This is part 2 of 3 posts covering SPD / PGP during pregnancy. Yesterday I posted on Exercises for SPD / PGP, today its about living with it!

A Few Tips that Might Help:

DO:
• Be as active as possible within pain limits and avoid activities that make the pain worse
• Ask for help! Many household chores & everyday activities may be difficult or painful – ask for & accept help wherever you can get it
• Rest & relax when you can. Sitting on a large exercise ball is often more comfortable than a chair & easier to get up from.
• Sit down to get dressed and undressed – avoid standing on one leg
• Wear flat supportive shoes
• Avoid standing for prolonged periods (someone else’s turn to do the ironing:))
• Try to keep your knees together when moving out of the car.  A plastic carrier bag on the seat may help you to swivel (another top tip from the Association of Chartered Physiotherapists for Women’s Health)
• Sleep on your side with a pillow between your legs
• Try different ways of turning in bed e.g. turning under or turning over with your knees together and squeezing your buttocks
• Roll in and out of bed keeping your knees together
• Take the stairs one at a time or go down on your bottom (top tip from Nisha at the Nine Month Club – see her blog for more)
• Use a small rucksack to carry your stuff around – this leaves your hands free to hang onto something for support or to use crutches if you’ve been given them

AVOID activities which make the pain worse:

• Standing on one leg
• Bending and twisting to lift or carrying a toddler or baby on one hip
• Crossing your legs
• Sitting on the floor
• Sitting twisted
• Sitting or standing for long periods
• Lifting heavy weights (shopping bags, wet washing, vacuum cleaners, toddlers)
• Vacuuming
• Pushing heavy objects like supermarket trolleys
• Carrying anything in only one hand

Of course not all of these activities CAN realistically be avoided – you may have to lift & care for other children, pick up something or go to the supermarket. Just try to get as much help as you can, go slowly & think before you move.

Stay as active as you can. Follow your physiotherapist’s guidelines & keep doing the core activation & pelvic floor exercises described in yesterday’s post EVERY DAY. You will get some relief as well as be training your vital core muscles in preparation for your post-baby flat tummy!

Thanks again to the Association of Chartered Physiotherapists for Women’s Health for their great guidelines & also have a look at the Pelvic Partnership for more tips & information on SPD / PGP.

All No More Excuses personal trainers are experienced & knowledgeable when dealing with SPD / PGP – if you would like to meet with a trainer for a free consultation then just fill out the form in the column on the right.

What strategies worked for you? Please share your SPD / PGP stories – I know many women suffer (1 in 5 pregnancies) but often don’t realise how common the condition is. If you know something that does or doesn’t work, please leave a comment here!

Symphysis Pubis Dysfunction (SPD), now referred to as Pelvic Girdle Pain (PGP) describes pain in the joints that make up your pelvis. They include the symphysis pubis joint (SPJ) at the front &/or the sacroiliac joints (SIJ) at the back. The result is pain felt across the front or back of the pelvis, which can range from mild discomfort to severe pain.

This is the first of 3 related posts on SPD / PGP coming over the next few days. I have dealt with exercises first as that’s what so many of you have asked for! The next one will deal with everyday activities & minimising discomfort & the third will give more of an explanation of the diagnosis & causes. Apologies offered at the outset  that these posts are a little longer than usual!

If your SPD / PGP is causing you pain, you should be referred to a physiotherapist who will assess the position and the symmetry of movement of your pelvic joints, especially the sacro-iliac joints at the back of the pelvis. Treatment will involve a combination of joint realignment or mobilisation and soft tissue or muscle treatment.

When the body is experiencing pain, muscles tighten & compensate, causing asymmetry & misalignment of joints. It is important that you receive treatment from a physiotherapist, chiropractor or osteopath to correct this, as well as carrying out these exercises on a daily basis, preferably 2-3 times every day. Complimentary therapies such as acupuncture or cranial sacral therapy may also provide relief. Please share your stories on what has or hasn’t worked for you!

