Written by Esme Soan - Accredited Exercise Physiologist
Whilst everyone living with endometriosis (or Endo for short) is individual and has different symptoms and experiences, there are some general guidelines for using exercise as medicine every day! We often speak about a ‘toolkit’ to help with pain flares, that can include things like hands on therapy from a Pelvic Health Physiotherapist (like Sami & Patrice at Pear), massage, heat packs, aromatherapy, pain medications and….. exercise!
1 - To be physically active as often as possible
Walking, Swimming, Cycling, Gym classes, Yoga, Pilates, team sports - what ever makes you move that you love to do!
Endometriosis is an inflammatory condition - and exercise has the ability to increase anti-inflammatory markers. Physical activity also increases blood flow to the abdomen, which improves clearance of the by-products of inflammation - so you can see exactly how powerful exercise can be!
2 - Restoring length and strength to the anterior muscles of the body
What daily stretching series - check out our video at the link below! Here are also some pictures of how to perform your stretches.
Endometriosis pain can cause many of the muscles through your front line (ie/ abdominal muscles, chest, anterior hip) to become very tight and the posterior muscles can become weak. Think how those days spent in the foetal position, curled up tight. Our brain responds to pain by causing muscles to contract to ‘protect’, and restricts your movement - but this can actually contribute to making you feel worse.
When your abdomen is bloated, your pelvis is sore, and all you want to do is curl around a hot water bottle the idea of exercise probably feels like the last thing you want to do. However - our mobility exercises and stretching series really helps reduce the tension held in these muscles, increases your blood flow and can decrease your pain.
The pelvic floor can also become tight (yes - Pelvic Floor is a muscle too!) which can then lead to symptoms of urinary stress incontinence (leaking), constipation and lower back or hip pain. Pelvic floor muscles can’t be stretched externally (but you can work with our Pelvic Health Physiotherapists to learn how to perform internal releases) - however breathing work and stretching of surrounding muscles can really help
There are also specific kinds of stretching exercises called PMR (progressive muscle relaxation) that has great improvements on pain. In PMR we need to think of first further contracting the muscle group - ie squeezing & working it further, before relaxing into the stretch of the muscle. This would be like squeezing your hands into fists before relaxing your hands out flat.
3 - Using exercise individualised to YOU!
Exercise is not a one size fits all - and doesn’t always need to look like star jumps or burpees!
Everyone is unique in their own body, strengths, weaknesses and Endo pains. Some may need to avoid excessive abdominal or pelvic floor contractions, HIIT training, Pilates and other high-intensity exercises - which can often not be the most supportive to your body when you have pain.
Throughout the month, in time with your cycle, try swapping your HIIT training for a yoga session, or coming and working with the team at Pear who would be able to modify exercises to what your body needs. The more you learn how to work with your cycle, the better we can become and supporting your body with movement medicine!
What exercise can I actually do, before and after pregnancy?” All your questions, answered by an expert.
READ THE ORIGINAL ARTICLE ON MAMMAMIA HERE
BY Hannah Mansur
There are two types of pregnant people: those who follow *All The Rules* and those who... well, "don’t". And never the two shall meet.
Well not quite, but it’s probably best to avoid brunching together. If you can get past the menu minefields of mimosas (nope!), smoked salmon (ooh, soon) and poached eggs (see you next year), you’re sure to trip when the conversation turns to, “So, are you sleeping on your front or back?”
When it comes to pregnancy, everyone has an opinion on what a pregnant person should and shouldn’t be doing.
Of course, there’s medically recognised advice for what to do during pregnancy but many of The Rules we hear are actually rooted in superstition or myth.
Full disclosure: I’m a card-carrying rule follower. So when I finally got pregnant after years of trying having dropped my hard-earned savings on IVF, I wasn’t taking any chances.
But that presented a problem when it came to exercise.
According to Exercise & Sports Science Australia (ESSA), the organisation behind Exercise Right, exercise is, of course, important for everyone; regular physical exercise can provide many social, mental, health and fitness benefits.
Exercise has been shown to reduce stress, anxiety and depression as well as make people happier in general. This is all thanks to endorphins, the “happy hormones” associated with peace, calm and stress relief.
For all those reasons and more I’ve been working out regularly for most of my adult life.
Until I got pregnant and waded into the quagmire of pregnancy Facebook Groups. All of a sudden, I thought my options were limited to aqua-aerobics and pregnancy yoga (but not until after 12 weeks and something about keeping a “gentle uterus” ¯\_(ツ)_/¯).
I found it hard to separate the fact from the fear-mongering.
So, I jumped at the chance to ask Esme Soan, an Accredited Exercise Physiologist, the recommended dos and don’ts on exercise during pregnancy.
