation.com/

2.  Energy – Short, energising exercise session, a great diet, some key supplementation (high quality multivit, essential fats), good hydration and a dedicated strategy for resting as much as possible and not trying to be superwoman during this challenging life phase will go a long way to ensuring that your mommy has hugely improved energy levels.  Top tip:  If funds permit, suggest to clients that they find someone to help with the big cleaning jobs a few hours a week can be transformational and probably not far off the price of the 2 bottles of wine they won’t be consuming per week anymore.

3.  A better looking and functioning belly & core.  OK, second only to Pelvic Floor issues ‘OMG, look at my belly!’ is the sentence that I hear uttered the most often.  Indeed,  after  at least 6 months of skin, fascia and muscles being stretched and the curious and annoying development of cellulite on the deflated tummy not to mention the dreaded stretch marks, the return journey back to a flat or at least half decent tummy isn’t always as smooth and rapid as most moms hoped it would be.  Also for many, Diastasis (the separation of the two bellies of the rectus abdominis alongside a flaccid and weakened mid-line tissue) adds an extra dimension to a difficult restorative period.  The final annoyance comes in the form of C-Section recovery which, I REALLY GET NOW!  (I managed to have 2 C-Sections  – only 12 months apart!).  Not only is C-Section blooming painful in the early days – you are left challenged to perform the simplest of tasks (bending over to put knickers and socks on!!!!) but then when you start to feel stronger after a few months and lift a heavy object , wear high heels or stay on your feet all day, the gift of an achy scar pointedly reminds you that the healing process still has a way to go.  Below are 3 core-restore exercises that I used on myself, and in my programmes with clients that I’ve found to be extremely effective and with clients with their core strength assessed to be at Level 2 or above ( Level 2 = 2 finger or under distension with still weakened midline unable to withstand significant intra-abdominal pressure continuously).


 Kneeling Scapular Retraction & Abdominal Scooping

Looks simple but there’s a lot’s going on here.  This exercise is great for activating the lumbar and thoracic musculature/fascia.  Holding the kneeling hip flexion position ‘turns’ on this musculature and fascia from lumbar to the thoracic back, whilst simultaneously performing scapular retraction by pulling the band wide further activates deconditioned thoracic musculature.  TVA/PF activation occurs as the client aims to withstand the pull of gravity on her abdominals by activating TVA and its synergist PF. Suitable for Levels 2, 3 & 4 clients.  If the client is unable to activate TVA she works, and experiences a bulging of her abdominals, this position is too advanced for her.  You can regress this exercise by performing it in a standing position (still with knees bent and in hip flexion) to reduce the effect of gravity on still weakened abdominal muscles and midline.  Here this exercise is shown being performed on a Power Plate.  The principles of Whole Body Vibration accelerate this brilliant exercise, taking it to another level but is still highly effective when performed on the ground.  The settings are 30-30-Low.  (Please seek advice from a certified experienced Power Plate Trainer if you are not certified to use this equipment with Post Natal clients).

Assisted Heel Drops and Heel Slides

One for the Pilates massive! – I teach this in the ‘flat back’ or ‘imprint’ lumbar position for the PN client to off-set and de-train her anterior tilted pelvis and to assist in lengthening shortened lumbar musculature and fascia.  The flat back also ensures that the lengthened abdominals are being re-strengthened in a shortened position (the anterior tilted pelvis and Pregnancy has lengthened the muscles and tissues).   Client gently holds her knees as she works, ensuring the at TVA activation and the lumbar position is maintained throughout.  As the client progresses, the hands can be placed on the floor as she works.  NB: You might find that early returning C-Section clients might first need to start with HEEL SLIDES before progressing onto this ASSISTED HEEL DROP as lifting the legs into the start position might be too challenging for them.


  

Heel Slides (With Glider) With Arm Extensions

 Kneeling Straight Arm Press Downs with NEUTRAL PELVIS!

