Post graduate trained Women’s Health Physiotherapists in Continence & Pelvic Floor Muscle Rehabilitation - focus on bladder leakage, prolapse symptoms & pelvic girdle pain
Women's Health Physiotherapy
Innovative Physio physiotherapists are passionate about Women's Health. Gill Smith and Lauren Hooper have post-graduate qualifications in Continence and Pelvic Floor Muscle Rehabilitation. It is very important if you have incontinence or prolapse issues that you are managed by a physiotherapist that has these post-graduate qualifications.
Conditions commonly treated by Pelvic Floor Physio
• stress urinary incontinence
• urge incontinence (overactive bladder)
• mixed urinary incontinence
• pelvic organ prolapse (POP)
• pelvic girdle pain (pelvic instability) ante-and postnatal
• low back pain with incontinence
Management strategies may include
• teaching pelvic floor muscle contraction correctly via vaginal examination
• real-time ultrasound biofeedback to teach optimal motor control of the pelvic floor muscles
• individual targeted pelvic floor strength exercise program
• clinical pilates program to help bridge the gap between pelvic floor exercises in day to day pelvic floor function
• discussion of lifestyle change to help best manage the problem
• assessing how diet and fluid intake may influence their problem
• bladder training
• relaxation of the pelvic floor
• optimal defecation dynamics
Evidence supports Pelvic Floor Muscle Strength Training
The Good news is that in 2010 the Cochrane Collaboration (which puts all relevant studies together) published a review, Pelvic floor muscle training vs. no treatment, or inactive control treatments for Urinary Incontinence in women, which analysed the effectiveness of pelvic floor strengthening in stress, urge or mixed urinary incontinence.
The conclusion of this analysis was the strongest level of evidence available, which is Level 1/Grade A evidence that pelvic floor strengthening should be offered as the first line of treatment for stress, urge or mixed urinary incontinence.
In Britain the National Institute of Health recommends that all women with Stress Urinary Incontinence (SUI) considering surgery should undertake pelvic floor strengthening education from a Pelvic Floor Post Graduate trained Physiotherapist. Those clients who are unable to effectively strengthen their pelvic floor muscles to significantly reduce the symptoms of SUI are then considered for surgery.
43% of subjects with incontinence and prolapse depressed their pelvic floor on ultrasound when instructed to lift (straining strategy)
Changes after Pelvic Floor Muscle strength training (RCT);
• Correct motor control action of the pelvic floor muscles (PFM)
• Increased muscle (PFM) thickness
• Decreased vaginal opening
• Shortened muscle (PFM) length
• Elevated the position of the bladder and rectum
• Increase maximal urethra closure (wee tube)
• Reduced vaginal opening and muscle length at maximum Valsalva indicating increased pelvic floor muscle stiffness
• Inhibition of detrusor (bladder) contraction (Obstetrics & Gynaecology(2010) Hoff Braekken)
Innovative Physio treat - Mastitis - Inflammation of the lactating breast / Blocked ducts
Our team at Innovative Physio promote breast feeding as a health promotion priority due to the many health and well-being benefits to mother and child.
Mastitis, inflammation of the lactation breast often referred to as blocked ducts is the most common reason to wean in the first 12 weeks after the birth of your child.
Mastitis means inflammation of the breast. It can be caused by blocked milk ducts (non-infective mastitis) or a bacterial infection (infective mastitis).
Only in recent history has the medical world understood the correct anatomy of the lactating breast.
Our understanding of anatomy for many years was based on dissections that were over 100 years old that described the lactating breast incorrectly. This was due to the anatomist pouring hot wax into the nipple opening distorting the delicate breast tissue. Through modern ultrasound imaging we now understand the lactation breast anatomy and this has directed clinical practice.
There are around nine ductal openings in the nipples and the ducts extent into the breast likes roots of a tree. The ducts role is to transport milk, not to store milk.
If the breasts are not emptied ideally due to many varied reason (which will be assessed by the lactation consultant / physiotherapist) the milk can then leak into the surrounding breast tissue forming a solid thickened tender often red area. The body lymphatic and venous system was unable to get the excess supply back into the body circulation via the axilla (armpit) and clavicular (collar bone). A developing clinical reasoned hypothesis is that the fascial (connective tissue) bands that make up the structure of the breast are tight and restricting the movement of fluid.
