Finding Fitness - Episode Transcript

Helen

Hi, I'm Helen, and this is Why Mums Don't Jump: busting taboos about leaks and lumps after childbirth. All the stuff that happens to your pelvic floor that no one ever talks about - incontinence prolapse, pelvic pain. Problems that affect millions of women, one-in-three! I'm one of them. I have a prolapse. My pelvic organs fell out of place after the birth of my second child five years ago. And if you had told me back then that I would be speaking about this stuff out loud, I would have told you to give your head a wobble.

Welcome to episode six! I'm recording this in the park after a run on a beautiful Sunday morning. It's like 08:00. There's hardly anyone here, the sun's shining through the trees. It couldn't be nicer. Don't roll your eyes. I'm not always up at this time on a Sunday, but, yeah, I'm here because it just felt right for this episode.

I know that getting back to fitness, when your bits are in bits - this is a scary thing to navigate. I've had my prolapse for about five years and for most of that time I avoided all the things I thought I was supposed to avoid. Lifting anything too heavy, squats, sit ups, jumping, dancing and, of course, running. But I missed moving so much. Before kids, I used to love playing netball. I would run, I would go to the gym, I would enjoy yoga. But now I was terrified of all those things.

And then when I started my Instagram account and started speaking to other women with pelvic floor dysfunction, I realised that maybe I could do more. So I started slowly following a postnatal recovery fitness programme, the one I did with Holistic Core Restore. There are others. I used the Squeezy App to remind me how to do pelvic floor exercises. Don't worry, I'm going to put all this in the show notes. And then I built up to pilates. I saw Katie, my physio, and eventually I put my running shoes on and I did couch to 5k. Fast forward six months and I am running five k two times a week. And I love it.

And I'm not saying it's a good idea for everyone. I'm not always certain it's the best idea for me. There's definitely an element of risk, but it makes such a difference to how I feel. And I am sure that pelvic floor dysfunction should not mean that fitness in one form or another is finished. Which is why I really wanted to make this episode and to speak to Emma Brockwell, a specialist women's health physio who has recently cowritten the first set of guidelines on returning to running after childbirth. She's also co founder of the pelvic health campaign, pelvic roar and I went to visit her in Surrey a few months ago when it was cold and rainy, and she was lovely and she even picked me up from the train station!

Helen

So I've followed you on Instagram for quite a while and to be honest -I'm going to go a bit fangirl - but for me...it's just because when I found out that I had a prolapse I just read all the 'don't run, don't jump, don't lift', kind of stuff and I felt like I would never move again. And that was really crushing, actually. And then I came across accounts like yours and I was like, oh, she's a proper physio, and a runner, and she has a prolapse, and all those things exist together, so that gives me hope. Maybe I can do something like that.

So let's start with...as a physio and a runner, you had your children and then you had a prolapse. Like, what was that experience like for you? How was that?

Emma

There's two sides to it. There's a side where I have a better understanding of what was before me - and my prolapse is really small, so I had a good understanding of how it could be managed and rehabilitated - but there's the flip side of thinking that I'm a women's health physiotherapist, I shouldn't be getting prolapses or incontinence or diastasis, which I also have. So there's a side where you feel you've let yourself down and then there's the professional voice saying, but these things just happen. You know, it's a lottery to a point, and there's certainly some genetics involved in that. And I'm lucky in that I know how to manage and to be able to do the sport and exercise that I still love. But at the time, certainly when I found out, there was what appeared to be a real lack of information out there, even even as a clinician. And there was no real guidance. It's about seven, seven and a half years ago now. We have a lot more information now or we've become more open about the information. So a contrast of feelings, really. I would rather not have a small prolapse, to be honest. But it but it is what it is. It doesn't stop me doing anything. So it means I can empower others.

Helen

Exactly. And so immediately you were just kind of like, right, I'm going to find my own way through this. This is not game over, this is just...

Emma

No

Helen

Ooh no, she says, ooh no!