A great way to strengthen the abdominals without creating the usual intra-abdominal pressure associated with crunches against a weakened core.  Emphasize NEUTRAL PELVIS and TVA activation at all times to ensure the abdominals are not strengthened in a lengthened position and the Pelvic Floor muscles are in the perfect position to be activated.  Start and finish positions are shown.  Suitable for Levels, 2,3 and 4 clients.  Remember to coach: EXHALE ON EXERTION (ie., when the band is being pulled down).

4.  A Non-Leaky Pelvic Floor – Pelvic Floor exercise has come a long, long way since Mr. Kegel and his great revelations BUT there is still a way to go beyond the walls of research and academia.  In plain terms….women are still leaking and those sales of Tena Lady are increasing year on year (yes I actually checked!!!).  So, a bit controversial here,  can I posit the notion that if Kegels are the sole answer to urinary and faecal incontinence (ie., they were easily taught, people understood them and compliance was easy) why does just one half of my local supermarket shelf look like this?

Right now, there is a huge, well researched and vociferous movement towards emphasising the importance of including MOVEMENT to re-train the Pelvic Floor once the client is out of the acute tissue trauma phase post birth.  That said, movement won’t necessarily solve the problems of more complicated and critical cases such as prolapse, but in the case of those simply seeking a restorative programme post birth,  the principles, practices and rationale of MOVEMENT BASED PELVIC FLOOR EXERCISE really has to be in the kit-bag of any medical and fitness professional who specializes in rehab in this area.

So what does the PF love?  Squatting, lunging, lifting, pulling, tilting, multiplanar movement, hopping, and balancing – do these moves sound famililar?  THESE ARE ALL FUNCTIONAL MOVEMENTS THAT WE’RE ALREADY PRESCRIBING FOR OUR CLIENTS!  All give superior unconscious stimulation to the PF muscles without the aid of performing or cueing Kegels and fit beautifully with modern exercise prescription and preparing the client for her REAL LIFE!  Combined with an optimal breathing strategy, basically (exhale on exertion – this puts a ‘lock’ on the Core Cannister and offsets increased intra-abdominal pressure against weakened abdominal tissue) PELVIC FLOOR EXERCISE BECOMES FUNCTIONAL.   I’ve summarized the ‘turn-ons and turn-offs’ for the Pelvic Floor in the table below:

Pelvic Floor ‘Turn On’s’/Strengtheners

Pelvic Floor ‘Turn Offs’ / Weakeners

Integrated Whole Body Movement!  Think of the effect of immobility on the continence of sedentary elders. Immobility
Vibration – whole body vibration also involves Pelvic Floor muscles too! Combative sports or those that involve body blows (consider a parallel bar gymnast).
Instability – the whole core is activated included TVA which is a synergist of PF. Anterior tilted pelvis (the usual pelvic position of the Pre & Post Natal client).
Adduction –due muscular & fascial links between adductors of the Femur and PF. Over-active Piriformis – seen by some as part of the Posterior PF.  The rear PF gets strong, the front PF gets weak!
Abduction – due muscular & fascial links between the deep lateral rotators of the Femur and the PF. Pregnancy (stretching of the PF muscles by the weight of a growing baby).
Multi-Planar Movement –a combination of stimulation of adductors and the stretch reflex occurring in the PF muscles. Vaginal birthing especially when assisted (ventous/forceps/episiotomy) – produces varying degrees of soft tissue and nerve trauma that can have a direct impact on the function and connection to the PF muscles post birth.
C-Section –crucial synergistic core ligaments, nerves, skin, blood vessels and fascia are severed and take many, many months  and in some cases, years to repair/reconnect
Working against gravity, especially with progressed speed and power.
TVA Activation & Diaphragmatic Breathing – TVA, Diaphragm and PF muscles are synergists. Persistent coughing without mindful control of the increased intra-abdominal pressure.
Co-Activation of PF through activation of the Muscular Sling and fascial systems ie., full body integrated/compound movements. Obesity  – causes chronic increase intra-abdominal pressure.
Menopause – causes a fall in Oestrogen production which affects connective tissue formation and strength.
Ageing – an ongoing decrease in Collagen and Elastin formation affects connective tissue tension and less resistance to gravity and pressure.

