Posts

TREATMENT OF URINARY INCONTINENCE WITH HYPOPRESSIVE EXERCISE

The Spanish Scientific Nursing Society journal (SCELE) has just published an original research article titled Hypopressive exercise for the treatment of urinary incontinence in multiparous women: clinical series.

 

The study presented the results of treating a clinical series of multiparous women who suffered from urinary incontinence. Based on the hypopressive exercise guide described by the founders of Low Pressure Fitness (Rial and Pinsach, 2014), a novel protocol was proposed with the objective of improving urine leakages.

 

Urinary incontinence is very common after delivery. The type and number of deliveries are considered major risk factors. In many cases, women do not seek appropriate treatment since urinary incontinence has become socially normalized after a certain age or as a consequence of delivery. However, supervised treatment with specific exercises can be helpful and at the same time healthy.

 

In recent years, hypopressive exercise has started to be applied in the treatment of pelvic floor dysfunctions such as prolapse and incontinence. Although it is very popular, there is a limited body of evidence regarding it’s benefits. Additionally, there are very few references available regarding the best protocol for treating urinary incontinence with hypopressives. In this study, the authors suggested a new protocol which consisted of ten minutes of Level 1 LPF exercises practiced once a week over three weeks. After that, the session duration increased to fifteen minutes and was carried out twice a week. Lastly, in the last two weeks practice time was increased to twenty minutes twice a week.

 

After a seven-week intervention protocol based exclusively on hypopressives, urinary incontinence was again assessed. All cases showed improvements in both, the severity and quantity of the leakages. Two cases showed complete remission of urine leakages and all the women expressed great satisfaction with the program.

 

urinary-incontinence

 

The results of this study:

  1. Provide more data on the potential effectiveness of hypopressives for the conservative treatment of urinary incontinence.
  2. Lay the ground work for new experimental studies involving larger groups.

 

The fact that the sessions were short, supervised and progressively introduced to the patient could influence the desirable findings. The results of this study show us that a short protocol (10 to 20 minutes of hypopressives performed once to twice a week) can also be effective in reducing urinary incontinence in a case of multiparous women.

 

All the certified professionals of Low Pressure Fitness, experts in hypopressive exercise can be found in this link.

LOW PRESSURE FITNESS AT RIMINIWELLNESS 2018

RiminiWellness is the largest fitness and wellness trade show in Italy and one of the largest in Europe. With participation in 2017 at 268.120, this year’s event promises even greater numbers. Low Pressure Fitness was present this year with 4 workshops and 8 mini masterclasses to present, inform, instruct and demonstrate the pressureless training system to the Italian fitness community. While participants in the masterclasses were predominantly Italian, there were also many participants from Slovenia, Czech Republic, Poland, Ireland and many other European countries.

 

LPF-RiminiWellness-2018

 

The workshops presented included: “What nobody has ever told you about Core Training, myths and new perspectives”, “The core’s missing link: diaphragm and pelvic floor”, “Myofascial relaxation and Postural Re-Education with LPF” and finally, “Low Pressure Fitness: much more than hypopressives”. Each workshop was attended by fitness professionals as well as physical therapists and other medical professionals, that all expressed interest in this innovative and exciting training method for both men and women.

 

Low Pressure Fitness: much more than hypopressives

 

The participants in the mini master classes over the four days included exercise professionals, health professionals as well as exercisers. All were enthusiastic about the new technique and especially the sensations experienced during the workouts that were all geared at teaching the basic fundamental postures and breathing and, where possible, having them try the expiratory apnea, our “signature exercise”.

 

LPF-RiminiWellness-2018

Low Pressure Fitness staff at Riminiwellness

 

The staff of Low Pressure Fitness instructors was on-hand to assist the participants during the mini masterclasses and give information and distribute material on LPF in Italy.  They were also invaluable in sharing their own personal experiences and results of their work with many of their own clients to show the participants that the LPF method is both instructor and user-friendly with benefits that can be attained when the exercises are performed with precision. RiminiWellness has proven to be an excellent event to showcase this innovative, multidisciplinary training method. To learn more about Low Pressure Fitness and courses in Italy for health and exercise professionals write us to: [email protected]

 

Author:
Mimi Adami
Low Pressure Fitness Italy Director & LPF-Coach

Facebook:
Low Pressure Fitness Italy

SHOULD I DO HYPOPRESSIVES DURING THE IMMEDIATE POSTPARTUM PERIOD?

