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At Warman Physio we have been working hard behind the scenes to get a secondary location going for all the clients that are unable to get out to Warman. We are pleased to announce that as of June 3, 2019 we will be located in Saskatoon!

To top it off, we are not only opening a second location, but we also have two NEW staff members to introduce to you!

First, our physiotherapist Scott Golding!

Scott is joining us from his current practice in Llyodminster where he sees a mix of pelvic health clients including women and men, and orthopedic (sprains, strains, concussion, etc) clientele. Scott is passionate about pelvic health, and is specifically interested in providing assessment and treatment for:

  • Pelvic pain
  • Prolapse
  • Incontinence
  • Concussion
  • Back pain
  • Sports Rehabilitation
  • General orthopedics

Scott’s future goals include becoming a strong support and resource for male health. He wants to help decrease and remove the stigma associated with male pelvic health and provide exceptional resources for males who need or are seeking help.

 

We are also pleased to announce our RMT Signe Bone to the team in Saskatoon!

Signe has been working as a massage therapist for a number of years, and has always had a desire and drive to understand the human body from a very young age. She has been working in Saskatoon as an RMT as well as continuing her education in Prenatal Massage through Axiom Collage, and has begun her Visceral Manipulation through Barral Institute and Craniosacral Therapy through Upledger Institute. The areas of practice that Signe is most drawn to includes:

  • Prenatal & postpartum massage
  • General Injuries (whiplash, TOS, piriformis syndrome, etc)
  • Abdominal Health thorugh Visceral Manipulation
  • Critical Alignment Therapy
  • Cranial Sacral Therapy: CS1

Her love for learning and solving problems helps her provide the best care and treatment she can through working with her clients to better understand them as a person, not just as a body.

The schedule for physiotherapy assessment and treatment can be found HERE and to get on the list for booking for massage can be found HERE.

 

Spread the word and make sure you share this fantastic news with your friends! As per our vision – the Saskatoon location will be infant and child friendly, providing compassionate, comprehensive, and personable care to each and every client.

 

Location of the Saskatoon clinic is: 2543 Dudley St, Saskatoon

As with many issues, often we aren’t sure if what we are experiencing is normal and expected, if it will just go away, or if we need to have it looked at. For many women who are pregnant and postpartum, this is made even more difficult as we are often told that symptoms we are experiencing are normal because “you’ve had kids” and that “this is just how it is now” which can delay effective treatment of these issues! Here you can see a case study on Prolapse, which outlines some of the issues that someone may experience.

The presenting symptoms:

A 31 year old woman attends the clinic mentioning a history of intermittent pelvic floor heaviness “feeling like things are falling down” and discomfort. She has noticed that the heaviness has been worse since starting back with weight lifting at her gym 1 month ago. She has two children ages 2 years and 4 months old.  She had continued to go to the gym throughout her pregnancy (symptom free), but notes she had reduced her weights somewhat during her third trimester.

She hadn’t returned to the gym until now, as her life has been quite busy since the delivery of her second child! No pelvic floor pain, urinary or fecal incontinence is reported.  She had felt like now was a good time in her life to return to the gym and is quite devastated at this setback. Going to the gym and working out had been an

important part of her life-mentally, socially and physically and she is worried she won’t be able to do any activity at all anymore.

She went to see her family physician as was concerned about her symptoms and was referred to pelvic floor physiotherapy for prolapse. She reports no symptoms first thing in the morning, but these progressively worsen as the day goes on.  Some days are better than others with her symptoms.  Lifting weights at her gym and lifting her children aggravate her symptoms.  She notes she did just get over a bad cold and had been coughing/sneezing quite a lot during the past month. She also identifies that she has always had issues with constipation.  Both of her deliveries were vaginal with no instrumentation (forceps or vacuum) or complications. She is currently breastfeeding.