5.  Finally, last but most definitely not least –  Rest – For too long, meditation and those with a consistent practice have been seen as some sort of secret society but thanks to advances in modern technology the rest of us mortal souls can now enter the loop.  The power of meditation is HUGE and it’s a massive asset to health and well-being  and FAT LOSS even if you have just a few minutes a day to dedicate to it.   Even when night-time sleep is hard to come by using strategies such as ASSISTED MEDITATION wearing a set of headphones listening to an audio recording is a huge asset to redressing the imbalances caused by sleep deprivation.  Check out http://www.centerpointe.com and www.blissitations.com.  Both of these sites have products that you can purchase and or download that literally give your brain the equivalent of the best massage you’ve EVER had!  Utterly blissful and even 10 minutes does you the power of good!  Perfect for the time pressed mommy.  For more on this, check out my previous blog on Stress, Sleep Deprivation and Fat Loss.

So, in conclusion, fat loss is tricky at the best of times, never mind after the endocrine turbulence associated with pregnancy, birthing and breastfeeding.  Helping your clients to understand the facts will help to temper her anxiety that her body has gone to pot FOREVER.  Simply helping her to detoxify/clean up her diet and teaching her new ways to rest can be a great way to start on the journey to losing her baby weight in the early days but ultimately, this is one time in most women’s life when they are forced to learn the art of patience, self-acceptance regardless of what size they are wearing and a time for redefining what success means in terms of their diet and fitness.  It’s always a little dark before the light :-).  With our help, great guidance and empathy they will make it back and be better, stronger and wiser for their ‘down-time!

Til next time!  Remember…..Mediocrity is a Sin!  Go Bold or Go Home! 😉

I‘ll be presenting at the UK Top Fitness Convention later this month, check out the amazing line-up & my sessions….

http://tinyurl.com/7uur4ld

Venous Thrombosis in Pregnancy and After Birth – RCOG Patient Info

24 Oct

What is venous thrombosis?

Thrombosis is a blood clot in a blood vessel (a vein or an artery). This information is about a thrombosis that occurs in a vein – the blood vessels that take blood towards the heart and lungs.

A deep vein thrombosis (DVT) is a blood clot that forms in a deep vein of the leg, calf or pelvis. If the clot moves to the lung, it is called a pulmonary embolus.

What are the symptoms of a DVT during pregnancy?

The symptoms of a DVT usually occur in only one leg and include:

  • a red and hot swollen leg
  • swelling in your entire leg or just part of it
  • pain and/or tenderness – you may only experience this when standing or walking or it may just feel heavy.

Seek advice immediately from your doctor or midwife, if you notice one or more of these symptoms.

During pregnancy, swelling and discomfort in both legs is common and does not always mean there is a problem. Always ask your doctor or midwife if you are worried.

Why is a DVT serious?

The danger of a DVT is that the blood clot may break off and travel in the blood stream until it gets stuck in another part of the body, such as in the lung (pulmonary embolus).

The symptoms of a pulmonary embolus may include:

  • sudden unexplained difficulty in breathing
  • tightness in the chest or chest pain
  • coughing up blood (haemoptysis)
  • feeling very unwell or collapsing.

Seek help immediately if you experience any of these symptoms.

Although a pulmonary embolus is rare, it can be life-threatening. The risk of developing a pulmonary embolus once a DVT has been diagnosed and treated is extremely small.

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Who is at risk of venous thrombosis?

Pregnant women are ten times more likely to develop venous thrombosis than women who are the same age and not pregnant. Venous thrombosis related to pregnancy can occur at any stage of pregnancy and for six weeks after birth. This is due to the changes from being pregnant.

