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Fibromyalgia, managing the pain

Fibromyalgia International Awareness Day 2020

Chronic pain is more common than most people realise. It affects between 20 – 50% of people in the UK although most are able to carry on with daily activities.

Fibromyalgia is a rheumatic syndrome characterised by chronic widespread pain, often associated with fatigue, unrefreshed sleep and cognitive problems.

fibromyalgia-symptoms

Effective management of fibromyalgia requires a multi factorial and proactive approach to help settle pain down and allow the patient to take responsibility for self-care. There are several physiotherapy modalities which can be utilised to assist this.

Activity and exercise is helpful for chronic pain conditions but the exact type is not so important. What is important is that the exercise you do is something you enjoy, and that you are able to do regularly. If you are not sure where to start, a Physiotherapist can assess you and create an appropriate exercise programme for you to follow. It is important to get the intensity of exercise correct to avoid flaring up pain symptoms.

Flare-ups in pain are normal in conditions like Fibromyalgia. The usual symptoms you experience may change from day to day and there will be times when they increase. It is helpful to plan for these periods of flare-up so that you can manage through them and keep doing the things that are important to you. This maybe where some additional physiotherapy input maybe helpful to reduce pain (soft tissue massage, advice on exercises, acupuncture, floatation therapy) to get you back on track with your regular exercise regimes.

A 57 year old patient with Fibromyalgia says “I would encourage anyone who doesn’t do much activity to choose something they enjoy, to start slow and build up. Sometimes you feel tired and it’s the last thing you want do but the important thing is to stick with it, and you do see the benefits over time.”

At Emma James Physiotherapy we have expert Physiotherapists who are able to assess and treat Fibromyalgia and other chronic pain conditions, and help patients effectively manage their symptoms.

lisa

Lisa
x

Blog post by Lisa
Senior Physiotherapist
MSc MACP MHCPC MCSP 

Emma James Physio

Radio presenter Rachel Horne on her journey to dry running with the help of physio Emma James.

Rachel Horne, newsreader and Chris Evan’s co-presenter on Virgin Radio UK. 

“My friend Jools recommended I visit Emma James Physio, a specialist pelvic floor physiotherapist at her clinic at Champneys, Tring after I announced I was going to do The London Marathon. (Rachel was cajoled live on the Virgin Radio breakfast show by Vassos, Chris and the team back in November 2019!).

I’d never attempted a long run without desperately needing the loo.

“As soon as I’d said yes to the marathon, I panicked that my weak pelvic floor wasn’t up to it and was going to stop me from running the 26 miles. I’d done the odd bit of cross country before at school and outdoor fitness boot camps but never attempted such a distance or gone for a long run without desperately needing the loo!

rachel

“In fact, I used to dread it in summer when I did the Boot Camps and would always wear an incontinence pad, tie my hoodie around my waist and take a towel to sit on in the car on the way home in case the inevitable happened.

“I had three children in just over three years; carrying them put extra pressure on my pelvic floor and then I had complicated births giving me second and third-degree tears which weakened my pelvic floor further and the reason I leak when I run. 

“I hadn’t got round to doing anything about it mainly because as one of many 30 and 40-something women who are always busy looking after other people, fixing ourselves goes right down the list of priorities.

It’s almost a badge of honour for women to say they leak.

“I think I’d also just fallen into the trap of just accepting bladder leakage was normal. It’s almost a badge of honour for women to say they leak whether that’s when they run, get on a trampoline with the kids, or sneeze. Everyone laughs about it. You see it on TV adverts where women laugh about having the condition and it’s so normalised that women think they should say nothing and just use an incontinence pad whenever we leave the house.

Emma is a force for good.

“Emma is a force for good. My first visit to her was almost like a therapy session. She took the time to ask me about myself and encouraged me to tell her my story, giving me a safe space to open up. When she said she could fix my bladder leakage I felt like a weight had been lifted off my shoulders. She was wonderful.

“She helped me to realise it’s NOT OK to leak and made me see that unless I took steps to strengthen my pelvic floor, my leakage would just get worse, particularly as I approached the perimenopause and menopause.

