World Continence Week raises awareness for pregnant women world-wide

Urinary incontinence is a loss of bladder control which results in leaks of urine. This can be stress incontinence which is leaking urine with a cough, sneeze, laugh, exercise (including running, jumping, lifting weights), or even during sex. Or it can be urge incontinence which is a strong overwhelming desire to urinate and losing control before reaching the bathroom. Women over the age of 35 and women with a high BMI have a greater risk of both stress and urge incontinence during pregnancy and after birth.

Why can women suffer from incontinence during pregnancy?

It is quite common for women to develop some form of incontinence during pregnancy, and the most common form is stress incontinence. There are many reasons for this but the biggest reason is the extra weight of the unborn baby and the pressure of the uterus on the bladder. This is why pregnant women can often only develop incontinence in their third trimester. Sometimes constipation can also lead to incontinence because of the added pressure of the full bowel on the bladder.

One other major reason is the large hormonal changes in pregnancy, which make the connective tissue including the ligaments very soft and lax. Women need their joints and tissues to be more elastic (particularly around the pelvis) for childbirth, but this also reduces the support of the bladder, hence why some women will leak. This extra weight and pressure combined with the laxity of the joints puts added pressure on the pelvic floor muscles. Pelvic floor muscles will then fatigue quicker, and if the pelvic floor muscles are already weak, it can lead to incontinence.

Why is incontinence prevalent after pregnancy and birth?

Leaking is common in one in three women after childbirth. Sometimes women lose their ‘connection’ (brain message to muscle) to their pelvic floor muscles after childbirth and the muscles weaken. Perhaps it is the pain associated with the birth and its interventions which cause this. This weakness means the muscles can’t tighten around the urethra efficiently and a leak can occur. Sometimes these pelvic floor muscles can become weaker due to prolapse, or sagging, of any of the pelvic organs, which puts extra load and pressure on the pelvic floor muscles.

After childbirth, the biggest risk factor for stress incontinence is having a vaginal delivery, especially if instruments such as forceps or vacuum were used, as these can injure pelvic nerves and muscles. Other risk factors include having your first baby, having a large baby over 4 kilograms, having a long labour, especially the second stage of labour, and having a difficult vaginal delivery, which involve stitches or tears around or outside the vagina. If a woman has tearing of her perineum or prolapse of her bowels, she may also develop faecal incontinence. Women who have had caesarian sections can also develop incontinence especially if their pelvic floor muscles are weakened from the pressure of the uterus.

Is there anything that can be done to prevent pregnancy-related incontinence?

It is important for all women to do their pelvic floor exercises during pregnancy and after childbirth. An excellent way to do these exercises and help to manage or prevent incontinence is to join a Pregnancy Pilates group exercise program, such as those offered at The Fix Program. After you’ve given birth, it is highly advised to see a women’s health physiotherapist if you are experiencing any incontinence to make sure you get the therapy you need. At The Fix Program our women’s health physiotherapists are highly skilled in assessing pelvic floor function and can help you manage any incontinence as well as treat any prolapse or scar tissue you might have post-birth.

Make time and enjoy our 15 minute post natal Pilates workout for you and baby

In the first few weeks after you give birth, it may feel unsafe to exercise – or you might never have enough time away from your bub to focus on your recovery.

This set of stretches and exercises is designed to safely help your body back to full strength after pregnancy and childbirth. We would recommend that you wait 4 weeks after having baby to start on these, but don’t forget to work on your pelvic floor lifts as soon as possible after the birth.

We recommend also our 1 hour post-natal check up would help you to discuss any concerns about your pelvic floor, spinal health and abdominal separation post-baby. We can direct and further target your exercise program for home also at this checkup. Call us for more details

Do you find it nearly impossible to remember to do your pelvic floor exercises?

Try to associate doing them with another activity, such as taking a drink of water, changing nappies or feeding times.

Do you not feel much of a lift or activation down below?

Don’t worry. This is very normal in the early days and weeks after having a baby. Don’t stop ‘doing’ your pelvic floor lifts however. Your brain is still connecting to these muscles every time you send the message, which is all very important. Your pelvic floor is probably take some time off to recooperate after your pregnancy and birth. Perhaps the pain of having stitches (or not) has switched the muscles off for a little while. They will start to get going very soon.