Emma

I love running so much that I figured there has to probably be a way of getting back to it in a safe and preventative way. We've had a very conservative approach to how we manage prolapse because the research isn't there. And that's the big thing with pelvic health, there just isn't enough research. And we've found that by holding women back, it's not changing their symptoms. It's not necessarily making them any worse either. It's definitely not making them any better. So we've got to a point now where we feel we can challenge tissue in the sense of pelvic organ, in the sense of abdominal tissue, and we're learning and finding that actually women are reporting improved -certainly from a symptomatic point of view - improvement, which is amazing.

Helen

I love this. This is the positive attitude, that...this is what kind of brought me to you, really. Because it is that thing of when you first find out, a lot of people will Google, and a lot of people will be told by health professionals, okay, so no running, no jumping, no lifting. And you're just left with this 'well, I'm feeling really unfit. I've just had a baby. I'd love to get back into shape. How do I break a sweat without losing my insides?' How do we get people running again? You have a running group, don't you? How do we get these women back to moving?

Emma

I think the most important thing is...in my ideal world, every woman who's had a baby would have a women's health postnatal check, because then we can really establish where the tissue, or what level of tissue damage there is, and guide you independently and specifically as to how to rehabilitate. And that's the big thing. There is no one-size-fits-all for this approach. It's better to see a women's health physio who can give you some stronger, better guidance. And then we work out how we grade you back according to your symptoms and how your tissues respond, so that it's a recipe for you. Ultimately, there is generally a recipe, I think, for most women. Not for every woman. I don't necessarily think high impact is for everyone, I need to be clear with that. But for most women, so long as we're being specific and retesting and reevaluating, we can formulate a programme that helps get you back to the exercise that suits you and that you like.

Helen

And is that something you've seen in the running group? The people that come, are there...do some of them have pelvic floor dysfunction?

Emma

Yeah, the running group is interesting. So I set it up because I was finding that I was tending to refer or signpost girls back to running, but almost losing them again and not knowing how they were getting on. So...it sounds like I was trying to control my patients, but it was really to say to them, Look, I'm still here. I can still give advice, not necessarily in clinic, but we can see how you're getting on. And I could also try and encourage them to do a graded response. So the way that my running club works is that I have a walking group, which is for women who just don't want to run but want to get sociable and exercise with others. It's for...also women who are injured, if you like, and not ready to run. Then we have a return to run group. So, again, you're in a group, you're doing it together. And I would refer those girls in, once I felt they were ready to start a walk to run programme. And then we have a group of runners, some who are slower and do shorter distances, some who are faster and asymptomatic and often who don't have symptoms at all. So it allows me to try and grade them back in the way I consider sensible. But it also allows me to pick up women who haven't perhaps heard of women's health physiotherapy and say to them, look, I can't stop you running. I can't stop you doing the sport you want to do, but you should know that if you're feeling heaviness or dragging in your vagina or you're leaking urine, or you have a really obvious doming tummy, then actually, there's someone like me that can help grade you back to running in a way that hopefully will prevent further issues later on as well. I haven't seen all the girls in my running club for treatment. It's just a way of exposing them to women's health in a slightly different way.

Helen

And I'm interested in what the feedback has been like. So I'm thinking about, from my experience, I've never been a massive runner, but before kids I did the odd 10k and I just used to like the fact that you could just go and you could just do it. And after my prolapse, I'll be honest, I kind of really resented seeing other women running because I was so sad that I felt like I would never do that again. And that if I ever did, it would be really irresponsible of me because everything would get so much worse and it would be all my fault because I would have run when I wasn't supposed to.

And then the past six months or so, I've been on a bit of a bit of a kind of journey, if you like, with a physio who I really rate and a pilates instructor who has really pushed me to do more than I was - I was really scared to do stuff. And I have almost completed a couch to 5k training programme. Amazing. So that first run, I was really nervous to even step out of the door, but I can't remember what it was now - 1 minute of walking, 1 minute of running, or whatever it was. But it was so exhilarating!