A breast lump (mastitis) develops which can be painful and distressing, requiring immediate expert care to relieve symptoms and restore normal comfortable breastfeeding. Symptoms of mastitis can include; redness, tension, pain and increase skin temperature of the breast, flu like symptoms of lethargy, and feeling unwell, you may even experience a headache or the baby starts to fuss while feeding.
The recent clinical thinking is the milk that has left the ducts and is in the surrounding breast tissue is being stopped from returning into the circulation by mechanical tightness from the dense fibrous bands that make up the structure of the breast. These fascia tissue blends into the pectoral muscles of the chest and this tightness may impact on reducing venous and lymphatic drainage from the breast to the armpit and collar bone.
Gill Smith has complete advanced physiotherapy training in the treatment of mastitis being mentored and educated by much respected Melinda Cooper, physiotherapist and lead educator of the Lactating Breast for Physiotherapist courses. Gill has completed both part 1 & 2 and constantly furthering her knowledge. Gill has trained her team at Innovative Physio to ensure that women can receive physiotherapy care in a timely manner whenever possible.
How can physio help?
Therapeutic Ultrasound is used to soften the hard solid breast tissue to encourage drainage back towards the armpit and collar bone. Once the milk has left the ducts we do not encourage massage down to the nipples (this logic was based on incorrect anatomy description). The therapeutic ultrasound is based on a pulsating quartz crystal that simply causes vibratory movement of the tissue resulting in softening of this tissue. The therapeutic ultrasound has been used safely for many years in physiotherapy practice. It would be commonly applied to a tight calf muscle or tight band on the outside of the thigh often bringing about instant relief of symptoms as these tight tissues causing the discomfort are softened.
The breast tissue is delicate it is not advisable to massage vigorously as this could result in f damage to the ductal tissue and unwanted scarring...
Lymphatic massage gently to the breast directed either to the armpit or collar bone and into the arm pit follows the therapeutic ultrasound to soften any thickened glandular tissue. You will be shown how to massage gently the breast and armpit.
Pectoral (chest) muscles stretching to assist in elongating the front myofascial tissue - enhancing softness through the breast tissue.
Exercises are given to encourage the diaphragmatic, lymphatic and muscular pumps to enhance lymphatic and venous drainage from the breast.
Treatment is recommended to be done over three consecutive days and this appears enough to soften the breast tissue and enhance drainage and dramatically reduced the breast thickening.
Other helpful information:
Factors that predispose a woman to blocked milk ducts, which can lead to mastitis, include:
Poor drainage of the breast – this can be caused by poor attachment of the baby at the breast or limiting the baby’s time at the breast
Engorgement of the breast due to a missed feed or delaying a feed
A tight or ill-fitting bra or consistently lying in one position during sleep
Holding the breast too tightly during feeding
Trauma such as a kick from a toddler or pressure from a seatbelt.
Poor physical health
Nipple trauma caused by incorrect attachment of the baby during feeds
The use of nipple creams, which can harbour bacteria.
To help prevent mastitis:
Mothers should thoroughly wash their hands before touching the breasts after a nappy change and toileting and use an alcohol based hand rub prior to feeding and throughout day if anyone in the house has a cold.
Make sure the baby is positioned and attached properly on the breast.
Avoid long periods between feeds. Feed frequently.
Wear loose, comfortable clothing. Bras, if worn, should be properly fitted. Take bras of if possible and wear a tank top or singlet.
Avoid nipple creams, ointments and prolonged use of nipple pads.
Other treatment options for mastitis
Making sure the baby is feeding well on the affected breast – offering the affected breast first can help
Check babies chin is well planted chest to chest and chin to breast
The application of heat for a few minutes before a feed, and cold packs after a feed and between feeds for comfort
A change in feeding position
Frequent drainage of the breast through feeding and expressing.