Additional risks for developing a venous thrombosis in pregnancy are when you:

  • have had a previous venous thrombosis
  • have a condition called thrombophilia, which makes a blood clot more likely
  • are over 35 years of age
  • are overweight – body mass index (BMI) over 30
  • are carrying more than one baby (multiple pregnancy)
  • have severe pre-eclampsia (see RCOG Patient Information Pre-eclampsia: what you need to know[4])
  • have just had a caesarean delivery
  • are immobile for long periods of time, for example, after an operation or when travelling for four hours or longer
  • are a smoker.

How is venous thrombosis diagnosed during pregnancy?

DVT
Your doctor will examine your leg and may offer you an ultrasound scan of your leg to show where the clot is. If no clot is seen but you are still having symptoms, the scan may be repeated after one week.

Pulmonary embolus
The tests may include:

  • a chest X-ray (this can also identify common problems which could be the cause of your symptoms, such as a chest infection)
  • a CT scan (specialised X-ray) of your lungs
  • a VQ scan (ventilation perfusion) of your lungs. This needs a drip into a vein in your arm
  • an ultrasound of both your legs to look for an existing blood clot which may not have caused you any symptoms.

Are there any risks with having the tests?
The chest X-ray, CT scan and VQ scan use radiation (X-rays). You may be concerned about the risk of these tests to the baby. The chest X-ray uses a very small dose of radiation and the baby will be shielded. The risk to your baby of developing cancer in childhood after a VQ scan is extremely rare (1 in 280,000).

There are small risks with CT and VQ scans and these need to be weighed up against the risk to mother and baby of an undiagnosed venous thrombosis. A CT scan gives a higher dose of radiation to your breasts than a VQ scan and the lifetime risk of breast cancer may be increased. The risk may be increased by up to 13.6% with a background risk of 1 in 200.

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What is the treatment for venous thrombosis?

As soon as your doctor suspects you have a venous thrombosis, you will be advised to start on treatment with an injection of heparin (an anticoagulant) to ‘thin the blood’. There are different types of heparin. The most commonly used in pregnancy is ‘low-molecular-weight heparin’ (LMWH).

For most women, the benefits of heparin are that it:

  • works to prevent the clot getting any bigger so your body can gradually dissolve the clot
  • reduces the risk of a pulmonary embolus
  • reduces the risk of another venous thrombosis developing
  • lowers the risk of long-term symptoms developing in the leg, known as ‘post-thrombotic syndrome’ (see What happens after birth and can I breastfeed?).

What does heparin treatment involve?
Heparin is given as an injection under the skin at the same time(s) every day. The dose is worked out for you according to your weight before you became pregnant. You (or a family member) will be shown how and where in your body to do the injections. You will be provided with the needles and syringes (usually already made up) and you will be advised on how to store and dispose of these. You will have regular check-ups, including blood tests, as an outpatient. You will probably not need to stay in hospital.

How long will I need to take heparin?
Treatment is usually recommended for the remainder of your pregnancy and for at least six weeks after the birth. The minimum treatment time is three months.

Contact your doctor if you experience any worrying symptoms when you are taking heparin (such as chest pains, unexpected bruises, a sudden change in your health). Also contact your doctor if you have any heavy bleeding during this time.

What else can help?

  • Stay as active as you can.
  • You will be prescribed a special stocking (graduated elastic compression stocking) which helps to reduce the swelling in the leg.
  • If you need pain relief, ask your doctor or midwife.

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Are there any risks to me and my baby from heparin?

Low-molecular-weight heparin cannot cross the placenta to the baby and so is safe to take when you are pregnant.

There may be some bruising where you inject which will usually fade in a few days. One or two women in every 100 (1–2%) will have an allergic reaction when they inject. If you notice a rash after injecting, you should inform your doctor so that the type of heparin can be changed.

What should I do when labour starts?