Once you can feel some small ‘closing and lifting’ of the pelvic floor hammock, you can begin to enjoy these exercises. These fifteen minutes each day are also bonding time with your new bundle of joy - your baby forms an integral part of each exercise! All you need is a mat and a pillow or towel.

 Leg rolling and out and in 

Getting ready

• Lie on your back on a mat with your knees bent and your baby lying on your belly or chest

• Have your feet and knees hip width and check that your tail bone rests flat and heavy on the mat (this should give you a gentle arch behind your lower back)

• Rest your hands on your ‘headlights’ (the pointy bones at the front of your pelvis) on each side to check that you are not rocking your pelvis in any direction.

  Exercise

• Breathe in deep and wide as you allow the right knee to roll slowly out to the side

• Breathe out, gently lifting the pelvic floor and drawing the headlights together as you draw the knee back to centre

• Repeat 5 times each leg, alternating legs each time

  Hot tips

• Keep your pelvis still, and don’t let your lower back to arch or flatten

• Keep a heavy feeling in your tailbone, focus on keeping it flat on the mat behind you

• As you draw the headlights together at the front, check that your lower abdomen draws in and does not dome outwards

• The leg that is not moving should stay quite still as you roll the other out and in. Imagine that hip is heavy, weighted in place

• Allow the thigh, calf and butt muscles to feel soft, relaxed and heavy. Imagine your legs are being dragged through thick honey, resisting your movements

Bird Dog 

 

 Getting ready

• Stay on all fours with your baby between your hands looking up at you or having tummy time
• Find your neutral pelvis and small lower back curve
• Keep your lower ribs from sinking down in the middle
• Draw your shoulder blades gently down your back, away from your ears, and grow long up the back of your neck

       Exercise

• Breathe in deep and wide and extend the opposite arm and leg away from centre (in front and behind)
• As you breathe out, gently lift the pelvic floor, draw the headlights together and bring the arm and leg back to the starting position
• Repeat, alternating sides, four times each way for a total of eight

     Hot tips

• Keep your pelvis neutral and your lower back arch from increasing or decreasing
• Keep your shoulder blades drawn gently away from your ears
• Imagine you are gently holding a big mango between chin and chest. Don’t drop it!
• You should feel the pelvic floor, tummy, shoulders, butt and thighs all working gently

The Clam 

 Getting ready

• Lie on your side with your baby in front of you
• Have your knees bent, feet back in line with your bottom, neck supported by a pillow or towel
• Stack your hips one right over the other
• Find your neutral lower back arch, tuck your ribs in at the front, and stack your shoulders one right over the other
• Lift your lower waist a little off the mat to straighten out your spine

Exercise

• On a wide breath in, squeeze your heels together and lift the top knee in line with your body
• As you exhale gently lift the pelvic floor, deepen the naval and smoothly lower the knee
• Repeat eight times on each side

 Hot tips

• You should feel the top buttock working hard
• Keep your top hip still, not allowing it to roll back at you lift the knee
• Try to keep your small lower back arch the same shape, not tucking the bottom in or flattening your back
• Imagine your leg as a floppy, heavy, dead weight dragging through thick honey

Lunges with bub 

    

     Getting ready

• Stand facing a full length mirror with your baby held facing the mirror, low down in front of your hips with your arms relatively straight, hands hooked between their legs for support
• Starting with your feet hip width apart, step your left foot forward then your right foot back
• Keep your pelvis neutral – your right foot should be on tip toes. Check you have not twisted back on the right side, find your neutral zone and grow tall

     Exercise

• Breathe in deep and wide as you bend both knees and lower yourself straight down

• Breathe out, lifting the pelvic floor, gently deepening the naval to the spine and push back up

• Repeat 2 sets of eight on each leg

• Most of your weight should be through your back leg, and the front of that thigh should be working hard

• Keep your pelvis neutral, not tucking your tailbone under or flattening your lower back arch