If “Accredited Exercise Physiologists” sounds like a big deal, it is. They are university-qualified allied health professionals. They specialise in designing and delivering safe and effective exercise interventions. Services are also usually claimable under compensable schemes such as Medicare and covered by most private health insurers. So yeah, Esme knows her stuff.
Let's get this straight: can I actually exercise while I'm pregnant?
YES! We know exercising during pregnancy is safe and supported by the research – and that exercise is medicine. Even, previously inactive people are encouraged to start new activity once they are pregnant; just start slowly and gradually progress until you are doing 150 to 300 minutes of moderate intensity physical activity or 75 to 150 minutes of vigorous physical activity each week.
Plus, it's great to also perform daily pelvic floor exercises, and muscle strengthening activities on at least two days each week.
If you are already active, keep going but you may need to modify or adapt activities as pregnancy progresses.
Does my type of exercise need to change from trimester to trimester?
First up, exercise is *not* a one size fits all situation – so consider getting an individualised prescription from an Exercise Physiologist.
If you were completing triathlons before falling pregnant, your level of activity across the week will look different to someone who didn’t have a regular exercise routine.
Take the triathlete example: In your first trimester we might support continuing running and higher intensity work. In trimester two we would change to resistance training and walking. After 28 weeks of pregnancy, we’d be modifying to avoid supine exercises (lying flat on the back) and some yoga poses.
In the last trimester we would be focusing on pelvic stability with pilates, swimming, walking and/or weights.
So I’m allowed to run when pregnant?
Yes, you can! But there may come a point in your pregnancy when it’s not a good idea, even if you physically can do it. Your pelvic floor is a network of ligaments, fascia and muscle, and already is doing a lot of additional work to support the ever increasing weight of your uterus.
What exercises should I actually completely avoid during pregnancy?
Avoid activities that involve:
If you are feeling unwell with dizziness, shortness of breath (really huffed and puffed with usual activity), headache or chest pain before or during exercise, it’s advised you stop, and seek advice from your care provider (OB, GP, midwife or exercise physiologist). Also, any gush of fluid from your vagina: cease and seek medical attention.
Can exercise actually reduce things like hypertension and gestational diabetes when I’m pregnant?
Yes, "exercise is medicine" is the mantra of exercise physiologists like myself! Research has shown that regular exercise before and during pregnancy (and especially in the first trimester) may have a protective effect and reduce development of gestational diabetes. Exercise can also assist with regulation of blood glucose in women diagnosed with gestational diabetes.
What are the rules about body temp when exercising?
Avoid heat stress and high body temperature, especially in the first trimester. Although it is unlikely that normal physical activity/exercise would cause core body temperature to reach levels that may be harmful to foetal development - exercise levels should be adjusted in excessively hot weather, especially when there is high humidity. Stick to air con, try not to exercise in the middle of the day (high temperatures), and keep well hydrated!
Should I be tracking my heart rate? Is this an excuse to get an Apple watch?
Heart rate is not used as an indicator of intensity in pregnancy anymore.
Instead, we recommend using the (free!) RPE (Rating of Perceived Exertion) scale, where 1 is sedentary (not moving), and 10 is maximal effort! Activities in the range 3-7 are considered safe and recommended for health benefits in pregnancy – intensity can also be judged using the ‘talk test’; in moderate intensity activities you should be able to talk, but not able to sing!
How long after giving birth can I start exercising? Is the six week rule hard and fast for everyone?
You can return to some gentle rehabilitative exercises earlier than 6 weeks, like walking, but you certainly don’t get the green light automatically at 6 weeks to return to high impact work like running or impact work!
Regardless of what kind of delivery you have (C-section or vaginal birth), your tissues need at least 6-8 weeks to heal, and even up to 6-12 months to regain their tensegrity (fancy word for ‘bounce’)! The best way to restart exercising is with an individualised plan from an Exercise Physiologist. We can help to safely build back up to the activity you love to do, with consideration of your pelvic floor, abdominal wall, pelvis and body – whilst recovering on minimal sleep!
How can I start incorporating regular exercise into my postpartum routine?
Walking with the pram, joining parents and bubs fitness class like Pilates, and getting a home program designed by an Exercise Physiologist. If you have barriers to getting back into exercise like leaking of urine, heaviness in your pelvis, prolapse, pain, or abdominal separation, don’t be put off. These are all things that we know exercise rehabilitation can help manage.
What type of exercise can help a postpartum body?
In general, slow and steady wins the race with returning to exercise postpartum, and there are brilliant professionals like Exercise Physiologists out there who are here to help with program design and guidance!
Some of my favourites are:
My own exercising view these days! Image: Supplied.
So, what have we learned? If you are pregnant and are not experiencing any complications, there is no reason why you can’t enjoy exercise whilst pregnant.