So I'm imagining that some of the women that come to your group as well, it's just the feeling that you can do that again. I don't need to run a marathon, but just to know that that is not a clause option anymore has mentally made all the difference.

Emma

It does, doesn't it? I think for some of the girls, they will talk about their pelvic health issues. As I say, some of them haven't got any. But for those girls who are comfortable in talking about it, they've found it really empowering speaking to some of the girls who have got prolapse and seeing how well they're doing. And we've got some amazing runners who have got prolapse, and they're some of the best runners we have there. And seeing how well they've done and how well they've managed -and it's not been a simple journey, it hasn't all been a linear progression for them - but they're inspiring and they give you the confidence or give them the confidence. But they also show that it can be done if you take it sensibly.

And I think for me, a lot of women that I see when I say to them, right, we need to, first of all, help you find your core, then we need to help you synchronise it, then we need to rehabilitate it, and then we need to build our strength and then we need to talk about running. And for a lot of women, that is a long, lengthy process and that's quite overwhelming. But if in the group they can see that others have done that and see that they're finally running, then that's a powerful message. I think that's why the group works so well.

But on the flip side, I have got girls who are adamant about running and they just are too symptomatic and possibly their connective tissue is just too lax, if you like, to cope with the impact. And I have suggested, well, come to the walking group, try it. We have got some walkers in that group who are probably faster than some of our slower runners. And my goodness, I think the feedback I get from the walkers is possibly the most interesting because they're a really strong group and they love walking, and I could easily be a walking convert because of how they talk about it and feel about it. So some girls haven't gone back to running and are delighted just to be walking with their friends.

Helen

It is just a thing of anything you can do to feel like, yeah, you're breaking a sweat and getting your body moving and feeling like you're not just confined to a dark corner of the room. Never to move again.

Emma

And that's the big thing with prolapse, because women are fearful of movement, because the medical model and certain messages on social media are still saying, well, if you have a prolapse, never jump again, never do a sit up again. It's the wrong information. And that's where you perhaps need the guidance to find out if you can do that. But also, we have a really bad habit of saying that low impact is a bad thing. Low impact exercise, you can still break a sweat, you can still get an endorphin rush from it, you just have to find that low impact exercise that floats your boat. And I'm really keen on promoting more and more low impact exercise simply because it can be just as effective, if not more so, than running for lots of women.

Helen

I sort of wonder if there's a bit of a disconnect that could be improved between the physio world of people who understand the full anatomy and what's going on, and then the fitness world of people who are delivering gym classes or whatever. I had an experience where I was like, I really want to do something. I feel like I can't do this, that and the other. But I think I'm allowed to do spinning. So I went to a spin class, and they ask you to let know if you've got any problems, which I did. And she'd never heard of a prolapse, which is understandable on one level, because before it happened to me, I had never heard of it either. But as a fitness professional, then...it makes me feel like I'm not in safe hands, actually. I'm really, really nervous about making this thing worse and okay, fair enough, you've not heard of it, but I don't now feel safe doing this.

Emma

Yeah, we need to hugely bridge the gap. There is a disconnect. There are some fitness professionals who are certainly pre and postnatally trained, and within that training, they'll learn about pelvic floor dysfunction. And they're incredible, those trainers, because they get it. But I really feel that that needs to be every fitness professional that has that level of knowledge, and if not knowledge, at least the awareness to then signpost to the right fitness professional. Because every woman should be encouraged to exercise. It's essential for our health. And if these things are becoming a barrier and stopping women exercise, then we need to do something about it.

Helen

Let's talk about the running guidelines. So this is quite a recent thing, isn't it? Return to running after babies - running instructions, and mostly aimed at professionals. Is it? Or for women as well?

Emma

Yeah. So it's aimed at medical professionals and fitness professionals.

Helen

Okay, so what drove you to get involved with that? Where does that come from?