• Make sure you drop your hip on the front leg side, not keeping it hitched up towards your ribs and shortening your waist – this will help your butt to work on the front leg side

Cat Stretches

      Getting ready

• Kneel on all fours, hands under your shoulders and knees under your hips
• Pop your baby on the floor on their back, looking up at you

      Exercise

• Breathe in and round your back up towards the ceiling like a cat, bringing your chin to your chest and pressing through your arms
• Breathe out and sink down through the middle of your back, drawing your head and tailbone high
• Repeat five times each way

 Hot tips

• Keep your shoulders still, always directly above your wrists, and pivot around them

Thread the Needle

     Getting ready

• Stay on all fours from the previous exercise
• Pop your baby off to your left side next to your hands, about an arm’s reach away
• Find a neutral pelvis by rocking it forward and back and settling where you have just a gentle little lower back arch

     Exercise

• Lift up your right hand and reach it through underneath your left arm, turning from the waist not the hips
• Reach towards your baby and give them a pat, a tickle or a touch on the nose
• Come back to centre, then repeat four more times, and again 5 times to the other side with your baby off to the right

Hot tips

• You should feel the stiff upper back, ribcage and shoulder get a lovely stretch
• Keep that gentle lower back arch the same shape as you turn, not allowing it to get bigger or smaller
• Repeat five times each way

For best results repeat the whole program at least three to five days per week. Try this routine out the next time you are alone with your new baby – it will do you both a lot of good and prepare your body for returning to more intense exercise between six weeks and three months after the birth.

These exercises are safe for a new mum and are starting to return your body’s core or inner strength. Remember this is essential before moving onto your outer strength, or running and other high impact exercises. If you are at worried, please chat with us.

Our 1 hour post-natal check up would help you to discuss any concerns about your pelvic floor, spinal health and abdominal separation post-baby. We can direct and further target your exercise program for home also at this checkup.

Why you don’t need to be a tennis player to suffer from a painful shoulder

With the Wimbledon tennis tournament having started this week, it got me thinking about the incredible amount of training and the slogging of tennis balls that players must endure in preparation and on the court. Hitting a tennis ball with great power as they do puts such an incredible strain on the joints and soft tissues of the arm. This is particularly so at the elbow and the shoulder.

Today I will explore the common injuries at the shoulder joint in tennis players. However, as sport physios we see these injuries very commonly in a large proportion of the population. Let’s take a look at the injuries and how to they are best managed through physiotherapy and exercise.

Why is the shoulder so susceptible?

The shoulder joint has great mobility and inherent instability. It is a shallow ball and socket joint and therefore has a heavy reliance on the soft tissue support, including the ligaments and muscles. Stability of this region also comes from a coordinated control of muscular activations, or good muscular ‘balance’.

Because of this heavy dependence on muscular support for the shoulder, injuries are common in these muscles. Muscles and tendon strains can occur frequently with overstretching or overloading. This is especially so with ballistic or high power arm movement such as with throwing, tennis shots and serves. Improper warm up, poor strength and condition, or fatigue of the muscles can result in strain. Not only do the shoulder muscles need to generate power for the tennis shots, but also decelerate or slow the swinging arm. This is a huge amount of work load on little muscles about the region.

Poor neck and upper back postures in us non- tennis players can cause the same gradual wear and tear of these muscles and soft tissues. The common postures such as the ‘slumped spine’ or ‘poke chinned’ posture can set up a multitude of poor shoulder postures and therefore risk of injury and pain in the arm.

What is the rotator cuff?

You have possibly heard about the rotator cuff through time spent at the gym, or at our Fix classes. But what is it and why is it so important for a healthy and happy shoulder?

The rotator cuff is actually a ‘cuff’ or fan of 4 muscles. These 4 muscles run across the shoulder blade surface and attach to the shoulder joint up near the tip of the shoulder. They are essential for controlling the movement precision required at the shoulder when elevating or reaching upwards with the arm. They are considered the stabilising muscles of the shoulder and also keep the arm bone (or humerus) set into the joint, effectively stopping it from slipping down your arm. The most commonly heard rotator cuff muscle is the supraspinatus.