Hypopressive exercise has been suggested as an alternative rehabilitation tool for abdominal and pelvic floor postnatal recovery. Nowadays, hypopressives are widely prescribed by health and fitness professionals during the postpartum period in many European countries. However, there is a lack of scientific literature about the optimal time to start a hypopressive program after delivery. Therefore, the purpose of this article is to address some of the common questions we receive at Low Pressure Fitness regarding this topic. Among the most frequent questions about postpartum and hypopressive training we highlight the following:

 

  • How soon after giving birth can I start my hypopressive training?
  • Can I do hypopressives if I am breastfeeding?
  • Can I do hypopressives if I had a c-section?hypopressives-postpartum

At present, there are no randomized controlled trials on the long-term effects of hypopressives during the postpartum period. Additionally, there are different opinions regarding the best time to start these exercises. Opinions vary from beginning immediately after delivery to waiting until the late postpartum period. Here we summarize opinions from different experts on this important topic.

 

What do professional associations say?

The puerperium corresponds to the period right after delivery. That is, the first week after giving birth. It extends from the first day to the tenth day after the baby is born. The late puerperium period includes day 11 through day 42. While the remote puerperium makes reference to day 43 onwards. The following period, generally called late postpartum, starts in week six or 40 days following birth (the famous quarantine). Of note, the postpartum period can last up to six to twelve months after giving birth.

 

The guidelines from the Spanish Association for Physical Therapy for the late postpartum period recommend starting hypopressive training six weeks after delivery. They state “abdominal exercising should always be hypopressive”. Regarding the puerperium (first 48 hours-first week), this association suggests that women should avoid traditional abdominal exercises and perform hypopressives.

hypopressives-postpartum

On the other hand, the Professional Guide for Mothers’ and Fathers’ Education in Pregnancy and Childbirth, coordinated by the Service for Assistance Coordination and Care, recommends hypopressive exercise only during the late postpartum period (from the sixth week onwards). The Ministry shares a similar view for Health and Social Services of the regional government of Cantabria (Spain). They state in their guidelines that women should perform hypopressive exercise during the postpartum period, specifically 30 to 45 days after delivery (the quarantine).

 

During the postpartum period, it is advisable to seek guidance and instruction from an exercise professional

 

Our Delivery emphasizes that once the quarantine is over, it is important to practice kegel exercises and hypopressives with the supervision of a physical therapist who can explain how to perform the exercises properly. Our Delivery also recommends Kegel and hypopressive exercise to women who had a cesarean section.

 

Tamara Rial, PhD, Director of Low Pressure Fitness, suggests that when there is no medical contraindication to exercise, hypopressive training can start after the quarantine (six weeks postpartum). However, in the case of surgical procedures such as a caesarean section, it is advisable to wait three months. It is also important to visit a health care provider after delivery and to check the pelvic floor prior to commencing a postnatal fitness program.

hypopressives-postpartum

During the postpartum period, it is advisable to seek guidance and instruction from an exercise professional who can adapt the program and address individual needs. To find a certified Low Pressure Fitness specialist visit our online directory.

 

Author:
Dr. Tamara Rial

HOW CAN LOW PRESSURE FITNESS BENEFIT PILATES?

In his first Law of Thermodynamics Antoine Lavoisier (1743-1794) said that matter can’t be created nor destroyed, it is only transformed. When a general law is properly stated, it will also apply to the specific. In our case, we are talking about physical exercise and recovery, where this rule certainly holds. After all, every new approach springs from the what our forebearers have said before, and in today’s fast paced world, fusion is the buzzword for any discipline.