Most women with a DVT continue with their pregnancy normally. If you think that you are going into labour, do not take any more injections. Phone your hospital immediately and tell them that you are on heparin treatment. They will advise you.

If the plan is to induce labour, you should stop your injections 24 hours before the planned date. An epidural injection (given into the space around the nerves in your back) cannot usually be given until 24 hours after your last injection. Alternative pain relief options will be discussed. An individual plan will be made with you.

What if I have a planned caesarean delivery?

Your last heparin injection should be 24 hours before the planned caesarean delivery (operation to deliver your baby). The heparin will usually be re-started within 3 hours of the operation.

What happens after birth and can I breastfeed?

Treatment should be continued for at least six weeks after birth. There is a choice of treatment after birth of continuing with injections of heparin or using warfarin tablets. Your doctor will discuss your options with you.

Both heparin and warfarin are safe to take when breastfeeding.

After birth, you will usually be given an appointment with your GP, obstetrician or haematologist. At your appointment the doctor will:

  • ask about your family history of thrombosis and discuss tests for a condition which makes thrombosis more likely (thrombophilia). These should be done ideally before any future pregnancies.
  • discuss your options for contraception (you should be advised not to take any contraception that contains estrogen, for example, the ‘combined pill’)
  • discuss future pregnancies: you will usually be recommended heparin treatment during and after your next pregnancy
  • give you information about a compression stocking: it is recommended that you should wear this on the affected leg for two years.

A glossary of all medical terms is available [5].
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Sources and acknowledgements
This information is based on the Royal College of Obstetricians and Gynaecologists (RCOG) guideline Thromboembolic Disease in Pregnancy and the Puerperium: Acute Management (published by the RCOG in February 2007). This information will also be reviewed and updated if necessary once the guideline has been reviewed. The guideline contains a full list of the sources of evidence we have used. You can find it online. [2]

Clinical guidelines are intended to improve care for patients. They are drawn up by teams of medical professionals and consumer representatives who look at the best research evidence available and make recommendations based on this evidence.

This information has been developed by the Patient Information Subgroup of the RCOG Guidelines and Audit Committee, with input from the Consumers’ Forum and the authors of the clinical guideline. It has been reviewed before publication by women attending clinics in Salisbury, Paisley and Bolton. The final version is the responsibility of the Guidelines and Audit Committee of the RCOG. The RCOG consents to the reproduction of this document providing that full acknowledgement is made.

A Final Note
The Royal College of Obstetricians and Gynaecologists produces patient information for the public. This is based on guidelines which present recognised methods and techniques of clinical practice, based on published evidence. The ultimate judgement regarding a particular clinical procedure or treatment plan must be made by the doctor or other attendant in the light of the clinical data presented and the diagnostic and treatment options available.

© Royal College of Obstetricians and Gynaecologists 2007

Chickenpox In Pregnancy – RCOG Patient Info

24 Oct

What is chickenpox?

Chickenpox is a very infectious illness caused by a virus called herpes zoster (part of the herpes family). The medical name for chickenpox is varicella. Most people in the UK get chickenpox in childhood, when it is a mild infection causing a rash. Once you have had chickenpox, you cannot catch it a second time. This is called being immune to it (your body produces antibodies, which are the body’s defence system against infection). Nine out of ten pregnant women (90%) in the UK are immune to chickenpox. If you are infected for the first time as an adult, it tends to be more serious.

If you grew up in a tropical or subtropical area, you are less likely to have had chickenpox in childhood. If you subsequently move to the UK, you have a greater risk of catching chickenpox than women who were born and grew up in the UK. Your doctor or midwife may discuss testing your immunity while you are pregnant.

What are the symptoms of chickenpox?

The symptoms of chickenpox take between 10 days to 3 weeks to appear. This is the incubation time – the time from when you catch it to when the symptoms start to show.

The first signs are fever and feeling unwell. This is followed by the formation of watery blisters which can appear anywhere over the body. The blisters itch. After a few days the blisters burst, crust over and then heal. This may take up to 2 weeks.

