Exercise is the most important adjunct therapy for those going through cancer treatments! It helps not only with improvements in cancer outcomes, but with reducing side effects of treatments.
Exercise has been linked to helping reduce morbidity and recurrence risks of cancer, but what we know the most about is how fantastic exercise is for helping side effects during treatment!
We know that for the physiological adaptations at the cellular level to occur to help with decreasing cancer risk & improving how well cells can tolerate chemotherapy - you have to exercise with resistance (and no… we don’t mean resisting coming to class haha).
Some of the research theories for why exercise is so protective and such a potent medicine for cancer patients is that exercise helps with blood flow, increases immunofactors, decreases inflammation, and helps overall health and strength to be able to tolerate more chemotherapy treatments.
Want to use exercise as medicine for yourself? Our Oncology Rehabilitation classes are called Pinkmoves - and are a fun exercise class for women who have experienced cancer!
Class runs for 45mins, and has a different focus on relaxation, aerobic work, movement and having a laugh & a chat. We want cancer patients to be physically active for 30 mins or more, on all days of the week - and working at a moderate intensity! If there are days when all you can manage is a gentle walk - great! If there are days you have some more energy reserves try to come to class!
You are able to attend Pinkmoves at any stage of your cancer treatment, including during chemotherapy, radiation & immunotherapy. At Pear all our Exercise Physiologists have experience with lymphedema, portacath, PICC lines, peripheral neuropathy & post surgical rehabilitation for mastectomy & hysterectomy - so never worry about any other complications!
We know from the research & from our own ladies experiences just how much exercise has helped improve their cancer related fatigue. Not feeling as much fatigue helps lift the fog on your mental health, and to be able to physically get more done in your days outside of treatment. It’s so much fun to come up with new exercises to help improve range of motion in shoulders after surgeries!
We hope that more Oncologists begin to refer to Exercise Physiologists to help better their patients outcomes & that exercise is used as medicine for all cancer patients!
Keen to get back to pounding the pavement, park runs and that mental space of a jog along the local pathways?
But when can I return to running!
The question on many of our postnatal clients lips - when can I run! The first research evidence guidelines were published in 2019 to help support graduated return to high intensity exercise postpartum, ie/ running. There are certain considerations when returning to higher intensity exercise - for short term & long term health outcomes.
First - we advise waiting til at least 4 months to return to higher intensity exercise - and this is due to the levator hiatus (that is the gap in your pelvic floor muscle through which your vaginal travels) widens during pregnancy, and significantly widens after vaginal delivery (uhh - duh!). It is thought to return to similar size 12 months post a vaginal delivery without inteventions (c-section deliveries return to similar size much sooner) however never to prenatal size.
The recovery of your levator ani muscle (part of the complex of muscles that makes up your pelvic floor team!) and all the connective tissue & nerves that have been stretched in your pelvis via delivery is thought to be maximised (that is - healed to the best it can) at 4 - 6 months postpartum. If you start jumping, running & placing impacting loads through this pelvic floor as it is still recovering, you may delay your recovery or take a step backwards in your pelvic floor recovery (not what we want!).
Consider this - if you had a surgery on your knee, or badly rolled your ankle - where ligaments were stretched, or surgically cut and stitched, you would have an enforced rest period, then a rehabilitation protocol, then a slow progression back to running post injury!
Why would we not provide the same rehabilitation and progression back after a MAJOR abdominal surgery, or vaginal delivery, where your pelvic ligaments have been stretched & abdominal or vaginal wall may have been cut/torn or sutured.
There are some important steps we get you to pass before you hit the streets with us - and we are here to help you at every step!
Firstly, we know that motor control (that is how your brain talks to your muscles) is altered between your deep abdominal wall & pelvic floor after pregnancy. We need to retrain the brain to speak with these to help with your core stability and controlling what’s called your intra-abdominal pressure. At this first stage we would want to see resolution of any abdominal separation (diastasis recti) and rehabilitate any pains or injuries.
