1. Pre-Natal Assessment and Education

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• We recommend 2 pre-natal sessions:

  • The first at approximately 16/40 (early 2nd trimester) to get a baseline of your pelvic floor function and any pre-exisiting issues (such as previous back pain, or urinary leakage for example). Click here to find out why this is important. 

  • The second at approximately 32/40 to check your pelvic floor again, and teach you how to do perineal massage

• Together with the assessment of your pelvic floor function, we also:

  • Educate you on the risks of different types of deliveries, perineal tears, episiotomies, birth positions and post-natal rehab to empower you to be able to make informed decisions during your labour and birth ​

  • Treat/help you to manage pelvic girdle, back or hip pain, and any other musculoskeletal issue that arises during pregnancy

 

Although we recommend those specific times, it is never too late to come and see us - unless you're already in labour, then it really is too late! 

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2. Pelvic Girdle Pain/Dysfunction Assessment and Treatment 

(including sacro-iliac, pubic symphysis, hip, back, coccyx pain and/or dysfunction)

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This may occur during or after your pregnancy. 

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The important thing to realise is, that although pelvic girdle pain in pregnancy is still commonly referred to as 'instability' and women often feel like their pelvis is 'falling apart', this is not actually the case.  The pelvis is an inherently stable structure that is designed to transmit massive forces between the legs and trunk (think sprinting and jumping).  It is also designed to protect the pelvic organs, and does so very well.  So, unless you have a history of significant trauma to the pelvis (really heavy fall, car crash etc), then your pelvis is NOT unstable.  This doesn't stop it being painful but they are two very different things.  

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Pelvic girdle pain may occur due to muscle tightness, weakness, minor accident (tripping is a really common cause), or simply due to the hormonal changes of pregnancy.  The key to management is working out what is your specific issue, we can then tailor a programme to address it.  This may, or may not, include the use of a pelvic support belt.  They are brilliant for some, and useless for others, depending on the cause of the pain.  So, if you've tried a belt and it's not making any difference, it may be that this is not the answer to your problem.  Come in and have an assessment and we can work out exactly what you need.  

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If you've had pelvic girdle pain in a previous pregnancy, it is highly likely that you'll get it again with subsequent pregnancies, so come in early and we can get you on a programme to optimise the chance of it not recurring, or if it does, helping you to manage it optimally so that it doesn't get worse. 

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3. Post-Natal Assessments 

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• We recommend coming in for the first check up at approximately 2 weeks post-partum.  At this appointment we:

  • Go through your birth experience and check for any symptoms internally or externally

  • Assess your abdominals for 'separation', and if ok with you, do a visual check of your perineum and pelvic floor function

  • We then start you on a tailored recovery programme.

• ​The second check up is then at 6-8 weeks post-partum to do a full check on the pelvic floor muscles and organs with the aim to either clear you to get back to your usual activities, or build up a full deep core/rehab programme to get you back to your usual activities.  All programmes are tailored to your own individual goals.  

 

The reason that we now assess you much earlier (at 2 weeks post-partum) is because of the hormone changes that occur post-delivery.  During the first 8-10 weeks post-partum (the 4th trimester), your tissues are naturally tightening back up again.  If you have any concerns and we see you at 2 weeks, we can optimise your recovery during this time.  If we don't see you until 6-8 weeks, we have missed a big 'window of opportunity'.   

 

​Even if you don't have any concerns post-natally, it is still recommended to come in for a check up.  Approximately 48% of women will have some residual physical effect from giving birth.  This may be pelvic floor weakness, a prolapse, urinary leakage, faecal urgency or leakage, or abdominal separation.  Not all of these will be symptomatic but may become a problem when you return to exercise or sport, during your next pregnancy, or when you reach menopause. Prevention is much easier, and better than a cure, which is why we recommend that all women have a check up regardless of whether they have symptoms or not.  Any 'silent' concerns can then be proactively addressed to prevent them becoming symptomatic in the future.  

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4. Mastitis Management

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​Mastitis is commonly caused by inflammation in the breast that narrows the milk ducts.  Even if you have systemic symptoms such as the chills, it is not necessarily an infection. 

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Therapeutic ultrasound is really effective in helping manage your symptoms of mastitis, especially when it's applied within the first 24-48hrs of symptoms occurring.  We have an ultrasound unit at the clinic and will endeavour to fit you in on the same day that you call to enable early treatment.  We also teach you lymphatic drainage techniques for the breast together with general management techniques.  

 

For more information, please read the following blog on mastitis

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5. Abdominal Separation Assessment and Treatment

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​Abdominal separation occurs, to some degree, in 99% of all pregnancies.  It is a normal part of the body's accommodation to the growing baby and uterus. 

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Pre-natally you often see a 'coning' or 'ridging' or 'doming' in the mid-line of the abdominal wall.  There are certain activities that you should avoid once your bump is growing.  These are written, along with more information, in our abdominal separation blog

 

Post-natally, as your hormones normalise after giving birth, your abdominal wall shortens again.  If your 'gap' is >2.5cm after birth we recommend that you wear a support garment, and come in for an early assessment so that we can help you optimise your recovery.  The majority of the muscle recovery will occur in the first 8-10 weeks after giving birth. ​Ideally in this time, the 'gap' between the muscles will shrink back to it's previous size.  Some women don't get a full shortening of the tissues and are left with extra 'length' in the abdominal wall, others will get full recovery.  Either way, the most important thing is to reactivate your deep core muscles and then coordinate this with your functional movements.  By doing this, you can restore your muscle tone and bulk and 'flatten' your abdominals.  

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As part of your assessment we use the real-time ultrasound to look at the function of the different layers of your abdominals and use this information to tailor a programme to you.  To compliment your programme we also offer a 'Restore Your Core' class.  

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6. Deep Core Retraining

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• Whether or not you had any abdominal separation, it is really common post-natally for the pelvic floor and deep core muscles to forget what they're supposed to do

• If you are left with a 'bulging belly' that doesn't seem to flatten however much exercise you do, or a feeling of 'looseness' in the pelvic floor, it is highly likely that your deep core is not working automatically

• We can retrain this easily using the real-time ultrasound for feedback, a home exercise programme along with the option to join our 'Restore Your Core' class 

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7. Return to Sport Assessment

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• During this assessment we check you for any abdominal separation, pelvic floor muscle dysfunction or prolapse and take some very specific measurements to help determine your risk for going back to exercise or sport.  Tailoring this to your own specific goals we then build a programme to get you safely back to what you love as soon as possible

• We will also assess global function specific to your sport/exercise choice.  For example: if you are wanting to restart running, we will also assess your lower limb biomechanics, control, strength, power, endurance and running technique. We will teach you specific breath and pelvic floor coordination techniques to use to minimise the risk of leakage or prolapse

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8. Other Pains 

• Back, hip, knee, shoulder, wrist and thumb pains are very common during and after pregnancy

• We can assess and treat all these issues

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