 

In the following article we will understand how Low Pressure Fitness connects to Yoga and Pilates, emphasising the benefits of Low Pressure Fitness training. Many people practice the three or just two of them in a training combo, or else they practice them in succession, depending on their mood or the class timetables available. The three disciplines share common ground and differences in approach, focus and style.

 

Centuries after it was first developed, Yoga is still a relevant holistic training method, and after its advent in the fifties the same can be said for Pilates. More recently created, Low Pressure Fitness is a great new approach to exercise and wellness, with particular aims and features.

 

Yoga, Pilates and Low Pressure Fitness share a common goal, which can be broadly stated as regaining control of the body through awareness. They prioritise body alignment, breathing and postural fitness. Stacking the spine, engaging the core, inhaling and exhaling with control are classic cues we will find in the three disciplines. Low Pressure Fitness is a training program with an ecclectic outlook, stemming partly from Yoga and which was developed some decades after Pilates.

 

Neither of them require complex machinery or a specific place, but they might make use of simple accessories. Low Pressure Fitness includes certain props such as massage balls and wood-rollers, Pilates uses the well-known swiss ball and Yoga, elastic bands and blocks.

 

The main difference between Yoga and Pilates and Low Pressure Fitness is the spiritual component of Yoga, which the other two do not have. Yoga is generally more static than Pilates and Low Pressure Fitness. Yoga poses or assanas are held for as long as possible, excepting the continuous movement of vinyasa, a continuous flowing sequence which connects several poses, like the sun salutation (surianamaskara).

 

Pilates exercises are usually done in a specific order, one after another, and like Yoga, have colourful names to identify them, like the swan, the jack-knife or the criss-cross. They appear to be simple, but they require precision and strength. Strong emphasis is put on technique.

 

The connection between Low Pressure Fitness and Pilates is obvious, since both aim for a better management of intra-abdominal pressure. Scientific research also shows that one of the common benefits of Low Pressure Fitness and Pilates is the increase flexibility.

 

Both Pilates and Low Pressure Fitness consider local body awareness. Pilates will focus on specific areas of the body, especially the voluntary contraction of core muscles. Low Pressure Fitness will also provide the added value of another type of concentration and centralisation, which is the apnea, that activates the involuntary muscles in the pelvic floor.

 

Like Yoga and Pilates, Low Pressure Fitness belongs in the category of useful exercises to balance myofascial tensions, realign posture and improve breathing. Exercises are also sequenced from the simple to the complex, with a focus on the core muscles, the pelvic floor and breathing. Low Pressure Fitness exercises include the same patient and focused attitude as in Yoga and Pilates, but with one distinctive feature: permanent focus on decreasing pressure on pelvic area.

 

What is specific to Low Pressure Fitness is the breath-holding which allows for a wider range of motion. Exercise will often focus on working on the sagittal plane (right or left sides) of the body. As we can see in the pictures, these are probably the exercises which provide more improvements, but we also find more advanced postures targeting coronal plan and the three planes at the same time, with complete torsions of the upper body.

 

Unlike the traditional approaches to abdominal and pelvic floor exercise, which will focus on one segment of the core at a time, the Low Pressure Fitness program addresses the core to perform synergistically and as a whole.  

 

What are the benefits of Low Pressure Fitness?

 

Among its many benefits, Low Pressure Fitness is used by physiotherapists and trainers for:

  • pelvic floor restoration
  • trimming the waist-line
  • preventing and reducing back pain
  • enhancing breathing
  • posture and balance.

It is specifically focused for:

Myofascial release of the abdominal wall and diaphragm, resulting from Low Pressure Fitness are also well-acknowledged benefits of Low Pressure Fitness. The constant movement of the diaphragm in a Low Pressure Fitness session, promoted both by breathing and by the apneas produces a cooperation between the need for a longer range of motion and the abdominal response. Connective tissue loosens up and so does the abdomen.

 

How does Low Pressure Fitness work?

 

Low Pressure Fitness optimises the body posture by adjusting the neuromuscular connections between the autonomous nervous system and portions of the body lacking in alignment and relief. It prevents urinary incontinence by restoring muscular tone in the abdomen and the pelvic floor. It improves breathing patterns by enhancing movement in the torso and the diaphragm and it relieves back pain by promoting flexibility and a wider range of movement.