Is shingles the same as chickenpox?

Shingles is related to chickenpox but the symptoms are different. After you have had chickenpox, the virus stays in your body and can become active again later and this time it causes shingles. Shingles is a patch of itchy blisters on the skin that dry out and crust over in a few days. It can be very painful (see section What should I do if I come into contact with shingles during pregnancy? [2]).

How do you catch chickenpox?

You catch chickenpox from someone who currently has it. A person is contagious from 2 days before the rash appears to when all the blisters have crusted over. During this time, you can catch chickenpox by being:

  • in close contact with them
  • face to face with them for at least 5 minutes
  • in the same room with them for at least 15 minutes.

Is there a chickenpox vaccination?

If you have not had chickenpox, you can be vaccinated against it when you are not pregnant. The chickenpox vaccination is effective in making nine out of ten women (90%) immune.

The vaccination cannot be given in pregnancy and you should avoid getting pregnant for 3 months after the injection. If you have been vaccinated and develop a rash you should avoid contact with pregnant women or women trying to get pregnant who have never had chickenpox.

If you find out you are not immune to chickenpox during pregnancy, your doctor may discuss vaccination after the birth of your baby.

What if I come into contact with chickenpox when I am pregnant?

If you have had chickenpox, you are immune and there is nothing to worry about. You do not need to do anything.

If you have never had chickenpox, or are not sure, see your GP as soon as possible. You can have a blood test to find out if you are immune.

If you develop a rash in pregnancy always contact your GP or midwife.

What if I come in contact with chickenpox when I am pregnant and I am not immune?

If you are not immune to chickenpox and you come into contact with it during pregnancy, you may be given an injection of varicella zoster immune globulin (VZIG). This is a human blood product which strengthens the immune system for a short time but does not necessarily prevent chickenpox developing. VZIG can make the infection milder and not last for as long. The injection can be given for up to 10 days after you come into contact with chickenpox and before any of your symptoms appear. VZIG does not work once you have blisters.

What if I have had VZIG and come into contact with chickenpox again?

A second dose of VZIG should be given if you have come into contact with chickenpox again and it is 3 weeks or longer since your last injection.

What could chickenpox mean for my baby during pregnancy and after birth?

Only a very small number of women (3 in every 1000 or 0.3%) catch chickenpox in pregnancy in the UK. Even fewer babies are affected in the uterus. The risk of a baby catching chickenpox depends on what stage in pregnancy you catch it.

If you catch chickenpox:

  • up to 28 weeks of pregnancy
    There is no evidence that you are at an increased risk of early miscarriage because of chickenpox. Damage can occur to the eyes, legs, arms, brain, bladder or bowel in 1-2 of every 100 babies (1-2%). You will be referred to a fetal medicine specialist for ultrasound scans and discussion about possible tests and their risks (see RCOG patient information Amniocentesis: what you need to know [3]).
  • between 28 and 36 weeks of pregnancy
    The virus stays in the baby’s body but will not cause any symptoms. The virus may become active again causing shingles in the first few years of the child’s life.
  • after 36 weeks and to birth
    The baby may become infected and could be born with chickenpox.
  • around the time of birth
    If the baby is born within 7 days of your chickenpox rash appearing, the baby may get severe chickenpox. The baby will be treated.
  • up to 7 days after birth
    The baby may get severe chickenpox and will be treated. The baby will be monitored for 28 days after you became infected.

It is safe to breastfeed if you have or have had chickenpox during pregnancy.

After birth, the baby will have an eye examination and blood tests. When the baby is 7 months of age, a blood test can check if the baby has antibodies (immunity) to chickenpox. The test can also show if the baby caught chickenpox before birth.

If you catch chickenpox in pregnancy or when you are trying to become pregnant, you should avoid contact with other pregnant mothers and new babies until all your blisters have crusted over.

Can I be treated if I develop chickenpox during pregnancy?