Emma

Because there weren't any, and it's just ridiculous that we aren't singing from the same song sheet, basically. And that was really an attempt to bridge that gap between medical professionals - there's a massive lorry just gone past my house - um medical professionals, healthcare professionals and fitness professionals, and ensure that we're saying really the same things to women with an evidence based approach as well.

Helen

Because it is that thing...so I guess we're talking slightly, maybe not necessarily about women who have pelvic for dysfunction...but it's that idea that a six week check. You're ticked off. Off you go back to the thing you were doing before.

Emma

How ridiculous.

Helen

Yeah.

Emma

How can we have been through nine months of really rapid change? Lots of weakness, lots of lengthening of muscle, lots of hormonal changes. Go through what is probably, for most women, the most traumatic time of their life at that point, childbirth. And that can even be someone that's had a beautiful, serene waterbirth. And then we're expecting women to recover within six weeks, having had no sleep, not really eaten that well and lifting a load that's possibly a little bit too much for what our system is ready for anyway. And then we tick a box to say your six weeks check is done and you can get back to absolutely anything you want. I mean, you just wouldn't do it in any other situation.

Helen

Thinking about women who might be listening to this podcast, who've only just entered the world of pelvic floor dysfunction. Maybe they've gone through the menopause, maybe they've recently had a baby, incontinence, prolapse, whatever it is, and possibly in that dark kind of place where you have been advised to basically never move again. What would you say to those women who really do want to get back to moving and find fitness again?

Emma

Yeah, I would strongly encourage them to go to their GP and ask to see a women's health physiotherapist. That should be available for them on the NHS, but not always - it does slightly depend on your location, your geography. There is something called the Squeezy Directory, where you can type in where you live and you'll find the local NHS and private physios that are around. And try and tap into them if you can. If you can't, there are online programmes, I guess, that are helpful or positive. I think the most positive one that I'm aware of is the Pop UpLift. I don't know if you've heard that one. And that's an online programme designed by Hayley Shevner, who is a fitpro in America, who has a prolapse, and she's very much of that thinking of challenge the prolapse and build your tolerance to what you can cope with in exercise. Her messages are really positive, but she does encourage that you see a pelvic health physio at the same time, so as to ensure that what you're doing is safe and correct.

But I would say anyone with a prolapse who is fearful of movement, you need to move. You can move. You possibly just need a little bit of guidance as to how to start it and how to make it work for you.

Helen

And for women who have incontinence...sometimes I have women who say to me, I have incontinence, it's not going to stop my life, I'm just going to carry on hill running and doing whatever. And if I leak, I leak and...to hell with it. Is that a good idea? Possibly not?

Emma

It's a difficult one, isn't it? Because we've got on the one hand where we should be encouraging women to exercise. It's so vital for us nowadays to exercise. It might just not be the right sport for you at that time.

If you're leaking urine, if you're having any issues with faecal incontinence, you can't control your bowel movements. You have heaviness in your vagina, you have that doming of your tummy, you have pelvic or low back pain. Really, you shouldn't be running until you've seen someone that can help you manage those symptoms. It's a sign your body is not coping with the exercise you're putting it through. So you just need to strip it back. And you need to find someone like myself, who can say, right, okay, you can't run at the moment, however, that doesn't mean you can't do something. And that might be that. Rather than go out for your run, you go for a really powerful, fast walk up the hill, which is wonderful for your system and will help in adaptation as well. You might find that spinning, you don't leak, so therefore you spin. You can use the cross trainer. There's so much you can do. It's just finding someone that can help you find your intermediate type of exercise until perhaps you retrain back to running. But I would encourage the, 'oh, well, I'll just whack a pad in my leggings and doesn't matter, or I'll wear black leggings and no one will see that I wet myself.' I wouldn't encourage you to maintain that approach. I would stop the running and seek some help.

Helen

I guess, for some people. Well, for all of it, really, there's not always a full cure. But I suppose if you go through the process with the right advice, I don't know, maybe a little bit of leaking is just what it needs to be for you to get that balance in life maybe?