 

Low Pressure Fitness promotes axial lengthening and restoring the strength of the abdominal oblique and transverse muscles.

 

Since there is so much in common between the Low Pressure Fitness, Yoga and Pilates, it is also frequent to find contentious attitudes, with people trying to argue which of the three is better. We feel that it is not necessary to choose between either. An all-inclusive stance will allow us to reap the benefits of all of them. Just workout, enjoy be ecumenical and enjoy!

 

Hugo Loureiro
Low Pressure Fitness Portugal Coach and Pilates Personal Trainer (PT Studio)
Dr. Tamara Rial
Founder & Developer of Low Pressure Fitness

PREPARE YOUR BODY FOR HIGH IMPACT TRAINING WITH LOW PRESSURE FITNESS

The  starting  point  for any  workout  should  begin with a pre-exercise evaluation  (assessment  of  cardiorespiratory  fitness,  muscular  fitness,  flexibility or body  composition) performed by an exercise specialist. A professional will ensure that the exercise program is safe and effective and consistent with each individuals needs and goals.

 

The Low Pressure Fitness system includes an assesment of core muscle function. This initial assessment will help you understand the health of the your abdominal muscles, and whether they are fit enough for their main functions: stabilization, movement and breathing.

 

In recent years, fitness centers are increasingly  focused on  high intensity workouts. This type of training can place excessive impact on core structures including the abdominal muscles, the spine and even the perineum.

 

Usually, when we sign up for a beginners class at a fitness center we do not ask ourselves if our core is prepared for the demands of high impact or high intensity exercise. The high price for quick results is often an injury or aggravation a previous pathology. That´s why a pre-exercise evaluation is essential to detect conditions that may  influence the design of an exercise or sport program.

 

 

After the initial assessment, one of the best ways to prepare your body for future higher intensity workouts is with Low Pressure Fitness. Through specific postural and breathing techniques, your body will decrease rigidity with observable  effects on the diaphragm and lumbar spine. Optimal muscle tone with no myofascial tension will allow your body to better manage intra-abdominal pressure which is crucial for supporting higher intensity training. There is a common misunderstanding regarding strength and tonicity: strong is not equal to tonicity You can have strong muscles but at the same time they can have high or even low tonicity. There is a widespread misconception about the importance of core muscle strength. It seems as if strength is the only relevant variable to achieve optimal physical condition.

 

The core helps to transfer the load of intra-abdominal pressure and body forces. When a link in the core chain is weak, the rest of the system will fail to function optimally. This is the case of many sportswomen who have high levels of general strength and fitness but a specific weakness in their core. In a previous article we address this topic. Another common ailment related to muscular weakness and imbalance of the core musculature is the sport hernia. Aggressive and inappropiate abdominal exercise programs can cause or a sports hernia. Low Pressure Fitness can be a safe alternative for beginners who need to restore the strength and function of their core muscles. Even if you are an athlete or fitness instructor who wants to perform high intensity training, you  can benefit from Low  Pressure  Fitness as part of your exercise program.

 

Eunice Moura

WHAT’S HIDDEN BEHIND ATHLETIC INCONTINENCE?

Let´s get real and take out of the closet the topic of urine leakage in women’s sport. Recently, wikipedia has introduce a new term to describe exercise-induced urinary incontinence, called Athletic Incontinence. It´s the specific form of stress urinary incontinence  stress urinary incontinence that results from engaging in high-impact or strenuous activities. Generally, it is thought to be the consequence of a decreased support system of the pelvic floor due to increased intra-abdominal pressure during high-impact exercise. It has become a condition too common in female athletes. It represents a huge problem related to the  quality of life of sufferers, but at the same time it´s socially invisible. Meanwhile, different types of incontinence effect a large proportion of american women and the prevalence is much higher for female exercisers of all ages!

 

If statistics state the problem, why we don´t talk about it?