Assessment and Treatment

The client was assessed with an internal pelvic examination by a pelvic floor physical therapist. A Grade 1 cystocele was found. (A cystocele means the prolapse was from the bladder descending into the wall of the vagina and a Grade 1 prolapse means the organ descent was halfway to the vaginal opening). The pelvic floor muscles were weak with a Gr. 2 strength (a weak squeeze and no lift of the pelvic floor muscles) and tight.

The client and the therapist worked together to increase her pelvic floor strength and coordination, as well as to optimize her intraabdominal pressure management systems. Toileting positions and discussion around constipation management were discussed and the client was able to implement these at home. Optimizing postures during breastfeeding and throughout the day were discussed to reduce strain on the pelvic floor and discussed on how to successfully get them implemented at home.  Education on anatomy of the pelvic floor and the pelvic organs/their supports as well as POP was provided which will help the client to take control and understand the why behind the recommendations.

Activity modifications were implemented but keeping her active was part of the plan and exercises were progressed as appropriate.  The client returned to her gynecologist for a pessary fitting to use intermittently during heavier weight lifting at the gym. She was seen in follow up 2 weeks after the initial assessment and then 1x/month for 6 months. She was able to return to her weight lifting and was symptom free with all tasks and activities at the conclusion of therapy, although her Grade 1 prolapse remained.

Have you been struggling with prolapse symptoms? Not sure if your symptoms could be part of prolapse, please feel free to contact us and we will help chat you through what you are experiencing as best we can.

Don’t delay start your road to recovery today!

Maja Stroh is a physiotherapist that has a particular interest in pelvic health and perinatal care. She graduated from the U of S MPT program in 2009 and has been working with pelvic health populations since 2013. Maja’s interest in helping her clients and spending quality time with her family has brought her to Warman Physio where she will be providing services in the Saskatoon and Warman locations.

In today’s day and age where information is literally at our finger tips via your smart phone, laptop, and all other technology, it is no surprise when clients come into the clinic armed with excellent information.

However, it is far to common that out-dated information, old wives tales, and unfounded statements are being perpetuated. As with all information, we must be a consumer of information. How do you know what you are reading online is accurate, up-to-date, evidence based, current and progressive for treatment and care? Unfortunately, creating a critical mindset towards what is being presented, and for what purpose, and by whom, often is not taught in school until AFTER reaching university. What does this lead to? In our instance at the clinic, it sometimes leads to clients coming in firmly believing misinformation.

Regrettably, it’s not just the world wide web that is spreading misinformation and falsities, but other well-meaning family members, friends, and, healthcare providers. How does this happen? Some providers must know information across a wide variety of areas, whereas some providers practice in very specific areas or specialties. In both instances the provider will have difficulty either a) keeping up with all the new information coming in through the large variety of areas they need to know or b) they are very well informed in their area of specialty, but haven’t kept up in other practice areas.

For our women’s health, prenatal and post-partum clients, we have seen a trend of misinformation come in that we would like to address piece by piece to help those that may be experiencing similar issues/symptoms figure out what is best for them.

 

Pain during pregnancy is normal and will go away after delivery

Often our prenatal moms come in with significant pain. Ranging from pubic symphysis pain (‘lightning crotch’, groin pain, etc) through SIJ pain (low back and pelvic pain) and sciatica (pain radiating down the leg) to name but a few common pregnancy-related complaints. Although pain during pregnancy is common, it should not be considered normal. We are often explained that during pregnancy the hormone relaxin ’causes’ pain – however, if this were the case, and relaxin is produced during every pregnancy, then wouldn’t every woman who is pregnant be painful? We know that this is not the case, so why do some women become painful and others do not? In my clinical population I have observed many women who are pregnant that are painful, with the start of their pain experience ranging from within the first few weeks of gestation to the last few weeks. The commonalities between these women with pelvic girdle pain in particular, is a combination of muscle length and strength imbalances around the pelvis (muscles that are tight and/or weak), common posture issues (think the typical ‘pregnant’ stance), and activity levels throughout the day (whether that be not enough or too much).