Pain associated with this cuff is usually felt down the arm a little from the tip of the shoulder. Wear and tear of these tendons, or small tears can occur due to their location in the top of the shoulder, or repetitive overhead motions of the arm such as with tennis serves or with a painter painting your ceilings all day long. It can be thought of as a pinching type erosion of the structures in the top of the arm, or impingement.

What is shoulder joint impingement?

Impingement is a very common injury of the shoulder. It is most frequent in occupations of sports involving over head activity. It can also be caused by old age, shoulder muscle weakness, poor shoulder joint stability or movement, and bony deformities. Many structures at the top of the shoulder can become inflamed, swollen and ‘pinched’, including the rotator cuff tendons, the biceps tendon, the fluid filled cushions, called bursa and ligaments.

Pain is felt on elevation of the arm and can again refer into the upper arm.

What about any other shoulder conditions?

There are a full host of shoulder problems and disorders that have not been mentioned here, from frozen shoulders to dislocations to those shoulder pains that may actually be referred from the close by neck and upper back nerves.

Am I always going to be stuck with a painful shoulder?

The short answer is ‘no’. The shoulder may be a complex joint, but as a result and in most cases, strengthening programs offer the best long term solution. Classes like ours at The Fix Program where there is a strong focus on good spinal, neck and shoulder blade alignment offer a fix to the cause, not just a bandaid for the pain. Sure, massage and physio, ice and taping can help also with the pain initially, but getting to the root cause of the movement problem and muscle weakness will prevent pain, swelling and injury in the future.

Exercises aimed at good shoulder blade posture such as

• the diamond press
• the dart
• the cobra,

and visual and movement cues such as

• slide your blades into their pockets
• melt your shoulders from your ears
• pivot your arm from the shoulder point
• gently lengthen through the base of the skull
• hold your mango under your chin,

will all assist in returning the upper back and shoulder region into a good movement control. Thoracic stretches and chest stretches will also aid good alignment. Even those over the favourite bolsters!

For some, the damage may be too great on the tendons and soft tissue about the shoulder joint. In this instance, surgery may be required (as a last resort- the rehab after shoulder operations is very very intensive), or an injection of cortisone into the injured structure to try to calm inflammation and encourage healing.

Regardless, you will get to know and love your physiotherapist very well, as they take you through a structured and slow course of treatment and exercise therapy to restore the shoulder and upper back to a well-oiled machine!

If you are at all worried about shoulder pain, get onto it early. As with most niggles, early intervention prevents a greater problem. Your physio will assess and work out what structure is involved - whether it be in the shoulder or neck- and start your road to recovery. Be prepared to work hard on it and you will get good long lasting results.

Another fine example of how ‘slow and steady’ will win the race - by Katie

Injury 

I was forced to stop running for nearly two months recently after experiencing hip pain/tightness. My physio did her job releasing tightness and prescribing a program of stretching and strengthening exercises to get my buttocks (gluts) working properly. After testing it out with a few long walks I wanted to start running again and was keen to get back into 10km fun runs as soon as possible. However I was scared about being sidelined with injury again if I went too hard, too fast.

Katrina suggested I try the Couch to 5K program to gradually ease back into it. So I downloaded an iPhone app. The App was labelled as ‘Couch Potato to 5km runner” and is an 8 week long program with 3 workouts a week to gradually get you from alternating walking with short interval runs, to a continuous 30 minute run. I was not exactly a couch potato because I had been keeping up my weekly Fix classes, an outdoor boot camp and weekly swimming squad sessions. So I toyed with the idea of skipping to week 3. Instead, I started at week 1 but moved through the ‘weeks’ a bit faster. 

Frustration

At first it was FRUSTRATING. I really enjoyed the run intervals but at only 1-2mins long I was only just getting into them before the App told me to start walking again. I just wanted to keep running. I had to keep telling myself that the end goal is to run 5K without reinjuring myself and I had to be patient.

Even though I thought I was fairly fit, the run intervals did start to get a bit harder from week 5. I guess my cardio fitness had dropped a bit. (Before injury I was exercising 5 times a week, including 3 runs). So from then on, I stuck to the prescribed 3 runs scheduled for each week.