Exercise cannot realign joints or tighten ligaments affected by the hormone relaxin, but it CAN help to stabalise the pelvis by strengthening the muscles that support it.

The muscles that need to be strengthened to improve stability for SPD / PGP are the core muscles, particularly the Tranverse Abdominus (TVA) & the pelvic floor. Depending upon the level of pain & range of movement, bodyweight exercises such as a supported squat (adapting the depth of the squat & how far your open your legs) will also improve strength & stability.

SPD / PGP Exercise No.1 TVA Activation: To start identifying & ‘engaging’ your transverse abdominus, you need to practice abdominal or belly breathing. Sit on a chair, exercise ball or cross-legged on the floor & place your hands on your belly. Breathe in, fill your lungs & let your belly expand. Then exhale, emptying your lungs, whilst drawing your belly button right back towards your spine. Keep your shoulders down & your neck relaxed.

SPD / PGP Exercise No.2 Pelvic Tilt: Get on your hands & knees, with your hands directly underneath your shoulders & your knees directly underneath your hips. With good neutral posture position, inhale, allowing the TVA to relax. On exhalation draw the bellybutton towards the spine & contract the PF. Draw the pubic bone toward the belly button & your pelvis will tilt slightly. Avoid excessive spinal movement. Hold in for a count of 10, then relax for a count of 10. Keep going for 2 minutes.

You can also do a pelvic tilt from sitting on an exercise ball. Sit tall at ‘12 o’clock’  (i.e. not on the edge) of the ball, hands folded across chest, exhale & draw navel to spine as you roll the ball forwards slightly as your pelvis tilts. Lift pelvic floor and engage your TVA. Control the movement with your abs not your shoulders. Inhale & return to neutral spine as the ball rolls back to the starting position.

SPD / PGP Exercise No.3 SuperMum (adapted): On all fours as above, with your hands directly underneath your shoulders & your elbows slightly bent. Engage TVA & raise your left hand & right knee approximately one cm off the ground (no higher). Remember to breathe (!) & hold this position for 5-10 seconds before lowering & repeat with the right hand & left knee. If you start to wobble, focus again on engaging TVA to stabilise yourself, then lower. Keep alternating sides for 2 minutes.

Make sure to not allow the hamstring to tighten & that the pelvis does not load (shift) into the hip that is in contact with the ground. Your core muscles should be doing the work!

SPD / PGP Exercise No.4 Kegels: Kegels or Pelvic Floor Exercises are often described as stopping yourself from urinating, but are more actually more effective if you imagine you’re trying not to fart… if you pull in your sphincter muscles (but don’t squeeze your buttocks), your vaginal muscles will also tighten. Then imagine you’re trying to stop yourself from urinating – try to differentiate & identify front, middle & back. Squeeze & release them from front to back, then back to front.

Try quick squeezes, as you contract & release the muscles for just a second at a time. Do this 10 times, rest for a couple of seconds, & then do another 10. Also longer holds. Starting with 5 seconds, repeat 5 times. Take a minute break then do the set again. You can build up to 10 second holds with 10 repetitions. Do both types & aim to do the whole set 2-3 times a day. It might not feel like much, but as well as stabilising your pelvis, these exercises are the difference between post-baby bladder control & wetting yourself. They’re worth it…

SPD / PGP Exercise No.5 Hip Bridge: Lie on your back with your knees bent & feet flat on the floor. Push down into the floor with your hands & raise your hips, off the floor. Your feet, shoulder blades & head remain on the floor, & your chin will tuck into your chest. Hold for 3 seconds before lowering hips back to the floor. Again remember to engage TVA as you raise & exhale, take a breath as you hold, then lower as you inhale.

Only exercise on your back for short periods of time during pregnancy & only if you are comfortable. If at any time you feel breathless, dizzy or uncomfortable, simply roll onto your left side & then slowly come up.