Antibiotics (for example, flucloxacillin or cephalexin) if infective mastitis, speak to your doctor
Anti-inflammatory medication (such as ibuprofen) or analgesia (such as paracetamol) to relieve pain, if necessary for non-infective mastitis, speak to your doctor or pharmacist regards what medications are proven safe for breast feeding mothers
Rest and adequate fluid intake
Varying the feeding position to increase breast drainage. Encourage lying down on your back to breast feed incline about 30 degrees leaning on some pillows and enjoy skin to skin contact with you and your baby. Your baby has strong reflexes that will help them lift their head up and effectively attach to your nipple. Tickling under their feet will help them move towards your nipples. Enjoy- you can now relax and alternatively stretch out your arms overhead to keep breast tissue soft and breast fascia internally elongated.
Physiotherapy treatment ideally commences within the first 24 hours of symptoms, but can be beneficial to reduce pain and inflammation at any stage.
Where to get help about breast feeding issues:
Contact your Maternal Health Nurse
A lactation consultant – contact the Lactation Consultants of Australia and New Zealand
An Australian Breastfeeding Association breastfeeding counsellor Tel. 1800 mum 2 mum (1800 686 2 686)
Call to discuss how Clinical Pilates or Fitness Pilates can help you.
Women's Health Physiotherapist and Musculoskeletal Physiotherapist
Post Graduate Certificate Continence and Pelvic Floor Muscle Rehabilitation (Melb Uni) (2009)
Post Graduate Diploma in Musculoskeletal Physiotherapy (LaTrobe Uni) (1997)
Bachelor of Applied Science in Physiotherapy (La Trobe Uni) (1987)
Level 4 Pilates DMA certified
Certificate IV in Training and Assessment
Lecturer at Filex Fitness Industry Convention ( April 2014) – “Tips & Tricks to optimise pelvic floor function”
Lecturer at Victorian Maternal Health Nurses Conference (2014) - "Pelvic Floor Health"
Gillian Smith for the past seventeen years has run Physio/Pilates/Women's Health clinics in bayside suburbs. In 2013 she constructed a purpose built Women’s Health clinic in Edithvale close to the beach. The studio consists of three consulting rooms and a large Pilates, Gyrotonic & Functional Fitness studio which converts to an educational venue for Pelvic Floor Fitness workshops.
Gillian has a special focus on the link that exists in women who suffer from bladder leakage and low back pain, an inseparable condition. Over a decade Gillian has been using the real-time ultrasound for assessment and client biofeedback rehabilitation. Many people are visual learners, seeing their muscles working on the screen and connecting to these muscles correctly brings about immediate positive outcomes. Gillian uses the real-time ultrasound on all muscle groups of the body and is very skilled in its use. She will rehabilitate shoulder, knee, hip, back, neck and pelvic floor muscle dysfunction with real time ultrasound biofeedback sessions.
Gillian has two postgraduate qualifications in Physiotherapy. In 1997 she spent a year studying musculoskeletal medicine. She refined her skills in assessing a musculoskeletal condition and developed advanced clinical reasoning skills to form a sound diagnosis and consequent treat plan unique to that client. In 2009 she undertook six month postgraduate training in Continence and Pelvic Floor Muscle Rehabilitation which taught her how to assess and rehabilitate issues associated with the bladder, bowel and pelvic organs due to dysfunction with the pelvic floor muscles.
Gillian integrates clinical expertise with evidence-based research, in the assessment and management of movement disorders associated with Musculoskeletal and Women’s Health issues.
Gillian is passionate about Women’s Health and keenly continues to advance her knowledge in this field of study. She is a great advocate for lifelong learning. Gillian is also a mother and appreciates the challenges of work life balance. This topic is often spoken about by the women in our fun, nurturing group exercise classes. Innovative Physio is developing into a community of women who are motivated to keep their mind connected to their functional fitness.
Cofounder of Pelvic Floor Fitness with Debbi Fretus (Pilates, Gyrotonic, Dance Medicine Practitioner Myotherapist and Educator), an educational product promoting awareness, knowledge and practical know how regards optimising pelvic floor function in the rehabilitation and fitness industry.
The objective of this program is for allied health practitioners and fitness instructors to be empowered gaining assessment skills determining whether clients are correctly recruiting pelvic floor muscles. This is a critical movement pattern for safe and effective exercise especially working with women, pregnant and post-natal. Pelvic Floor Fitness promotes pelvic floor safe exercise for women.