I had a few weeks towards the end where my hip was sore again. I gave myself a couple of extra rest days but still finished the program in around 8 weeks. 

Success

It felt great to finally do the 30 min, 5km run and be back into running.

In the month since then I’ve been doing 3 runs per week, between 5-6kms. I have had a few niggles of pain & tightness and have had to accept that I will always need to keep up my strengthening exercises & stretches if I want to run regularly. It needs to be a permanent part of my schedule but I think it’s worth it to be able to keep running.

The final word

Now Katie and I are running again! We have our 10k fun runs lined up for the coming months and it is great to have these as our next set of goals. It’s all about finishing each one and with a hopeful PB!

If you are keen on starting your own running program to improve fitness, get ready for the City to Surf, or Blackmore’s Bridge Run in September, now is the time to get started. Here are the Apps we suggest.

Here we are together at a recent fun run in Balmain.

http://c25kfree.com/ (watch the ads popping up regularly)

https://itunes.apple.com/au/app/c25k-5k-trainer-free/id485971733?mt=8

https://itunes.apple.com/au/app/run-10k-interval-training/id350529744?mt=8 

A big thank you to Katie for sharing her pacing experience.

What really goes on with one of the most common causes of persistent pelvic pain

Endometriosis is one of the most common gynaecological causes of chronic pelvic pain. It occurs in a whopping 1 in 10 women and has a ridiculously delayed diagnosis of 7-10 years!

So what is endometriosis? Isn’t it just killer cramps? It will get cured by getting pregnant, right? It means you can’t have babies, right? Wrong. These are just some of the common misconceptions surrounding endometriosis.

Let me break it down for you. You’re never too young to get endometriosis. There is a genetic link to it, which means if your mother, grandmother, sister or aunty has it, chances are you might have it too. This means it’s part of our genetic makeup and as soon as you have that first period, whether you were 16, 13 or even 10, you’ll know it. I should mention though that not everyone with endometriosis gets pelvic pain.

This brings me back to my first question. What exactly is endometriosis? Think of the cells that make up the lining of the uterus – in a normal person these cells exist exclusively in the lining. In a person with endometriosis, cells that are similar to the cells of the lining exist in other places too. This means they can be found on the ovaries, the fallopian tubes, the bladder, the bowels, in the vaginal walls, on the pelvic ligaments inside your pelvis, in the Pouch of Douglas (which is the space between the uterus and the bowels) and funnily enough can even be found in places like your lungs and diaphragm too! These cells all over the place will act like your cells do with your monthly cycles.

If you think about all the places this tissue exists it’s no wonder women with endometriosis present with a myriad of symptoms! Some of the common symptoms include:

• Heavy, prolonged and irregular periods including spotting between periods.
• Painful periods – the “I can’t get out of bed – it feels like I’m being stabbed over and over again – it feels like its shredding” type of pain.
• Painful sex (during and after) – to the point that you just don’t want to have sex anymore.
• Pain with bowel movements (sometimes only during periods) – including intolerances to inflammatory foods e.g. dairy, wheat, soy and sugars - it feels like you have Irritable Bowel Syndrome (IBS) with the chronic bloating and constipation and bouts of diarrhoea.
• Painful urination during periods.
• Pelvic pain – over time the pain can cause the muscles and connective tissue around the pelvis, back, tummy and hips to become sore. You can start to get changes in your muscles too, including pelvic floor spasms and tension.
• Infertility.

Interestingly enough, not all women with endometriosis experience symptoms. And the severity of their symptoms is not related to the severity of the disease. For example, you can have a woman with Stage 4 endometriosis (the worst!) that experiences minimal pain and the only reason she finds out she has endometriosis is trouble falling pregnant; and another woman with Stage 1 endometriosis (the least severe) who experiences incredibly severe amounts of pain. The severity of endometriosis is classified according to the location, extent and depth of endometrial tissue, the presence and severity of scarring called ‘adhesions’, and the presence and size of ovarian endometriomas (“chocolate cysts”) but not the presence of pain.