SPD / PGP Exercise No.6 Adapted Squat: Strengthening the muscles of the lower body will also help to stabilise the pelvis, & so try some squats, but with adaptations: Stand side-on to the back of a chair or sofa & hold onto it for support. With legs only just wider than hip distance apart, lower your bottom down as if you were going to sit down. Keep your knees behind your toes & only go as low as is comfortable. Imagine your tail bone is reaching away down to the floor behind you, rather than sticking your bottom up in the air. To come back up, exhale, engage TVA & push up through the outside of your feet & your heels. You will feel the muscles in your backside & thighs working.Repeat 10 times.

Keep active, as doing nothing at all will make the pain worse. Walk as much as you can, using smaller strides if large steps are painful. Walk with good posture – don’t hunch your shoulders or bend forward from the hips. Drop your shoulder blades down & draw them together, engage TVA, breathe deeply & look straight ahead.

Try to do each of these exercises at least once a day. They will only take a few minutes. If your pain is severe & debilitating make sure you also get referred to a physio, chiropractor or osteopath to realign your pelvis. Your muscles will be inhibited from allowing these exercises to work for you properly  if they are overcompensating for misalignment or pain.

Please let me know how you get on, & share your stories on what has or hasn’t worked for you!

Next post on this topic coming very soon: Alleviating pain for SPD / PGP during everyday activities.

Chatting to a new postnatal personal training client yesterday about the particularly traumatic, & frankly pretty crappy, birth she had experienced, I was reminded yet again of how little of this whole pregnancy & postnatal ‘thing’ we actually have any control over.

DH has taken 2 kids & a dog for long walk, leaving me to my laptop & my pot of Redbush… bless him. So I’m indulging in some Sunday afternoon empathy for the sisterhood.

I had to change some of the wording of my advertising for my pregnancy & postnatal personal training business after I had my first child. You see I used to tell potential clients how easy their birth would be if they just followed the correct pregnancy exercise regime. How quickly they would pop out their baby with their finely tuned pelvic floor muscles & how swiftly they would zing back to energetic gorgeousness.

Then I had a go at that birth thing. And boy did I feel short-changed. In the weeks that followed I figured that it was just so unfair. I did everything right! I had eaten, relaxed & exercised by the book, so how come I didn’t get my perfect birth?

Here We Go Again...!

The lesson came shortly afterwards when my visiting midwife put it in perspective & stopped me feeling quite so sorry for myself. ‘You think most women can still hold a squat position after 24 hours labour?’ she asked. She reminded me of my aerobic fitness & stamina, of my core & lower body strength & of how my nutritional knowledge had enabled me to nourish my severely hemorrhaged self so quickly back to vitality.

That was 4.5 years ago & since then I had another baby (not exactly a walk in the park either) & my team & I have trained hundreds of pregnant & postnatal women. Many have had much more traumatic or physically damaging birth experiences than mine. Just as many of them had fantastic, unassisted & empowering experiences.

But the lesson Mother Nature & my Midwife taught me, & that I now try to convey to my clients, is that whilst there is an awful lot about labour & birth that really is in the lap of the Gods… there is also quite a lot we can do to help.

By looking after our physical well-being, we give our bodies the best possible chance of being able to cope with whatever is thrown at us, & of recovering our strength afterwards. By eating for optimum health, exercising correctly & having confidence & respect for our body, we allow it to do (& bounce back from) incredible things.

I work with postnatal personal training clients on ‘re-connecting’, especially when they have preferred to ‘cut off’ from certain body parts when faced with incontinence, flab or stretch marks. Your body’s ability to recover & look fabulous is still there, but again, it needs some help in the form of very specific exercise & great nutrition.  A flat tummy & restored body confidence unfortunately doesn’t ‘just happen’ for most of us!

I do hope you will leave a comment & let me know what you think! Birth is a very big deal, & I know only too well how many women continue to be affected by their experiences (good & bad) many years later. This post is not supposed to be about who has a ‘perfect birth’ & who doesn’t, but rather how a little self love & physical TLC can go a very long way, whatever the experience. Please share your thoughts!

My post today is intended to simply spread a little mummy-camaraderie, empathy &, hopefully motivation & encouragement!