Secondly, we need to restore strength & stability to your pelvis - as running is performed on a single leg we want to make sure you are strong enough in your muscles to stabilise on a single leg - and strong enough in your pelvic floor to withstand impact! Did you know how many muscles are active during a running cycle? You have at least 10 muscles just in your lower limbs (glute max, glute med, quadriceps group, gastroc & soelus, long head biceps femoris , semimembranosus, tensor fasciae latae, adductor
PLUS your core stability helping with increased demand on breath! That’s a lot going on! We also work closely with women’s health physiotherapists at this stage, helping give us information from internal exams on what pelvic floor is doing, and how we can best help support with your training. We don’t have x-ray specs, and without this knowledge you may feel like your running great - but your pelvic floor muscles, ligaments and pelvic organs may not be doing so great. If you do have a prolapse, we can help with improving strength surrounding the pelvis, your control of your breath through exercises, and alternatives and modifications to exercises, to keep you moving without fear and supporting your pelvic floor!
Thirdly, we actually want to expose you to running - and make you as efficient at it as possible! Picture Phoebe from friends jogging through the park - a great example of NOT efficient running! Efficiency means being able to run at a given speed -with the least amount of effort, that is working smarter not harder! Exercise Physiologists are experts at this, we work with patients completing rehabilitation after chemotherapy all the way up to athletes trying to better their performance times!
So - where do I start!
Our postnatal clearance to exercises appointments are appropriate from 6 weeks postnatal for vaginal delivery and 8 - 10 weeks postnatal for c-section or interventions (forceps, vacuum, episiotomy) deliveries.
At this appointment we will screen your abdominal wall for diastasis recti (abdominal separation), pelvic floor co-ordination, any pelvic girdle dysfunction and help to graduate you from low intensity exercise back to the activities you love with a combination of in studio appointments, mums & bubs classes & home programs!
About Pear Exercise Physiology
We are passionate about all stages of Women's Health at Pear Exercise Physiology, and our team of exercise physiologists & remedial massage therapists have further education & in depth understanding of the physiological changes in your body brought on by pregnancy, birth, surgery and rehabilitation for the pelvis & pelvic floor.
Working with our exercise physiologists can help transition you back to exercise safely after birth, with rehabilitation for your abdomen & pelvic floor, and graduated return to exercise, sport & running! Babies & children are always welcome at Pear, with Mums & Bub's classes & one on one appointments available Monday - Saturday.
How we can help:
- check any abdominal separation (also known as Diastasis Recti or DRAM)
- how to protect your pelvic floor in the gym, and at home
- how to safely lift your baby
- pelvic floor & core restore exercises
- a home rehabilitative exercise program
Welcome to day 1 of 5 of sharing blogs, tips, tricks and information on all things Women’s Health & exercise medicine.
Today, I wanted to share a little bit about ‘Womens Health’ - what that umbrella term means, how the female physiology is so incredible, and why we need to do better to support women in health.
When you think of women’s health, automatically we imaging pregnancy & babies - right? But womens health covers everything that may affect women - from pelvic floor dysfunction & babies - to osteopenia & hot flushes in menopause - to heart disease & endometriosis.
Our anatomy is unique - we are not just little men - our monthly fluctuating hormones are often seen as an inconvenience, or flat lined with medication like the oral contraceptive pill - but periods can be considered our 5th vital sign, behind heart rate, blood pressure & respiration. Vital signs indicate the status of the body’s vital (life-sustaining) functions.
Cardiovascular disease is the biggest killer of women in Australia - but when you think of a heart attack we often imagine a middle aged man clutching his chest. These ‘Hollywood heart attack’ symptoms of chest pain & left arm pain are uncommon in women - with women presenting more often with stomach pain, breathlessness, nausea and fatigue.
Women also have to navigate pharmaceutical interventions more difficulty, as with our hormones (some drugs have been found to work differently in different times of the menstrual cycle), different physiology including metabolic pathways in rest and with exercise (we know women burn fat more than carbs vs men during exercise - and that women respond better to resistance training than men to help with blood pressure) we may metabolise drugs more quickly - or require a smaller dosage!
