PART 1 - Rehab To Function
Cancer. One word I was not expecting to hear so soon after the birth of our first child, Eeva. I had noticed a pea sized lump just under my chin, near where you would find swollen glands with a headcold. At the time, I was 8 months pregnant and thought “I’m pregnant, I’m tired, I’m probably just rundown”. Fast forward 6 weeks postpartum and I was off to QScan for my first appointment, of five. It was a long 4 weeks, being told by my GP that they didn’t find anything of special note but because of my history of melanoma, we better continue the search. I was referred to an ENT and she noted a nodule on my thyroid which we had biopsied. It was thyroid cancer. We made the decision to have surgery as soon as possible so that I could proceed with my treatment.
Barriers to exercise
The first couple of months of recovery were difficult. Not only did I just have major surgery, but I was also dealing with the trauma of diagnosis, coding on the post op ward and an ICU stay. Not to mention, I was waking up every 3 hours to pump with the goal of storing as much breastmilk for Eeva before weaning for treatment. I was tired, really tired. No amount of sleep was helping and I found myself going through the motions to get through our day. Somehow, I managed going to mum’s group and baby sensory classes. I did not want Eeva to miss out! But this meant it was difficult to find time to exercise. I would steal moments whilst Eeva was sleeping or jump down on the floor with her and do my postnatal rehab exercises. But with everything going on, I did not put enough time into rehabbing my neck and shoulder
What got us back to function?
Booking an appointment at Pear with my team was the best thing I could do for my recovery. Although I knew what to do and how to do it, I needed the accountability to focus on myself. I’ve now been able to complete my strength training program via physitrack twice per week and am back to doing long walks and jogs. I’ve also benefited from our reformer pilates classes. I’m so looking forward to starting swimming in a couple of weeks to really put my neck/shoulder rehab to the test! Bring on the Team Pear Tri!
I keep hearing people talk about pelvic floor health. What does that mean? Does that mean I need to do more kegel exercises or does pelvic floor health mean something else?
Pelvic floor health is an important part of women’s health and has an impact on sexual health, sexual pleasure and function. It can impact bowel and urinary function as well. In order to address the question what is pelvic floor health, we spoke to our amazing Pelvic Physiotherapist Sami Cattach to find out more.
This article explains how the muscles in the pelvic floor work and some simple steps to look after your pelvic floor.
I realise that I've been going on and on about tight and shortened pelvic floor muscles, but what does that really mean? Let me enlighten you!
Muscles have a very specific length that allows them to function optimally according to a length-tension (strength) relationship.
This demonstrates that a muscle that is too short or too long has a decreased ability to contract compared to when it is within it's optimal range.
Ever tried to do a pullup? If you start with your elbow slightly bent - where the muscle is in its mid-range - it is much easier than starting from a fully extended elbow or fully bent elbow.
A muscle that is shortened, already contracting/holding tension is actually placed at a mechanical disadvantage and therefore cannot generate as much tension (think "strength") compared to when it is relaxed. In the case of the pelvic floor muscles, a position longer than the optimal length is more akin to a situation where the muscles have been overstretched or torn - rare without having experienced some direct trauma to the area - so you don't have to worry about relaxing too far.
This is where a lot of people with pelvic floor issues spend their time - constantly contracting because we've always been led to believe that more activation = more strength which is better. Not so! In my experience, the majority of people that I treat for pelvic floor issues have muscles that are on the short side of the equation, rather than just being weak, and this can manifest in many different ways:
In most cases, we need to learn how to relax and lengthen the pelvic floor muscles first, prior to any strengthening (if needed at all) in order to restore their optimal function. Contributing factors to shortened pelvic floor muscles
Standing and walking with your tailbone tucked under - again this is encouraging the tailbone and sacrum to move toward the pubic bone with similar effects as above. Shortened hamstring and calf muscles wearing will also keep you in this perpetually tucked pelvic position.
Esme is our Principal Exercise Physiologist & Director here at Pear, and is passionate about working with women, helping improve the care that women receive through pregnancy, early postpartum, in rehabilitation, after cancer and in chronic pain management.
After all the worry and times of extreme caution over the last 2 years, I tested positive to the dreaded COVID-19 in early January.
Mostly I was just frustrated at being quarantined / stuck at home for a week - I really only had a couple of days of symptoms with a sore throat, some headaches and fever. At this stage the recommendations for return to exercise and activity during COVID infection were really not clear - and I was going stir crazy, so I completed a couple apartment block walks inside our courtyard and some youtube pilates in my bedroom!