Emma

Yeah, I think you're right. There isn't always a cure for pelvic floor dysfunction, but you tend to find the women that haven't found a cure just haven't had any rehab, and you can certainly make things a lot better. And maybe it's a case of mixing a walk with a run.

The reality is some people just probably shouldn't run. But I firmly believe you can find a new form of exercise that you can learn to love. But it's not often that you're saying to someone that you can't run or weight train. There's often a solution. You just have to work with someone to find them.

Helen

What do we do about the messaging around this? About the fact that when you do find out that you've got some sort of pelvic floor dysfunction, the official medical advice is don't run, don't jump, don't do high impact, don't lift. It just makes me really cross. It just seems like completely the wrong idea. Why is it like that? What do we do about it?

Emma

It's like that, I think, because we don't have the answers, because we don't have the research. I mentioned it earlier that we really are lacking in research in pelvic health. And anything like the NICE guidelines, which is how the NHS runs. It always bases their services around the NICE guidelines. And to make it into the NICE guidelines, it's got to be really strong, amazing evidence, but we haven't got that. So therefore a lot of what we know can't get into the NICE guidelines.

So what we really need to do is say at the moment, if you are symptomatic with pelvic floor issues, don't do high impact, probably don't do really heavy weight lifting or not yet. It doesn't mean rule it out forever. And that's the message that needs to change. There is a chance that you will get back to those things, but you have to rehabilitate first. And perhaps we need to find a way of slotting in that word rehabilitation. So we say, until we have resolved your symptoms or helped you resolve your symptoms, or manage your symptoms better, we rehabilitate you and then help you return to the sport that you love. But the 'never again' should go.

Helen

Like you would with any other injury, right? I don't know why this should be any different.

Emma

Yeah. I know it shouldn't be. And if you had just had your ACL in your knee, your ligament done in your knee, the first thing it would say is, don't run until you've seen a physiotherapist and until you've rehabilitated. But we have so much evidence and research around how to manage an ACL that the NHS is comfortable in putting that in the NICE guidelines and then the clinicians are comfortable in letting that message come across. But with postnatal issues and pelvic floor issues, we don't have that, so we just say, don't. But it's completely and utterly unrealistic and unhelpful.

Helen

Well, luckily, we have people like you trying to get out a good, strong, positive message.

Emma

And there is - there's loads of us getting that message out there.

Helen

And Pelvic Roar, right? So you are part of - amazing name, by the way. Love it...

Emma

I can't take that. Elaine Miller came up with that.

Helen

So I guess this is another place where people could maybe look for inspiration.

Emma

Absolutely. So if you're a man or woman with any form of pelvic health issues, we do lots of campaigns. We try and signpost you to the safe and helpful experts - be it patient expert or health care professional. And we try and normalise pelvic floor dysfunction and encourage other people to talk about it and also educate you, because there's a lot of scare mongering out there. When you Google prolapse, you'll see a massive grade 4 prolapse. It's quite frightening what you can see on Google and the stories you can read as well. So we're trying to use it as a way of reassuring, signposting and educating men and women that there are there is hope, because there is hope and that's the most important message to come across.

Helen

There is hope. I know we're dealing with different issues, every one of us, and there's no one size fits all solution. But let's push for more help and push for more research and start talking about this more. Because pelvic floor dysfunction shouldn't mean the end of movement.

I'll put links to Emma Brockwell's website and all the things we talked about in the show notes. If you want to follow her on Instagram - and I really recommend you do, because she's got some really helpful content on there - she is @physiomumuk. You might also be interested to know that she's currently working on a book which will bust some myths around pregnancy and the postnatal journey, so watch out for that.

This podcast is not intended as medical advice, so please do look for your own professional help. Seek some support, but get involved. Subscribe. Tell me what you think and spread the word. Tell a friend spam a WhatsApp group? Share it on Instagram. Let's end the stigma. You've been listening to Why Mums Don't Jump, with me, Helen Ledwick. You can find me on Instagram @whymumsdontjump or online at whymumsdontjump.com. Bye for now.