The management of endometriosis is multi-disciplinary which means many health professionals may need to get involved to help you out. It can involve the GP, gynaecologist, physiotherapist, dietician, and pain specialist.

Women’s health physiotherapists play a large role in pain management. If the woman with endometriosis experiences painful sex or chronic pelvic pain, a women’s health physiotherapist with a specialty in pelvic pain can help to treat the musculoskeletal concerns externally and internally.

If you are experiencing pain within your pelvis, buttocks and hips and you are concerned about it, speak with Heba at The Fix Program for women’s health.

International guidelines on diabetes recommend aerobic and resistance exercise like Pilates

We all should know now the benefits of exercise in preventing and controlling diabetes, heart disease, vascular disease and even early onset dementia. Guidelines for exercise have always suggested medium to high intensity workouts 3 times per week to benefit from these exercise effects. There is now a mounting stack of evidence concluding that strength or resistance training has an equally positive effect on us. This is particularly so with respect to type 2 or non-insulin dependent diabetes.

I recently read a short grab in a health magazine. It read like this:

150 minutes per week of aerobic exercise + 60 minutes of resistance work per week = 40% drop in diabetes risk!

I was intrigued and so read further on this topic myself.

The website for the Joslin Centre for Diabetes research at the Harvard Medical School was a fantastic source of medical facts, recent research findings and practical tips for preventing and managing the disease. Here I have extracted some of the most interesting of facts and tips from my reading.

• High-quality studies establishing the importance of exercise and fitness in diabetes were lacking until recently (the past 10 years), but it is now well established that participation in regular physical activity at a moderate to high intensity improves blood glucose control and can prevent, delay and manage type 2 diabetes.
• The international guideline specifically recommends that such moderate exercise correspond to approximately 40% to 60% of maximal aerobic capacity and states that for most people, brisk walking is a moderate to high-intensity exercise.
• To measure 40-60% maximal aerobic capacity, the ‘talk test’ can be used as an additional suggested guideline. This ‘talk test’ recommends that you are able to maintain (just), a ‘breathy’ conversation with your exercise partner to estimate this level of effort.
• For people who already have type 2 diabetes, the new guidelines recommend at least 150 minutes per week of moderate to vigorous aerobic exercise spread out at least 3 days during the week.
• The international guideline also recommends that resistance training be part of the exercise regimen. This should be done at least twice a week — ideally 3 times a week — on non-consecutive days.
• Resistance training is defined as any exercise incorporating weight, whether that be through weights at the gym or home, body weight, resistance bands and the like.
• People with or without type 2 diabetes who perform resistance training strengthen their muscles.  This results in a higher metabolism and more calories burnt, improving insulin sensitivity (glycaemic control, or ability and effectiveness for insulin to convert your sugars to energy). This also helps with weight loss, and may reduce the amount of diabetes medications required if already diagnosed as a diabetes sufferer.

Offering practical exercise sessions and advice about exercise, the Joslin Centre website had me thinking that many of our exercises at The Fix Program were very much similar to their programs. They suggested exercises such as weighted biceps curls, chest presses, tricep dips, squat, lunges and planks. Sound familiar?

Think of all those Pilates classes you have done at The Fix Program, with squats and lunges with weights from our beginners Pilates, wallplanks, ‘mad minutes’, ‘skull crushers’,’ tree huggers’ and ‘scissor arms’ from the advanced Pilates classes.

So, for all of you continuing with your classes with us currently, now all you need to do is add your 150 minutes of moderate to high intensity aerobic exercise, and you are well on your way to reducing not only your type 2 diabetes risk, but other health risks also. For those of you not continuing currently with weighted exercise, try these suggested exercises from our Pilates classes for an hour in total over your week.

• Squats and/or lunges with weighted biceps curls.

  Try 3 sets of 10 squats/lunges with your arms curling. Don’t forget your deep and wide breath, pelvis neutral awareness and activation of your pelvic floor and deep abdominal muscles throughout. Remember that a slow movement in each direction (in time with your deep breaths to really slow you down) will increase the demand on your muscles and therefore the beneficial effects at the cellular level as outlined above.

• Scissor arms in sustained double float.