We need to continue to push for better understanding of women & their health, to close the huge historical data gap when it comes to female bodies, and to better our health services for women! We know just how potent a medicine exercise is for women - and at Pear we hope to break down the barriers of taboo and stigma in Womens Health, by providing specialist services from our friendly studio. We want to help all women to use exercise as medicine and to prioritise self care in all stages of life.
We support women through every stage of life, and our Women's Health Exercise Physiologists have additional training & focus on pelvic floor dysfunction, pregnancy, optimal foetal positioning and postnatal recovery. We recognise that there is a lack of support for women who experience injuries, illnesses or chronic diseases such as endometriosis or abdominal separation and want to help bridge the gap between diagnoses, acute rehabilitation and long term recovery and management.
I feel lucky to share my passion to improve health outcomes & health services for women through all stages of life with my colleagues at Pear Exercise Physiology!
As exercise physiologists we have an in depth understanding of the physiological changes in your body brought on by pregnancy, birth, surgery and rehabilitation for the pelvis & pelvic floor.
Below are some of our unique services to support women through pregnancy, motherhood & beyond.
Optimal Foetal Positioning (Baby Spinning)
Visit our Exercise Physiologists for assistance in getting baby the right way round for birth, suitable for breech or transverse lay babies and also proactive mums-to-be to keep baby head down! Our Exercise Physiologists will provide a combination of exercises, stretches and postures can help with optimal foetal positioning to complete at the studio & at home. Appropriate from 28 weeks through to 40 weeks.
Labour Preparation Massage
A labour prep massage (LPM) is a whole body massage where the focus is preparing the mind with relaxation and preparing the pelvic girdle for labour using remedial massage. From 38 weeks we can include acupressure points to assist in stimulating and encouraging labour to start. It is important to remember that each woman and labour is unique and certain techniques are not guaranteed to start labour, but will support your body in the stage it's at. During labour a mother may choose to use a number of body positions that are optimal for birthing her baby, like squatting, kneeling or even being on all fours. These positions require more flexibility in the legs and hips. So to facilitate these positions, we focus on working the muscle groups in the thighs, hips and lower back. Ideally including LPM in your pregnancy plan from 36weeks and continuing weekly to labour onset, will give your body the most benefit. Labour Prep Massages are an amazing way to prepare mentally and physically, allowing you time to rest and possibly sleep before the onset of labour.
Abdominal Separation (Diastasis Recti) Rehab
1 in 3 women will experience diastasis recti postpartum, and research shows that without rehabilitative intervention, the gap between your abdominal muscles & weakness in your abdominal wall will not get better. Visit our team who are specialists in postnatal rehabilitation for assistance in diastasis recti rehabilitation program for in the studio & at home.
Postnatal Return to Exercise Clearance
Keen to get back to the movement you love? Do it safely with the assistance of our Exercise Physiologists, this appointment is appropriate for 6 weeks postnatal for vaginal delivery and 8 - 10 weeks postnatal for c-section or interventions (forceps, vaccum, episiotomy) deliveries. At this appointment we will screen your abdominal wall, pelvic floor, any pelvic girdle dysfunction and graduate you back to low intensity exercise with a combination of in studio appointments, mums & bubs classes & home programs.
Mum's Return to Run Club
The first research evidence guidelines were published in 2019 to help support graduated return to high intensity exercise, including running! Join our park based exercise class, where you will progress from strength circuit work, to impact work, all the way back to shuttle run drills & a 5 km run!
Hysterectomy/ Prolapse Repair Rehabilitation
Most surgeries have post surgical rehabilitation, however Hysterectomy and Prolapse repair surgeries have long gone under serviced & with poor outcomes. We are working closely with Gynaecologists & Oncology- Gynaecologists to provide a comprehensive 4 week exercise rehabilitation to help reduce risk of re-prolapsing, incontinence & chronic pelvic pain.
Prolapse diagnosis can feel like the end of exercise & activity - but it doesn't need to be. Work with our Exercise Physiologists to help reduce your fear of movement, and to improve your pelvic floor activity in conjunction with pessaries, Women's Health Physiotherapists & specialist Pilates classes at Pear.