In fact, staying active has a heap of benefits for parents-to-be. Unfortunately for rule-lovers like me (and let’s be honest… you) there is no one-size-fits-all approach so you’re best to get in contact with an appropriately qualified exercise professional.
by Physiotherapist Sami Cattach
Pelvic Health Physiotherapist at Pear Exercise Physiology & Physio, natural mover, Mama of 2
Pain with sex?
Seems like an unusual topic for a physio to be involved in, however sexual pain and dysfunction makes up around 30% of the patients I see at Pear. It is an incredibly rewarding area to treat as you see the results and each individual's confidence grow!
While it is an area of taboo - not often talked about between women of previous generations, there is now a lot more research and awareness around female sexual pain and I'm pretty excited to be spreading the word.
Consensual intimate touch and sexual intercourse should never. be. painful.
Some women might experience pain with sex from their very first encounter, particularly if there are strong cultural beliefs around sex. Though for others it can be something that develops over time or in response to a particular event such as an injury, infection, childbirth (vaginal or Caesarean), stress, or sexual abuse.
The term for painful intercourse is Dyspareunia and can be further broken down into Superficial (felt around the entrance of the vagina) or Deep Dyspareunia (deeper inside). Pain and discomfort from touch and/or penetration occurring in the absence of infection can be due to one (or a combination) of the following reasons: Decreased arousal (both deep/superficial) Certain positions (usually deep) Decreased lubrication (superficial) Tightness/spasm of the pelvic floor muscles (both deep/superficial) Vaginismus (superficial) Vulvodynia (superficial)
* It is quite uncommon that a woman can be too small for a penis. Remember that the muscles and tissues lining the vagina are very stretchy and are designed for a baby to be able to pass through!
Decreased Arousal, Positioning and Lubrication
When you are aroused and ready for things to heat up, a few things happen: Increased blood flow to the vagina stimulates secretion of lubricating fluids to decrease friction and the cervix actually rises up and moves out of the way. Some women take a bit more time to become aroused and prepared for intercourse - so don't be afraid to take your time with foreplay. For postpartum Mamas, know that your natural arousal and lubrication can be decreased as influenced by your hormones (as well as available time and tiredness!)
Contact with the cervix can be quite uncomfortable and often feels like a deeper pain. This can be avoided by trying different positions, such as
Girl on top. This is basically the missionary position, except the female is on top. Being on top allows you to be in control of the pace and degree of vaginal penetration. Plus, being on top gives you more direct access to the clitoris, which may help you experience more pleasure.
Reverse cowgirl. In this position, you're on top but instead of being face to face with your partner, you're facing their feet. Because you're still on top, you can control the depth, speed, and intensity that works best for you. The angle of penetration may avoid some trigger spots.
Sideways. For some, the "doggy style" position can be excruciating - but that doesn't mean you can't enjoy other from-behind positions. The sideways sex position allows for shallower penetration without sacrificing intimacy.
External lubrication in the form of a gel or oil can be useful for superficial dyspareunia - but remember to check the labels! Certain lubricants contain harmful chemicals, such as glycerin which can irritate sensitive skin, as well as parabens (known carcinogens). We love Olive & Bee as an all natural lube - and we sell it in the studio!
Pelvic Floor Muscle Dysfunction (the goldilocks muscle!)
Increased tone/tightness, or spasm of the pelvic floor muscles can be a cause of deep dyspareunia. As with any tight muscle, repeated pressure can cause either immediate or latent discomfort. Trigger points within the muscles of the pelvic floor can also refer pain to the abdomen, creating menstrual cramping sensations and also hip and groin. Internal release work with our Pelvic Health Physiotherapy team can provide effective relief and improvement, as well as learning how to down-train the pelvic floor, and figuring out why they are becoming tight in the first place.
Vaginismus is involves the involuntary reflexive contraction of the pelvic floor muscles around the opening of the vagina with attempted penetration, whether it be during intimacy or with a tampon or speculum, sometimes even just the thought of penetration can cause this response. It can be a mild tightening, which causes pain initially with penetration and then eases, or could be a more severe contraction - with penetration being completely impossible, and partners often report feeling like there is a block or wall preventing further entry. Vaginimus can respond well to both Pelvic Health Physiotherapy and support from a sexologist, counsellor or therapist.
Vulvodynia & Vestibulodynia
Often characterised by a burning, itching or raw pain around the vulva (externally) or vestibule (inside the labia minor and around the vaginal entrance). Even though the burning and itching can mimic symptoms of an infection, there may only be a slight redness visible and cultures for yeast or bacteria will often come back negative. Vestibulodynia is due to irritation or hypersensitivity of the nerves that supply the vaginal area, and can make light touch feel like a sharp/stinging sensation. This can respond very well to Pelvic Health Physiotherapy - learning how to desensitise and retrain the nerves and calm down the pelvic floor muscles, and can be done in conjunction with topical numbing creams or medication.
Sami Cattach - Pelvic Health Physiotherapist at Pear Exercise Physiology & Physio