  Try 2 sets of 10 scissor arms. Again, keep in time with your deep and wide breath and become aware of your trunk and pelvis postures. Remember the low but constant activation of your pelvic floor and deep abdominal muscles throughout.

• Tree hugger in sustained pelvic bridge.

  Try 2 sets of 10 tree huggers. Remember all of the above for a controlled and slow loaded exercise for maximum benefit.

• Mad minute

  On your elbows and toes/knees, hold your plank for 60 seconds. Remember your low and constant pelvic floor and deep abdominal contractions, soft neck, shoulder blades in your ‘pockets’ and a good neutral spine and pelvis.

I’ve chosen these 4 Pilates exercises as they maximise the resisted or weighted demand on the body. Target large and multiple muscle groups to maximise the benefits of muscle strengthening and the effectiveness of insulin.

Where have our buttock muscles gone?

I know we have discussed the butt muscles or ‘glutes’ before, but it never ceases to amaze me how lazy our buttocks can be. I see many injuries day to day and nearly all of those of the leg can be traced back to weakness of the derriere.

I often ponder, what makes our buttocks just switch off? Can we blame our sedentary lifestyle? Can all those years at school, university or behind the desk at work be the cause? Surely our young children are born with and have a lovely active buttock, so what happens? I even think about whether our more active forefathers had lazy rear ends? Note the image below. Notice the perky and full buttocks before our time on Earth and the not so shapely rear of our fellow on the end. My goodness, that posture generally! I can barely look.

So, what is it that makes the buttocks muscles so critical for good performance of our back, hip and leg? And what happens when we have a comatose rear?

What is the importance of the buttock muscles?

The buttocks or gluteals have several important roles.

Firstly, they are the power house muscle of the legs (along with quads/thighs). You need these to get your power on push off on every step. This includes as you walk, run, take the stairs and get up out of your chair. They are also massive shock absorbers of your body’s impact every time your foot hits the ground (in other words known as eccentric or deceleration loading).

Secondly, theyare important stabilisers of the leg bone (femur) in the pelvis, stopping the sideways shift and drop of the pelvis every time you hit the ground. This is critical for good stability and safety of the region, including about the back.

This in all creates and ensures a great balance and efficiency of the work of all muscles about the area. Greater efficiency of your movement means more strength and endurance. This in turn equates to less injury risk of the back, hip and leg. And we all would like that.

What is the importance of the buttock for the hip region?

We need a good balance of muscles in any region of the body. This is the way in which muscles work together for good coordination of movement, control and stability. If there is not this balance or control, then there will be compensations or changes present. Some muscles will not work hard enough (the ‘under-actives’) and others will step up to work harder (the ‘over-actives’).

‘Under-activity’ or laziness of any muscle is important as this will result in your clever brain making allowances and it will do all in its power to adapt and have you still able to move. What could these adaptations be for a weak butt?

The brain can ‘rewire’ itself to activate any muscle about the joint that can chip in and do the work of the lazy butt – this can include any or all of the following muscles:

• Deep hip rotators ( ‘butt clenching’ tendencies)
• Hip flexors at the front of your hip
• Hamstrings (the long and big muscles that run from your buttock to behind the knee. Ever wondered why one is always tighter than the other, or why you find it increasingly hard to sit with your legs out in front of you on the floor or bed?
• ITB – the big muscle and its band that cross form your hip to the outer knee
• Large back muscles (‘back clenching’ tendencies)­­

‘Over-activity’ of these muscles will cause changes in the physics of the region, from altered movement to muscle engagement and joint alignment. This can include:

• Irritation and spasm of the lower back and pelvic joints
• Hamstring niggles and tears
• ITB syndrome
• Knee pain due to patella tracking problems
• Achilles tendon aches and tendonitis – recent research links weak gluts to Achilles tendon over-loading problems (Medicine and Science in Sports and Exercise).

Does any of this sound familiar?

The self test of weak buttocks. The step down test.

It’s really easy to see if you have weak or lazy buttocks. Perhaps you already have a hunch as you have back and hip pain, or really tight hamstrings running down the back of your leg.