 

There is a huge taboo around the topic so it´s still under-reported. One of the most common problems that female athletes face, during and after their sport career, is stress urinary incontinence. Unfortunaltely, the topic is rarely discussed by an athlete’s healthcare provider. Behind exercise-induced urinary leakage are hidden several consequences such as cultural taboos, embarrasment, lower self-steem, early sport drop or other related lumbo-pelvic issues. Is a threat to an athletes health and well-being since it may limit their participation in athletic activities. Enterprises, concious about the problem , sell the solution  in the form of “female exercise pads”. Sounds like a bad joke, but at the same time, they may be the only people aware of this secret.

Why athletic incontinence is so common?

 

A literature review about this topic (Goldstick & Constantini, 2014) states that the prevalance  ranges from 28 to 80%, with the highest prevalence in high-impact sportswomen such as trampolinists, gymnasts, aerobic gymnasts, hockey players and ballet dancers. Leakage is due to a failure of the pelvic floor system that is unable to overcome the increase of intra-abdominal pressure which occurs regularly during high-impact activities such as jumping, landing, running. Strenuous exercise may overload and weaken the pelvic floor muscles. There are several risk factors associated with this condition, notably pregnancy and childbirth. However, studies have shown about 25-30% of stress urinary incontinence occurs in young athletes with no obstetric past. These numbers are even higher in activities and sports that significantly increase intra-abdominal pressure such as the trampoline whereby athletes have the highest incidence (80%) of urinary loss (Eliasson, Larsson & Mattsson, 2002).

 

What other problems are related?

 

Recent studies confirm a relationship between low back pain and urinary incontinence. The highest prevalence of athletic incontinence, as mentioned before, has been shown  in high-impact sports like gymnastics. This sport includes activities such as jumping, landing, and running which  can also cause compression to the lumbar spine and result in nerve inflammation.

Eating disorders were also associated with higher prevalence of stress urinary incontinence. The lack of proper nutrition, hormonal changes, muscle weakness, and vomiting are possible causes that influence negatively the structural pelvic system.

 

How to prevent or treat it?

 

Just doing simple pelvic floor prevention exercises can help women stay dry. Pelvic floor muscle exercises should be the first-line of treatment and incorporated regularly into exercise and sport training programs.

Joinning a regular exercise program based on Low Pressure Fitness is the preferred method for pelvic and abdominal training for thousands of women around the world. In additon, this method has no side-effects and doesn´t need equipment. Low Pressure Fitness has demostrated to be an effective tool to decrease leakage symptoms in a randomized controlled trial done by Rial (2015). The satisfaction of practitioners is complete as shown in the following testimony of a female Spanish marathoner who experienced exercise urinary leakage:

 

“As an athlete I must say that Low Pressure Fitness for me has been a great benefit to my health, both in terms of improving my quality of life, sport and emotional.
I am 37 years old and love my job, as a physical trainer …. and in my free time I am a marathon runner. I run half marathons and races that goes from 40miles to 62miles. I have spent almost seven years running, and the small losses of urine will appeared in the fourth year. The loss starts in the first miles, where I feel like 4 drops fall and it´s very uncomfortable. Since I started doing Low Pressure Fitness every morning these small daily losses have disappeared. The Low Pressure Fitness for me have been my best medicine, I practice them every morning and then I repeat in the afternoon.
Thank you to all the people who are researching low pressure fitness!”

Anna
Madrid, Spain

AS WOMEN GET STRONGER, THE PELVIC FLOOR GETS WEAKER

On this occassion we would like to talk about a dirty little secret. Nowadays, extreme high intensity workouts like Crossfit or Bootcamp are gaining popularity among women all across the world. Meanwhile they strenght and condition their pelvic floor maybe  weaker. This is a condition some workout exercise programs normalize as we can see in this video titled Crossfit do you pee during your workouts?

 

Pelvic floor muscles have to contain this systematic increase of pressure

 

It seems quite strange or contradictory as women get stronger how can their pelvic floor muscles get weaker? And, the worst  part is… why aren´t we talking about the problems related to pelvic floor dysfunctions in female sport practitioners?