BOOK AN APPOINTMENT WITH AN EXERCISE PHYSIOLOGIST
FIRST OFF - WHAT IS EXERCISE PHYSIOLOGY? / WHAT IS AN EXERCISE PHYSIOLOGIST?
Exercise physiology itself is the study of the acute responses and long-term adaptations to a wide range of physical activity and exercise conditions in the body. That is, what happens in the heart, lungs, stomach, liver, muscles or brain when we exercise?
In addition, Exercise Physiologists study the effect of exercise on illness and injury in these systems of the body - and the mechanisms by which exercise can reduce, or reverse disease progression (for example how exercise can influence blood glucose without the need for insulin, and help type II diabetics manage their disease). We then use this knowledge to prescribe exercise – just like medicine! In fact, our mantra is that exercise IS medicine!
As a result, Accredited Exercise Physiologists have an amazing understanding of the human body, anatomy and especially at Pear Exercise Physiology- the physiological changes brought on by pregnancy! A lot of changes occur in the body when you are carrying a baby, even more if you are carrying 2 (or even 3!), and exercise can help at every stage of pregnancy.
HOW CAN EXERCISE HELP RESOLVE MY BACK PAIN?
Almost 80% of us will experience back pain at some point in our lives. Unfortunately it is a very common, but very treatable, injury. Your spine and the surrounding muscles are designed for movement - and in bouts of lower back pain can become rigid and immobile. Repeated bouts of Lower Back Pain can set off a "spiral of decline", in which someone takes to the couch because of the pain; this inactivity weakens muscles and joints; the person's now-weakened back and core become less able to sustain the same level of activity as before, leading to more pain and more inactivity; and the spiral continues.
Seeking manual therapy for Lower Back Pain is also very common, this is where a therapist such as an osteopath, chiropractor, physiotherapist, or acupuncturist will help manually manipulate your spine to help restore mobility, relax muscles and increase circulation. However manual therapy alone will not resolve your Lower Back Pain – active therapy, where you exercise and physically move these muscles is so important in recovery!
It is important to seek assistance with planning exercise if you have had multiple episodes of low back pain, because the back muscles can respond differently after repeated bouts of back pain.
LOWER BACK PAIN IN PREGNANCY
As many as 75% of pregnant women experience back pain at some point. Most often the pain appears in the second or third trimester and can become worse as pregnancy progresses. Again, although lower back pain during pregnancy is very common – it should definitely not be accepted as just part of the process! Exercise can help.
There are 2 main types of Lower Back Pain commonly seen in pregnancy - lumbar pain and posterior pelvic pain.
Lumbar pain during pregnancy is generally located at and above the waist in the center of the back - and is similar to lower back pain experienced by non- pregnant women. This type of pain typically increases with prolonged postures (such as sitting, standing, or repetitive lifting).
Posterior pelvic pain is four times more prevalent than lumbar pain in pregnancy. It is caused by dysfunction of the sacroiliac joint.
The sacroiliac joint is the junction of the sacrum and the pelvic bones. Hormones released in pregnancy cause this joint to become more mobile to prepare the pelvis for birth! However, this increase in motion causes instability of the sacroiliac joint – which can then become a source of pain. Posterior pelvic pain can be brought on or exacerbated by walking, running, swimming breast stroke, climbing stairs, getting in/out of the car, and rolling in bed.
Posterior pelvic pain is a deep pain felt below the waistline on either side across from the tailbone. It can extend down into the buttock and back of the thighs, but does not usually radiate below the knees.
The pain doesn’t resolve quickly with rest, and morning stiffness may also be present. Although you may want to rest, stretching and strengthening exercises will often improve your pain.
So in summary!
Lower back pain is very common in both the general population and in pregnancy – and we know bed rest unfortunately will not make things better!
Exercise helps improve pain, strengthen back muscles and reduce your risk of on going lower back pain.
Exercise Physiologists provide active therapy and work closely with manual therapists to help you improve and manage your lower back pain.