At the mere mention of ‘postnatal exercise’, all mums will say they HAVEN’T GOT ANY BLOODY TIME. Believe me, I know. I’ve got 2 pre-schoolers, a business & a household to run, not to mention a very energetic dog…

But it is often assumed that my postnatal exercise regime, being a personal trainer & all, consists of regular hour-plus long structured workouts. Now I’m a little odd I admit in that I actually like working out. Nevertheless, I honestly can’t remember the last time I did one of those workouts.

That’ll be because I haven’t got any bloody time…

So I’m hoping you might get a couple of ideas from my ‘exercise routine’ that help you inject a little momentum into yours.

My most enthusiastic running buddy!

If I get to walk the dog sans kids, I put my trainers on & run. If I’m walking her with kids, they think I’m hilarious doing my walking lunges, or stopping to do some pull ups from a bar. We have races, I carry them on my back & run around… you get the idea.

If you wait for an hour ‘gap’ to ‘do your workout’, guess what? You will NEVER get that hour gap. Result: no exercise at all. Feel a bit *failed* & a bit rubbish. Result: eat biscuits.

I’ve got 2 suggestions on where you go from this obvious truth – that mums have no time -  both with a very positive outcome.

1. You can be disciplined with yourself & your other commitments, & schedule that hour. It’s your entitlement & you totally deserve to spend some time on it. Everybody is motivated differently, & it may help you to get changed into some ‘proper’ workout gear & do an exercise DVD you enjoy, or go to the gym , or to a class. If it’s in your diary, however hectic that diary might be, then you will find make the time.

2. So you’re looking at option 1 & shaking your head, ‘Ain’t gonna happen’. An hour? Plus travel &/or shower time? Forget it.

In which case, my suggestion is to do what I do & just take what you can get. By that I mean 15 minutes. 25 (even better). 5 minutes even. Use the ideas in the interval workout post, & simply DO any combination of lunges, squats, press-ups, a minute’s plank (come on, you’ve got one minute).

Do some core activation (learn how in this post) & pelvic floor exercises while you cook tea or do a jigsaw with the kids. Use tidy-up time to do some serious squatting in perfect posture everytime you pick something up. When you lift your little one, do so with your core fully activated & do some squats or raise her above your head in a shoulder press. Next time you’re in the park, grab the next railing & do some pull ups (your baby / kids will think you’re doing it purely for their entertainment). Don’t watch them run around – join in.

Get your heart rate going & work big muscle groups. It doesn’t have to be more complicated than that to do some real good.

The key is to stop THINKING about doing some exercise, & just DO some. Just start. If DH gets home early or someone offers you a half hour break, grab your trainers & get outside – it doesn’t matter what you look like or how long you’ve got… I promise you’ll feel better afterwards.

When you’ve got a minute let me know how you fit exercise into your day! Do you MAKE it happen, or do you never seem to quite find the time?

How are you supposed to know if your pregnancy or postnatal personal trainer in London or Surrey actually knows what they’re doing?!?

Are you a mum who uses a ‘general’ personal trainer, boot-camp or gym instructor who may be giving  you inappropriate or ineffective advice?

I have just completed another few days of back-to-back Mummy Tummy Masterclasses, & have thoroughly enjoyed sharing my knowledge so that pregnant women & mums can exercise more safely & effectively.

But the women I meet on these sessions (some of whom have, or have had, personal trainers) are often surprised to hear that certain exercises will make diastasis recti (split abdominals) WORSE… but these exercises have been included in their personal training or gym programme.

Does your pregnancy or postnatal personal trainer encourage you to spend long workouts on cardio machines (treadmill, bike, cross trainer) at steady speeds? Does your pregnancy or postnatal personal training programme really address the postural shifts of pregnancy & mothering? Are you wasting your time with small muscle group exercise like bicep curls?

If so, you’re not getting the best advice & won’t get the results you’re after! I shall cover qualifications & credentials in a different post, but why not do a quick check on your programme to make sure that what you’re doing (& what you’re paying for!) with your pregnancy or postnatal personal trainer or gym instructor is actually going to WORK.