The good news is, pain in pregnancy is NOT necessarily normal! There are many factors that can be addressed, and truly our bodies are very capable of adapting and changing (I mean they grow tiny humans, that’s pretty amazing). When I was taking my prenatal courses while in the Master’s program, we were still being taught that women who are pregnant could not improve, but we could prevent them from getting worse. In a mere 7 years this dialogue is changing; women who are pregnant can and do improve and often resolve pain during pregnancy when appropriately addressed with conservative treatment such as physiotherapy!

How well we are able to do with each client depends on a multitude of factors: what do you need to do on a daily basis, how many weeks gestation are you, what is your pain level when you get started, did you have pain previously or is it new, and of course, how well are you able to do your provided homework?

Pain with intercourse post-partum is normal – just have some wine and relax

As a pelvic floor therapist, I am sad to say I have heard the recommendation for our clients with dyspareunia (pain with intercourse) to ‘just have some wine’ more times than I have kept track of. This sentiment is often expressed when clients get the courage to bring it up to friends, family and their healthcare providers; usually along with a ‘with time it’ll get better’.

Dyspareunia is something that again is common after labor and delivery, but is not normal. To the surprise of many, this pain can occur in those that have had vaginal deliveries with or without tearing, as well as those that have c-sections (scheduled or emergency). Often when we approach medical providers about dyspareunia, they search for a medical cause such as an infection. When there is no medical cause, women will begin to feel the ‘it’s all in your head’ message.

With a physiotherapy perspective, dyspareunia is approached much differently. In my clinical practice I often see women with pelvic pain that have very tight muscles of the pelvis and pelvic floor, restricted movement through scar tissue (either from the perineal tearing or c-section), as well as a variety of postural changes. Very often, it’s these tight muscles that will recreate ‘the pain’ when palpated (on internal and/or external exam). When the clients’ multiple factors are addressed such as muscle tightness, weakness, postural changes, scar mobility and breathing coordination, the dyspareunia is often improved/resolved. Contrary to our all too common advice to just ‘have some wine’, there are many factors that can be addressed with physiotherapy by a trained pelvic floor therapist. Which brings us to our next point…

You are leaking when you cough/sneeze – do your kegels

I am so thrilled to see an increase in awareness and discussion within a variety of groups and campaigns in regards to pelvic floor! The most common discussion is about leaking, usually with cough, sneeze, lifting, jumping, exercise etc (aka stress urinary incontinence). This is where typically women are told to ‘do your kegels’. GREAT! What does that mean? Often when I am seeing clients in-clinic, the understanding of kegels is incomplete – women are aiming to squeeze the pelvic floor for at least 10 seconds, 10 times in a row since that’s what they had read online or in a magazine. I ask – when you try to strengthen another area of your body, do you squeeze it (make it tight in a single position such as tightening your thigh muscle without moving the knee), hold for 10 seconds, pause and then repeat? I also wonder – when receiving this advice has anyone completed an assessment to check what the problem actually is?

I frequently discuss with my clients how differently we approach pelvic floor health versus the rest of the body. If someone comes into my office because their knee hurts, they expect for me to watch them walk, squat, and move in a variety of ways themselves, have me move it for them, take a look at all the muscles, ligaments and surrounding tissues as well as ensure they are doing whatever exercises or stretches I provide them with properly before going. When people come in for a pelvic floor issue, we are often expecting to receive advice, but do not expect to be touched or examined. Clients would not be happy if they came in and I didn’t once look at their painful knee, so why is it acceptable to expect to have no exam of the pelvic floor? A discussion for another day. Why is the exam important?