 

High impact exercise is directly related with an overload on intraabdominal pressure. Pelvic floor muscles have to contain this systematic increase of pressure. The management of intraabdominal pressure can fail if several risk factors coexist at the same time (frecuency, load, intensity, impact of training). So, it´s not a surprise when the scientific literature has described the highest prevalence of stress urinary incontinence in female athletes, reaching prevalences of 80% in the case of female trampolinists. Recent studies also show that young, fit and nulliparous women suffer urinary incontinence, specially stress urinary incontinence. Of note, female athletes have a decrease in vaginal pressure compared to non-athletes. Stress urinary incontinence is the involuntary leakage when an effort occurs (sneeze, cough, laugh, strength training, running..).

pelvic-floor-dysfunction

To lose the control of the bladder is not really the safest way to build a strong and funtional body. In fact, its a symptom of a dysfunctional core system, the spinal stability is compromised and is not able to manage correctly the increase of intraabdominal pressure.

 

To sum up, the following principle factors can lead to pelvic floor dysfunction in high impact exercise programs:

  • Systematic and repeated valsalva maneuvers during exercise.
  • Systematic and repeated jumps or impacts that directly affect the connective support tissue of the pelvic floor.
  • Poor breathing coordination when abdominal and respiratory muscles are fatigue.
  • Not performing a specific program of re-training the pelvic floor muscles like Low Pressure Fitness.

PAINFUL SEX? DYSPAREUNIA? CAN LOW PRESSURE FITNESS HELP?

A common sexual disorder among women is  dyspareunia which is pain that occurs before, during or after coitus. It involves sexual dysfunction with observable effects on a women´s quality of life. It is recurring or persistence pain that is experienced in the genitals or the pelvic structure. On average, its prevalence can reach 10%-15% of menopausal women, increasing in post-menopausal women. The causes of sexual pain are numerous. Nowadays, the mechanisms that trigger this disorder remain various and unknown. Among the primary causes, emotional factors such as sexual abuse, unsatisfactory sexual encounters, stress or psychological problems stand out; physical factors such as insufficient lubrication, other sexual disorders, vaginism, irritations, pelvic surgery, are important to consider too.

 

The treatment of sexuality and its disorders must be approached from a multidisciplinary perspective which includes treatment from a physiotherapist who specializes in pelvic floor dysfunction and sexuality.

 

Can physical therapy exercise like Low Pressure Fitness help?

Unfortunately, dyspareunia is a subject that often remains in the dark. So sometimes both physical therapists and patient remain silent. Currently, attending a specialist in sexual disorders and an expert Low Pressure Fitness teacher is an excellent way of support. Education, appropriate verbal instruction and application of physical techniques can help.

 

It has been found that 30% of women with some kind of pelvic dysfunction are incapable to contract their pelvic floor muscles. Physical feedback, awareness and body control are essential. Therefore, one of the primary goals of Low Pressure Fitness is to acquire awareness of the pelvic floor musculature. It is important to know anatomical structures and physical feeling of the perineum in any sexual disorder treatment. Other objectives of Low Pressure Fitness are to increase elasticity of the vaginal tissue and normalize the pelvic floor tone. In general, women who suffer from pain during sexual intercourse have a tendency towards hypertone and high pelvic stiffness. In this sense, keep balance between the fascial connective tissue and muscular components will help prevent pelvic floor hypertonicity. Myofascial stretching that Low Pressure Fitness produces facilitates muscular relaxation as well as blood circulation. It will bring mobility to the pelvic area and a body readjustment.

 

A recent study by Brazilian researchers found that Low Pressure Fitness helped in the local proprioception of the pelvic floor. In this sense, one of the main objectives to achieve with a physical therapist will be to raise awareness of the pelvic floor, and at the same time learn how to discriminate this from relaxation of the isolated muscular contractions.

 

Collectively, all of these factors will have a positive influence on a women’s physical and psychological well-being. Releasing muscular tension favors emotional balance. We must remember that the emotional and psychological factors are significant causes of sexual pain. If you suffer from any type of pain during sexual intercourse, don’t hesitate to get away from the social taboo. Talk about the subject with a professional and start an interdisciplinary treatment plan that is designed to enhance your physical and  psychological point of view.