• Forget the fat burning zone! IE long sessions of steady cardio. The most effective way to lose postnatal fat & build lean muscle mass is to INTERVAL TRAIN. You need to be constantly surprising & working your body by changing intensity, speed & duration of your workout.
• Pregnancy & mothering (feeding, lifting… & cuddling!) put us in a permanently hunched posture, shortening & tightening the muscles of the chest & front of the shoulders, whilst stretching & weakening the upper back. Strengthening exercises should concentrate more on working the upper back (IE rowing, or pulling type movements), than the chest (pushing movements). Aim for a ratio of 3:1 upper back work: chest. The upper back needs strengthening & the front needs stretching to ‘even you out’. Push-ups are great exercises, but need to balanced with upright rows, pull ups & the dumb waiter.

For the Dumb Waiter, keep shoulder blades relaxed & down, then move hands out to the side, keeping elbows in & squeezing shoulder blades together.

Dumb Waiter position 1

Dumb Waiter position 2

• Any crunch, sit-up or jack-knife movement will make diastasis recti (the gaping of the abdominal muscles experienced by up to two thirds of pregnant women) WORSE. Core work is absolutely vital during pregnancy & afterwards, & should concentrate on activation of the TVA & pelvicfloor muscles. You need to work the rectus muscles (the split ones) in a linear, not gaping direction. A plank is great, a crunch is not!

• For maximum efficiency, core strength & stability concentrate on large muscle group exercises using body weight. Examples are squats, lunges, pull-ups or planks. Or use multi-tasking exercises such as squats with a shoulder press or upright row with a resistance band. Standing there doing a bicep curl is boring, inefficient & won’t burn any fat!
• Your CORE should be involved in all these exercises, not just the specifically abdominal exercises. Again, multi-task your exercises, it’s what we’re supposed to be good at, & it’s realistic for busy mums!
• Are you getting expert instruction on dealing with your  symphysis pubis dysfunction (SPD) or back ache caused by postural & hormonal changes or imbalances?

For general safe pregnancy exercise guidelines see here, but if you’d like anything clarified or explained further, please just leave a comment here or contact me – I want to DE-mystify pregnancy & postnatal personal training & exercise so please let me know what you’d like more on!

I had coffee today with a friend who is also an old postnatal personal training client (well she’s not old. But then she’s not really postnatal anymore either). We sat right at the back of the coffee shop facing out so we could people-watch with impunity. Actually that’s mummy-&-baby-watch.

Since our postnatal personal training days Sue has adopted all sorts of Wendy-isms… She infuriates her poor husband with ‘But Wendy says…’ whenever he dares to offer some opinion on the virtues of a food or exercise regime, she mutters ‘nobody ever got fat eating brazil nuts’ to herself as she chomps on her omega-filled snacks, & always stands up straight, mindful of  the dreaded ‘buggy bottom’ when she’s pushing one of her 3 lovely kids around.

Sue is a typical client & a typical mum. She never has any time. We met during her lunch-break from the office, & by the time I’ve posted this she will have collected, fed, watered, cuddled & played & put her brood to bed.

But her attitude to exercise is now so positive. If she looks in the mirror & feels a little wobbly, she’ll tell herself  ‘Well, it’s not going to go away by me staring at it’ & will do a set of lunges, squats or press ups on the bedroom floor. Even if she’s only got 5 minutes, she knows that the only way most of us mums manage to exercise on most days, is to just fit it in when we can.

So today’s quote is from my dear friend Sue, who looked over at the other mums & quipped, ‘Well we’ve all got time to sit here having a coffee haven’t we? So we can find time to burn off some bloody fat’.

Charmingly put Sue. As always. X

Meet one of our  pregnancy personal training clients! This is Geraldine, 35 weeks pregnant & looking simply amazing! She is being trained by Jacqui O’Shea, one of the brilliant pregnancy personal training team at No More Excuses.