Pelvic floor analogy: if someone came into the office with an elbow that was stuck in a bent position (because the biceps is too tight), and their complaint is that they are unable to straighten the elbow to catch their cell phone for instance as it falls off the table in front of them (ie leaking), would strengthening the biceps muscle (ie kegels) be helpful? Likely it will not help, and more often than not, a worsening of symptoms may be observed. This is why it is not surprising to me as a therapist when people come into the clinic and their ‘kegels haven’t worked’. Analogy 2: if the pelvic floor to be functional needs to contract AND relax (think the arm bent as contracted and straight as relaxed), does training that muscle to squeeze help it to bend? Not likely. The pelvic floor needs to lift up and in when contracting, and move down and away when relaxing in order to be functional. To top it off, it also needs to have appropriate coordination with the rest of the muscles of the abdomen and pelvis in order to have optimal function. Having a pelvic floor that’s functional without addressing any other postural or coordination issues of the abdomen is like having a perfect pop-can bottom with crumpled sides and top – it’s just not going to be able to do it’s job.

This means, that each client will have a similar, and yet very different treatment approach to leaking. Although many things look the same, with the majority of my clients having a tight pelvic floor (possibly from all the 10 second squeezes we’ve been doing over the years), the underlying cause of tightness is extremely variable.

Having a diastasis means you’ll always look pregnant

First, what is a diastasis recti? This is commonly referred to as the ‘splitting of the abdominal muscles’. Related to women who are pregnant and post-partum, there are now countless ads, programs and ‘healing’ strategies that are being pushed on women to get rid of their ‘mummy tummy’.

I argue that almost 100% of women who are pregnant, that look pregnant at the time of labor and delivery, will develop a diastasis. The diastasis is meant to allow the growing fetus room as the belly expands rapidly, the rectus abdominis (6 pack ab muscles) just doesn’t stretch quickly enough. The size of the diastasis will be dependent on many factors such as the size of the client, the number of fetuses, how many children they have had, etc. There are things we can encourage prenatal to theoretically decrease the impact of the diastasis, including rolling to the side before sitting up, and eliminating exercises that cause what I refer to as ‘tenting’ of the abdomen (if you’ve ever seen the v-shaped tent on your tummy when you go to sit up – that’s your diastasis). The real changes and major impacts happen post-partum.

The size of the diastasis, the amount of space between the muscles, is what the majority of women who come into my clinic are worried about. “How BIG is the GAP?” “Has it CLOSED enough yet?” In my clinical experience the size of the space is not as important as what the muscles are doing. The function of the muscles is key;  both independently, and as a working group of muscles. This is where everyone wants a short answer “What should and shouldn’t I be doing?” “What exercise is going to fix my diastasis?” – and this is where I say; I won’t know unless I am able to do an exam. Not all bodies are created equal and some bodies adapt much more quickly than others from a rehabilitation and healing stand point. This means that for one client doing something like a down-dog in yoga could create excellent and appropriate tension, whereas the next person it could be very dysfunctional and problematic.

If we imagine the diastasis like a zipper that’s undone, the zipper being down doesn’t matter so long as you aren’t straining into it with the abdomen from behind (pushing into the open zipper). Think of doing a crunch, when you go to lift your head and shoulders off the ground what does your tummy do? Does the tummy stay relatively flat while you move, or does it push/balloon forward and become more round? From a movement perspective your tummy should not push forward as you do ‘core’ exercises, and this can be an indication of dysfunction and a potential factor for pain and problems. Now, someone may see me at the clinic and have a 3-4 finger ‘gap’ but be able to keep the abdominals coordinated without any pressure forward, whereas another client may have a 1-2 finger gap but be unable to hold appropriate tension.

Endometriosis – young girls, women; painful menses is ‘normal’

A diagnosis for endometriosis requires a surgical procedure to examine for the presence of lesions of uterine-like tissue outside of the uterus. What happens is this tissue continues to work the same as the tissue that is within the uterus, and can lead to fibrous tissue and issues within the pelvis. Often women live with common symptoms of endometriosis starting in their teens and it takes years to achieve a diagnosis. In addition, young women and teens often have difficulty being believed about the pain that they are experiencing.