TOO MUCH BACK PAIN DURING PREGNANCY, TOO LITTLE EXERCISE 

Unfortunately, lumbopelvic pain is too common during pregnancy. Around 45% of women experience lumbopelvic pain during pregnancy and 25% of women continue to suffer postpartum,. So…almost 50% of pregnant women experience low back pain!

Pain usually appears in the lumbar region or the front of the pelvis, due in part to changes in the stability of the pelvis as well as muscular and ligamentous tissues. Proper posture can influence the postural tension of the back muscles, known as “antigravitational muscles”.  When there is a deficiency or weakness in the back musculature, along with other risk factors such as obesity and physical inactivity, long-term postural and structural dysfunctions may appear.  Pregnancy related low back pain, also known as back pain or sciatica, is located in the lower back, sides of the sacrum, the buttocks and even down the back of the thigh extending below the knees. Pregnancy related low back pain can affect one or both sides of the back and limbs. Usually it´s aggravated by standing, walking, movements while you sleeping, tilting the trunk, or lifting objects,. So awareness and early prevention are the best solutions to fight pregnancy related low back pain.

 

Why low back pain occurs during pregnancy?

Back pain etiology is linked to the physiological, anatomical, and mechanical changes which take place during pregnancy. Normal physiological changes during pregnancy affect the spine. They may contribute to the onset of back pain during pregnancy and possibly postpartum. The most characteristic changes are the following: posture adopted by women during pregnancy; total body water content; the endocrine system and vascular alterations during pregnancy.

  • Postural Changes. There are noticeable postural changes throughout the nine months of pregnancy. These are characterized by increased lumbar lordosis. Hyperlordosis or excessive increase in the curvature of the spine is related to the contracture of the lumbar muscles which are forced to work harder, triggering pain in this area that can sometimes radiate down the legs. Most of the weight gained during pregnancy is concentrated at the bottom of the pelvis along with increased abdominal volume. Thus, a tendency to tilt your body forward would occur, which tends to compensate pregnant unconsciously with a rearward position of the upper body above the pelvis, restoring its center of gravity, but increasing the lumbar lordosis which can contribute to the development of low back pain.

  • Total body water content. The body water content increases similarly in both primiparous and multiparous, by an average of 8.5 liters. This fluid retention, particularly at the connective tissue of the spine and pelvis, increases the laxity of these joints, which could contribute to the genesis of pain.
  • Endocrinological  changes. The effects of fluid retention just mentioned is enhanced by hormonal changes during pregnancy, particularly the effect of the hormone relaxin which  increases laxity of the sacroiliac joints, symphysis pubis and cervix. This laxity, which is necessary to accommodate the growing fetus and facilitate childbirth, could also cause bloating and increased range of motion of the sacroiliac joints and symphysis, which can be a cause of lumbar pain. Also, serum levels of reproductive hormones and procollagen have been associated with the onset of pelvic pain in late pregnancy.
  • Vascular changes. Up to 67% of women report low back pain during the second half of pregnancy. It is often a consequence of the combined fluid overload with obstruction of the inferior vena cava by the enlarged uterus, which could, in turn,  result in congestion of the venous system ultimately leading to the onset of back pain, according to specialized literature hypothesis.

 

Scientific research links previous lumbar pain, stressful job or lumbopelvic pain related to previous work to a higher prevalence of low back pain during pregnancy. Even though, other important risk factors to take in account are:

 

  • Weight gain over medical recommendations, which forces the lumbar muscles to make an extra effort, increasing the risk of contractures.
  • The relaxation of the abdominal muscles: abdominal diastasis and the enlargement of the abdomen increases the physiological lumbar curve of the pregnant woman. But also the deep abdominal muscles (obliques and transversus abdominis) lose their competence and tone. To avoid this, it is essential to learn to exercise the deep abdominal muscles and implement safe core abdominal training before and during pregnancy.
  • Glute weakness. Glutes are related with pelvic floor health and spinal functionality. In the case of pregnant woman, an appropiate gluteal muscle strenght, will help stabilize lumbopelvic region, working synergistically with the lumbar spine and the pelvic floor.
  • Sedentary lifestyle: unless the pregnant woman is told by a health care provider to avoid exercise, regular physical activity is recommended for better postural control, correct biomechanical joint and a toned muscles, to suit their own changes pregnancy and childbirth reach the day in the best possible conditions.