Her programme includes a twice-weekly 30 minute brisk walk outside, interspersed with strengthening exercises, followed by 15 minutes of pelvic floor exercises & stretching. Pelvic floor exercises are done every single day, plus she sees Jacqui twice a week for a very focussed session of core, postural & strength work.

These pregnancy personal training sessions, totally focussed on building & maintaining core strength, are the key to a truly effective pregnancy training programme.

Try these 2 great pregnancy exercises from Geraldine’s programme to tone & strengthen your core muscles, improve posture & relieve back ache!

Superman (left) From an all-fours position, hands under your shoulders, knees under your hips. Take a deep breath, and as you exhale, tighten your abdominals and raise opposite arm / leg off of the floor to hip / shoulder height. Hold for 5 seconds, then do the other side. Repeat 10 times.

Clamshell

The Clamshell. Lie on your side with knees bent.  Keeping your feet together, raise the top knee until you feel your hip starting to roll backwards.  At this point, return to start position & repeat. Do this 15 times on each side.

Two great exercises for during pregnancy… & afterwards too! Find more great exercises for pregnancy here

Please note that if you’re suffering from SPD one or both of these exercises may not be suitable. Please leave a comment or contact me if you would like me to post on some SPD adpatations!

What about you? What are (or were) your favourite pregnancy exercises? What worked for you? I’d love to hear your stories!

PS As well as working with some of our clients, Jacqui also runs Total Personal Training in Surrey – ‘The Friendly Face of Fitness & Fat Loss’!

I was asked by a new postnatal personal training client today who wants to drop some weight: ‘Will I have to go on a diet?’ Then she added: ‘I seem to have spent most of my adult life on a diet, but the weight always goes back on…’

Which is why, IMHO, you should never go on one in the first place!

Here’s a postnatal personal training secret for you, with my compliments: Don’t Diet!

Look Familiar?

The best thing you can do to for your body shape nutritionally after having a baby (or at any time), is NOT to count calories or pick a ‘diet’, but to simply start to ‘EAT CLEAN’.

Make it a permanent change in the way you eat, not something you do or ‘go on’ for a few days or weeks.

Avoid processed foods & keep your food as close to its natural source as possible. By that I mean, if the original (natural) source of whatever you’re about to eat is un-identifiable , don’t eat it!

By the same token, if you can’t pronounce the ingredients list on the label… don’t eat the food!

White, refined grains such as white rice, white bread, & anything baked using refined flour are full of empty calories, which make you fat. They will also clog up your digestive system & may cause bloating… none of which is going to do much to lose the mummy tummy.

Switch to wholegrains for a lower GI & extra fibre, along with drinking plenty of water & herbal teas. This will help to keep your digestive system working efficiently & reduce bloating.

‘Diets’ by definition, always come to an end, & then you’re back to square one, whether they ‘worked’ or not.

I have this theory: if any of the ‘diets’ we’re told to go on actually worked, there’d only be one book. But there’s thousands. There is absolutely nothing remotely ‘magic’ about cabbage, or grapefruit, or any other wonder ingredient that we’re advised to eat exclusively for a set amount of time.

If you eat significantly fewer calories, you’ll lose weight. If you’re only eating a very limited selection of foods or food groups, you will by definition eat fewer calories (out of boredom if nothing else). The resultant weight loss doesn’t mean that a particular diet ‘worked’, it just means you ate less for a while, & lost some weight.

Diet ends… you go back to previous eating habits… the weight comes back. I’m not going to patronise anyone by listing the foods that make you fat.

This isn’t just about postnatal personal training, but about any personal training… if you’re being ‘put on a diet’, get a new trainer!

Every time you eat foods you know you shouldn’t (if you want a flat tummy that is) then you’re laying down an extra layer of fat. And every time you exercise more intensively & effectively, or eat cleaner, you’re laying the foundation for a lean, flat tummy.

Simple!

Note, I didn’t say it was easy. Simple. But not always easy.

What’s your story? What’s your ‘going on a diet’ experience? What has or hasn’t worked for you? Do you have ongoing struggles, cravings or battles with your food and drink choices? Please share your stories!