Although physiotherapy cannot change endometriosis, just like we cannot reverse arthritis, there are many factors that a therapist can look at to help manage, reduce and improve symptoms. Think of the first thing you do when something is painful, say get a paper cut on your finger. You will pull the hurt hand/finger into your body, grasp it with the other side and squeeze. This instinct to protect the area that is painful is pretty universal throughout the body. What will this increase in tone and tension of the surrounding muscles of the pelvis do when repeatedly, month after month, the pain continues to return, do to the muscles? Determining the underlying factors, which muscles are more tense, what the surrounding tissue is doing, and helping come up with a home program can be beneficial in managing pain. Just as addressing muscle length and strength imbalances around an arthritic joint can make a difference in the clients’ pain, it doesn’t change the arthritis, it changes some of the other factors.

Managing these symptoms as soon as possible, will help to reduce the chronic pain cycle that often develops and persists for years.

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Officially adding to her practice pediatric pelvic floor therapy in 2017. She has been advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Adding pediatric pelvic floor. Warman Physiotherapy & Wellness has been nominated as a finalist for the 2018, 2017, & 2016 WMBEXA, is a WMBEXA award recipient of 2017, and a finalist in the ABEX 2017 & 2016, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.

This past weekend I received several messages related to pelvic floor dysfunctions that are not being taken at face value. “Well you’ve had kids”, “it’s all in your head”, “this is a psychosocial problem not  a physical problem”. I have said it before and I will say it again, women need to be listened to, trusted, and most importantly, respected when they bring problems to healthcare providers, family, and friends. Although it may seem helpful to say that “this is something that happens when you have had kids”, it can be less than helpful AND is often not the case.

Pelvic Organ Prolapse (POP), is becoming a more well known topic of discussion in various mom groups, and in particular postpartum fitness groups. A large part of the impression I get as I am tagged, mentioned, and participating in these various forums is there seems to be significant panic associated with POP. People become paralyzed, hyper vigilant, and fearful of movement (also known as Kinesiophobia). So let’s break it down to dispel some of the hysteria that seeps into many pelvic health related issues.

Your top three organs that prolapse are (typically) your bladder (cystocele), your rectum (rectocele), and your uterus (uterine prolapse). Although most commonly occurring after child-birth, even those without children can have POP. Let’s focus on pregnancy and post-partum phase.

During pregnancy your uterus grows from approximately 5cm in size (which would hang out below your pubic bone), to what seems impossibly large to house the tiny little growing miracle (all the way up to the rib cage). This feat in and of itself does a few things, but thinking of organs specifically – they get moved, pushed and pressed all over the place because there just isn’t room.

How is this possible? Imagine your organs are like little boats at the dock. The boats (organs) wouldn’t do well in inclement weather (movement) if they were tied tightly or cemented to the dock; instead they have ropes (ligaments) to attach and hold them in a relatively stable position relative to the dock (abdominal wall/pelvis/ribs), and the other boats. Your organs aren’t cemented in place either, they essentially float being guided by ligaments, general positioning and support from other organs and the pelvic floor, as well as all the other connective tissue. So, when you are pregnant and the uterus is forging its way through the pelvic and abdominal cavity, everything else is able to move into new positions to compensate.

 

Once baby is born (vaginal or C-section), the organs suddenly have a lot more space to move around in – their ligaments and fascia have stretched, and there is no longer a tiny human occupying the extra space. As everything settles into a ‘new normal’, if everything is coordinating well, the organs will be situated in a similar position to pre-pregnancy with some slight variance. If the pelvic floor isn’t able to support, or other muscles around the rib cage are having difficulty relaxing, we can get changes in pressure that contribute to pushing these organs down and create POP and various symptoms.

What do we watch for? Feeling of heaviness, falling down or falling out, pressure, discomfort, or bulging, difficulty inserting a tampon, or keeping a tampon in, are all common complaints of POP.

There is much that Pelvic Floor Physio can do to assist with POP, and in many instances resolution of symptoms is possible.