What happened after my quarantine week, was that my fatigue got A-LOT worse. I had worked with plenty of clients who had fatigue (post cancer fatigue, or post-exertional malaise) - but never experienced true fatigue myself. My limbs felt extra heavy, my brain extra foggy, and I just felt like I was moving through a swamp. Most of my down time was spent horizontal. I even had to have a nap after a shower. I had such a tough time mentally, I wasn’t even able to work a full shift at Pear, which is very unlike me as I am an energiser bunny mostly.
My mind went to - oh no, have I got long COVID? Did I do the wrong thing to exercise during my infectious period? Will I be able to still work as an exercise physiologist & run a business? PANIC!
Main barriers to exercise
So I was dealing with some significant fatigue, headaches, brain fog and bruised ego. My knowledge of working with fatigue told me I needed to better pace my return to activity (including all of my activities of daily living - things like showering/cooking/groceries), work (which can be very physical with spotting weights, demonstrating classes and exercises - to sedentary work on my laptop) and then exercise (running, swimming, bike riding, pilates and weight training).
Luckily I touched base the Pear EP team, who helped to get my ego in check, and helped pace my return not just to work, but back to exercise as well!
The new evidence based guidelines to provide safe return to exercise after COVID are about to be released from Exercise & Sports Science Australia and allow an informed approach to rehabilitation of long-covid symptoms.
I've just got back to pre-covid levels of training, (chuck a month off on holiday in there which also helped to slow me down a little!) but now I feel I am able to comfortably recover within a 12 hour period - rather then booming & busting in energy all over the place - and complete all the work tasks I have in the week! I have now been able to return to my usual level of training (1-2 x swim, 1-2 x runs and strength training with reformer pilates classes and some gym sessions!) and have been feeling good!
My energy spent on exercise is being returned to me with interest in the fatigue management analogy - rather than bankrupting me. Ready for the next step - to amp up from rehab to performance!
Amanda Ravenswood is one of our senior Women's Health Accredited Exercise Physiologists on the team here at Pear.
Amanda loves all things women’s health including pre, during and post pregnancy conditions, rehabilitation following cancer treatment, prevention, treatment and management of chronic conditions including back pain, arthritis, diabetes, heart conditions. She is Pilates trained and prior to her AEP career, she spent nine years working as a Recreation Officer with children who had physical disabilities.
I was about 4 months pregnant when Esme hit me up to compete in the Noosa triathlon as a team and complete an individual event also. It has been on my bucket list to compete in this event, so I thought what better time than post-bub to commit and give me some focus for my return to exercise!
At about 6.5 months into my pregnancy I got quite unwell with parainfluenza and some rib cartilage pain from coughing (good ol’ relaxin hormone). I was unable to upkeep my regular weekly training due to the serious fatigue and the rib pain (weights x 3, cardio x 2, swim x 1), only able to occasionally go for a small walk. I got very de-conditioned, but by the 8th month I did manage to get back to 3 easy swims/week in the lead up to delivery. Due to the rib pain in conjunction with a rather traumatic recovery after my first pregnancy, I decided to have an elective c-section. I thankfully had a very smooth, straightforward experience.
Since becoming a mum, I have a new respect for barriers to exercise. I LOVE exercising and will prioritise it as all costs. I enjoy it, I love the health benefits – mental and physical, and it’s just my thing! But as a mum of two, barriers are REAL. The biggest things I have struggled with is:
Over the past 6 months my training has progressed through 3 phases to get from the acute rehab to functional stage. It looked like this.
We are passionate about women's health
Pear is an industry leading women's health clinic offering exercise physiology, pelvic health physiotherapy, remedial massage and small group strength and reformer pilates classes located on Brisbane's Northside.
address: shop 6/52 Jeffcott Street, Wavell Heights, Queensland, 4012 (entry via Kinmond Ave carpark)
call: 0478 116 700
fax: 07 3036 6550
We are proud to support our local communities of Wavell Heights, Chermside, Clayfield, Ascot, Kedron, Nundah, Stafford, Gordon Park, Nudgee, Sandgate, Albion, Hendra, Wilston, Grange & Wooloowin.
We are a children & baby friendly studio, have easy onsite parking and private health rebates available on all services.
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