Simply stand on a step and slowly step down to tap your heel to the ground. Come back up. Repeat 10 times slowly in front of a full mirror.

1. Does your pelvis drop down on one side instead of staying level?
2. Does your pelvis shift out a lot further laterally on one side?
3. Does your trunk shift and twist with the effort or can it stay tall and upright?
4. How does the control about your knee look? Does it wobble side to side or roll inwards excessively?
5. Is there an obvious difference left to right?

Answering yes to any of these shows a laziness or weakness in the glut. Perhaps it is there but not activating as your brain is choosing to ignore it over use of other muscles such as hamstrings.

OK, I’m weak, but how do I fix this now?

Why not make these a part of your warm up at the gym or spend 5 minutes in front of the telly at night? Just aim for 2 or 3 times a week, and be aware of good form. Slow down – slow controlled movements will really make all the difference.

Theraband squatting and side stepping

What for?

Gluteus maximus and medius strengthening – an all over buttock challenge

How?

Standing with your feet hip width apart and theraband looped around your knees, find your ‘neutral pelvis’ posture. Fold your trunk over your hips as if you were aiming to sit onto a chair, your knees bending and your weight shifting into your heels. Remember your tall waist posture and unchanging spinal curves. As you push up to a standing posture, push through your heels and be aware of your buttock muscles activating.

You can make this more challenging with sidestepping squats across the room. Remember your sinking hips, folding trunk, tall waists and pushing up through your heels. When sidestepping, feel your leading leg doing most of the work.

How many?

Squat or side step continuously for 60 seconds. Do this 3 times with 60 seconds recovery between sets.

Clam with theraband

What for?

Pelvic control and gluteus medius endurance

How?

Lie on your side with the theraband looped about the knees. Become aware of your pelvis position with ‘neutral pelvis’ zone and hips stacked on top of each other. Have your knees bent comfortably in front of you. Keeping your feet together, slowly raise your knee over a count of 3 and lower again over a count of 3. This is one rep.

How many?

Continue continuously for 60 seconds, 3 times with a 60 second recovery between sets.

Try to keep the pelvis controlled and hips always stacked. Make the leg heavy as if you were imagining dragging it through honey.

Step downs

What for?

Gluteus maximus and medius control and absorbing load or impact, such as is needed for walking and running

How?

Stand ona step with your left foot near the edge and right foot off the step. Become aware of your ‘pelvis neutral’ position and level hips. Lower your right leg to tap your heel to the ground. Return to the starting position for the first rep. Ensure that your knee does not pass the line of your toes on the left foot and keep your knee centred over the midline of your foot. Keep a close eye on your hip level, not allowing any drop side to side.

How many?

Continue slow and steady for 60 seconds, alternating 2 times on each leg.

Enjoyed this post? Here’s another from 2013 where I demonstrate my top 3 exercises for gluteal amnesia

So go forth, find your buttocks and your inner cave man with The Fix Program Online! 

Join an online class  from the comfort of your home - Katrina the principle physio at The Fix Program has designed a series of Pilates exercise programs that will help you immensely.

Your body as a very new Mummy

You have been attending The Fix Program for Pregnancy and together we have shared some wonderful experiences preparing you and your body for the joys of motherhood.

But what happens after you give birth?

Have there been any changes to your pelvic floor or tummy muscles?

How soon can you return to exercise?

What kinds of exercises are safe for you and your body post-natally?

Can you still exercise the way you did before and during your pregnancy?

Can I have sex?

What is ‘normal’?

The Fix Program for Women’s Health now offers a comprehensive 1 hour post-natal physiotherapy assessment with a women’s health physiotherapist which involves:

• Pelvic floor muscle assessment
• Prolapse and incontinence assessment
• Tummy muscle separation (DRAM) assessment
• Fitting abdominal binder or SRC Recovery Shorts
• Musculoskeletal assessment of the pelvis including sacroiliac and pubic symphysis dysfunctions
• Breastfeeding/bottle feeding posture check
• Individualised exercises and advice

Your post-natal check should be booked at 4-6 weeks post-birth but can still be valid up to one year.

Call us to book yours on 02 9264 0077