Haylie has been practicing women’s health and focused in prenatal and post-partum care since graduating from the U of S MPT program in 2011. Advocating for treatment for women, ensuring appropriate and effective care throughout pregnancy and post-partum, and helping all expecting and post-partum moms brought her to open her family-friendly clinic; where clients are encouraged to bring their infants and children to treatment. Warman Physiotherapy & Wellness has been nominated for the 2016 WMBEXA and ABEX Awards, is a WMBEXA award recipient of 2017, and Haylie was recognized as YWCA Women of Distinction for Health & Wellness in 2017.

It seems the topic of “Diastasis” is picking up speed in a variety of forums. Particularly on social media in mom groups and exercise discussions. There also appears to be a wide array of misinformation that continues to be spread around. I had one client tell me “I have been doing some research and one place I went to online said that if I have a diastasis I will ALWAYS look a minimum of 3 months pregnant.” This, for the vast majority, doesn’t necessarily need to be true; especially when you know what to do. I have been asked to write a few key things in regards to diastasis from a physiotherapy rehabilitation perspective.

…if I have a diastasis I will ALWAYS look 3 months pregnant

Let’s discuss what a diastasis is. The short version is it is the ‘splitting of the abdominal muscles’. A more specific answer is that in response to pregnancy, the abdominal muscles and associated tissue (fascia) stretch to allow room for a growing fetus. The muscles that are most affected by this is the rectus abdominis (the 6-pack ab muscles that sit in the front). This is not ‘bad’, cannot be prevented, and is in fact necessary during pregnancy. From a clinical perspective, I would say 100% of women who are pregnant, that look pregnant at the time of delivery, will have developed some diastasis during pregnancy. (Side note: diastasis  can also occur outside of pregnancy, but that is another discussion.)

In theory, after labor and delivery, the diastasis will ‘snap’ back together and the core muscles will work in perfect unison… Sometimes this coordination comes naturally to women post-partum. However, often women require some help in getting all the pieces working well together in a functional and coordinated fashion.

…after labor and delivery, the diastasis will ‘snap’ back together 

This is where people profit off our post-partum mommas  “Get your body BACK after baby”, “Post-partum BOOTCAMP”, “Get rid of MUMMY TUMMY in 1 simple exercise”. Unless someone is checking for diastasis recti, do so on a regular (weekly, daily) basis, and can ensure that you are coordinating those muscles well… claiming to be a Post-Partum Specialist is likely an over statement. Often times I see that someone has “healed” their own diastasis and want to “show you how” with their main credential being that they went through the same thing, and they are fine after starting back into heavy exercise at “6” weeks post-partum.

Simply asking people if they have a diastasis is not enough. Knowledge of the issue without being able to assist in modifying exercises to appropriately return to function is where many people stand. Are you wanting to start a class? Ask the instructor what they know about diastasis. If you don’t know if you have one, will they check? How many people have they checked? Not all postpartum fitness classes are created equal.

A diastasis is not necessarily a ‘quick fix’, and often people don’t realize they have it since it typically isn’t painful. What we do “know” is that a diastasis present at 8 weeks post-partum is likely to continue to be present (read dysfunctional) at a year post-partum. But what does ‘problematic’ mean if it’s not painful?

The tissue (fascia) of the diastasis doesn’t need to close in the sense of getting back to how it was, but it does need to be able to generate tension. If it can generate tension well and it is separated 2.5cm that person is going to have better function than if it is separated 1.5cm and not generating tension. (Think of tension as whether you have a firm uncooked noodle versus a soft, cooked noodle between the muscles. The cooked noodle will give away under pressure of the muscles on either side, and the uncooked noodle will hold and transfer force). Problematic could also be the contribution of diastasis to back pain, diaphragm dysfunction, and pelvic floor issues. Diastasis doesn’t cause these things, but it may contribute.

Focusing on the diastasis alone is a simplification of a complex situation, and each person will require slightly different treatment approaches.

What do I recommend? Contact your local pelvic floor physiotherapist, there is no time limit on when to go, but within the first 8-12 weeks will give time to get into a routine with baby and be early enough to have minimal “bad habits” or compensations to combat; or before you start back into exercise. It  is never too late to address anything that has developed during pregnancy and post-partum.