You can be given an antiviral drug called aciclovir within 24 hours of the chickenpox rash appearing. This will reduce fever and symptoms. Aciclovir is only recommended when you are more than 20 weeks pregnant. No medication during pregnancy is without its risks and these will be discussed with you.

Once you have chickenpox, there is no treatment that can prevent your baby from getting chickenpox in the uterus.

What could chickenpox mean for me in pregnancy?

Chickenpox can be serious for your health during pregnancy. Complications can occur such as chest infection (pneumonia), inflammation of the liver (hepatitis) and inflammation of the brain (encephalitis). Very rarely, women can die from complications.

You are at greater risk of complications if you catch chickenpox when you are pregnant if you:

  • smoke cigarettes
  • have a lung disease such as bronchitis or emphysema
  • are taking steroids or have done so in the last 3 months
  • are more than 20 weeks of pregnancy.

If any of these apply to you, you may need to be referred to the hospital.

When should I be referred to hospital if I have chickenpox?

Your GP should send you to hospital if you have chickenpox and develop any of the following:

  • chest and breathing problems
  • headache, drowsiness, vomiting or feeling sick
  • vaginal bleeding
  • a rash that is bleeding
  • a severe rash
  • if you are immune suppressed (your immune system is not working as it should be).

These symptoms may be a sign that you are developing the complications of chickenpox.

If you need to be admitted to hospital, you will be nursed in a side room away from babies and pregnant women.

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When should I give birth if I have chickenpox in pregnancy?

The timing will depend on you own individual circumstances. It is best to wait until the chickenpox is over, to let you recover. This will also give a chance for your immunity to pass to the baby. If you are very ill with chickenpox, particularly with any of the complications, your obstetrician will discuss whether you should have the baby early.

What if my newborn baby has come into contact with chickenpox?

If your newborn baby has come into contact with chickenpox in the first 7 days of life and you are immune, then the baby will be protected by your immunity and there is nothing to worry about.

If you are not immune, then the baby may be given VZIG.

What should I do if I come into contact with shingles during pregnancy?

If you are immune to chickenpox you do not need to worry. If you are not immune, then the risk of getting chickenpox from someone with shingles present on a covered part of the body, is very small. If the shingles is widespread or exposed (such as the face or eye) there is a risk of chickenpox infection to you when the blisters are active and until they are crusted over. See your doctor for advice about treatment.

What should I do if I develop shingles during pregnancy?

If you get shingles while you are pregnant, it is usually mild and there is no risk for you or your baby.

A glossary of all medical terms is available on the RCOG website [5].

Sources and acknowledgements

This information is based on the Royal College of Obstetricians and Gynaecologists (RCOG) guideline Chickenpox in Pregnancy [6] (originally published by the RCOG in July 2001 and revised in March 2007). This information will be reviewed again, and updated if necessary, once the guideline is reviewed. The guideline contains a full list of the sources of evidence we have used.

Clinical guidelines are intended to improve care for patients. They are drawn up by teams of medical professionals and consumers’ representatives, who look at the best research evidence there is about care for a particular condition or treatment. The guidelines make recommendations based on this evidence.

This information has been developed by the Patient Information Subgroup of the RCOG Guidelines Committee, with input from the Consumers’ Forum and the authors of the clinical guideline. It has been reviewed before publication by women attending clinics in East Sussex, South Yorkshire and London. The final version is the responsibility of the Guidelines and Audit Committee of the RCOG. The RCOG consents to the reproduction of this document providing full acknowledgement is made. © Royal College of Obstetricians and Gynaecologists 2008

A final note

The Royal College of Obstetricians and Gynaecologists produces patient information for the public. This is based on guidelines which present recognised methods and techniques of clinical practice, based on published evidence. The ultimate judgement regarding a particular clinical procedure or treatment plan must be made by the doctor or other attendant in the light of the clinical data presented and the diagnostic and treatment options available.

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