 

Exercise better than paracetamol.

For all the above risk factors, the best preventive medicine will always be exercise. Its too extended between some health professionals recommend analgesics like paracetalmol or complete rest to recover back pain. But its well known that prolonged bed rest promotes weight gain which further deteriorates physical condition. Also, taking painkillers may not be the best solution in the short and long term.

Engaging in a regular program of exercise like Low Pressure Fitness before, during and after pregnancy to an excellent  choice to reduce the risk of low back pain.  It is recommended to tone the core muscles and for postural re-education, two principal targets for fitness pregnancy workouts. Furthermore, Low Pressure Fitness as a global program will train glutes and pelvic floor, essential musculature that provides stability to the pelvis. Specialized trainers or physiotherapists will provide the best advise and training programs before, during and after pregnancy.

ABDOMINAL DIASTASIS: THE GOOD, THE BAD AND THE UGLY

We often hear mothers say that they have diastasis of the abdominal rectus or abdominal diastasis, which is the separation of the alba line of the famous six-pack. But, this doesn´t only occur in mothers during and after pregnancy, also to people who perform strenuous physical tasks as well as those who are overweight or obese.

  • What is diastasis of the rectus?

In the abdominal muscle group, we find a muscle known as the rectus abdominus. It is the muscle of the famous six-pack that is very appealing aesthetically and is well-defined in fitness enthusiasts and body-builders.

This muscle of the central part of the abdomen we can say is symmetrical from the middle point of the body and this middle point is connective tissue of the rectus, which is also known as the alba line. The line that splits the six-pack in the abdominal rectus.

This alba line is fibrous in texture and therefore cannot be stretched as with other structures. However, during pregnancy the abdominal girdle grows and the muscle stretches and separates to allow growth of the baby. In so doing, the fibrous membrane that joins the abdominal muscles is separated and thus there is a separation between the abdominal muscles, which turns this area into one at great risk of rupture.

  • What should you avoid if you have abdominal diastasis?

if you have abdominal diastasis or if you want to prevent it, you should avoid:

  Excessive weight gain, then this will help you to distend the connecting tissue of the abdominal muscle group.

–  Avoid wrong postures that will increase pressure in the stomach. A good body alignment will help the abdominal firm and without unnecessary pressure.

–  Avoid hyperpressive exercises or hyperpressure activities which are all those that increase pressure in the abdomen. Among this exercises we find: abdominals, sit-ups, planks, exercises requiring great strength like lifting heavy objects, running or jumping.

abdominal crunch

  • What can I do if I have abdominal diastasis?

If you have the slightest suspicion that you have diastasis of the abdominal rectus, consult with your health care provider.

A pelvic floor physiotherapist or a Low pressure fitness trainer can help you in this direction, both for the diagnosis as for the prescription of the best rehabilitation or preventive therapy. As much as if it is an anatomical diastasis as a functional one, it is recommended to perform physical therapy to improve the structures and to prevent future hernias. When the abdominal diastasis is very large, for example more than 4 cm, some individuals may need surgery. In my opinion, aside from the surgical option, planning to carry out a program based on exercise is the best preventive medicine.

Low Pressure Fitness, is an excellent tool for rehabilitate the abdominal structures. The strong myofascial traction that is generated during the exercises, the pelvic decongestion, the increase of abdominal tone and the decrease of intraabdominal pressure are some of the effects it will give to the abdominal wall. There are more and more cases of women in post-natal condition as well as athletic women who have submitted their abdominal girdle to excessive hyperpressive efforts that obtained stunning results with LPF exercises.