“Because of the challenge I was facing, training for the marathon in a little over five months, Emma suggested a multi-pronged attack although I was relieved to hear I didn’t need to have an internal exam, which I know puts many women off sorting out their bladder problems, as I don’t have a prolapse.

“Through Emma’s clinic, I’ve used a combination of pelvic floor strengthening exercises, tried pelvic floor trainer Pelviva, had sessions on the PelviPower chair, and used Secret Whispers and my bladder leakage has dramatically reduced.

Leaking has definitely improved my general wellbeing.

“After just six weeks of support, I was dry after the first mile which was never the case before as I always leaked just after I started to run. Recently, I managed 5km (3.5 miles) over hilly terrain and was completely dry at the end of the run which felt like such a massive, massive achievement. Leaking less has definitely improved my general wellbeing too as I feel more like myself again. I now no longer need to wear a pad EVERY SINGLE DAY and only keep one on for exercise in the unlikely case I might leak. 

I no longer need to wear a pad every day.

“Now due to the Coronavirus, The London Marathon is rightly postponed but I do hope to run it later in the year. Once I’ve done that, I don’t think I’ll ever do another marathon ever again! However, I’m planning to continue running between 5 and 10km on a regular basis to get that time to think, feel energised, enjoy the fresh air, and release those endorphins and will be able to do so without always leaking which is just amazing!”

rachelhair

 

 

Featured post

Endometriosis

Endometriosis Awareness Month

What is Endometriosis?

Endometriosis is a condition where endometrial tissue (tissue similar to the lining of the womb) starts to grow in other places, such as the ovaries and fallopian tubes. It is one of the most common gynaecological diseases needing treatment (NG73 September 2017). It can affect women at any age however it is mainly a disease of the reproductive years. Whilst the exact cause is not known, it is associated with menstruation and hormonal changes.

What are the symptoms?

enometriosis-diagramThe main symptoms include pelvic pain, painful periods, pain during or after sex, pain with passing urine or bowel movements during your period, feeling sick, constipation, diarrhoea, blood in your urine during your period and infertility.

As a result, endometriosis can have a significant impact on quality of life and in some cases lead to feelings of low mood or depression.

How can it be treated?

Treatments include painkillers, hormone medicines and contraceptives, surgery to cut away patches of endometriosis tissue or in some cases hysterectomy. The current NICE guidelines (NG73 September 2017) note in their recommendations that there should also be access to a multidisciplinary pain management service with expertise in pelvic pain as well as other things.

Physiotherapists can play a role in the management of pelvic pain by helping to strengthen the pelvic floor, which can improve sexual function as well as prevent unwanted leakage or continence issues.

HerPelvipower_magnetic_field_training_EJPhysioe at Emma James Physio we can provide expertise and insight into the management of pelvic pain. Emma herself has a special interest in Women’s Health and has been working hard to develop a service that is accessible for all, in the diagnosis, management and treatment of pelvic pain.

We can provide assessment and treatment using the Pelvipower chair, or perhaps why not try some acupuncture for pain relief. Why not book in for an assessment and find out more about the range of tools we have available to help manage your symptoms?

floatation-therapy-at-ejphysioNot quite ready to tackle it yet?……………..no problem, book in for a session in our floatation tank and take some time out for you. Looking after yourself with some ‘me time’ can do the world of good for your state of mind. Our therapists are ready and waiting to help to when you are.

 

maryMary
🙂
Blog Post by Mary
Senior Physiotherapist MSc, BSc (Hons), MHCPC, MCSP
Emma James Physiotherapy

Why we should Exercise

Adults should do some type of physical activity every day. Any type of activity is good for you. The more you do the better. The following advice is from NHS England.

Adults should:

  • aim to be physically active every day. Any activity is better than none, and more is better still
  • do strengthening activities that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms) on at least 2 days a week
  • do at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity a week
  • reduce time spent sitting or lying down and break up long periods of not moving with some activity

What counts as moderate aerobic activity?

exercisingModerate activity will raise your heart rate, and make you breathe faster and feel warmer. One way to tell if you’re working at a moderate intensity level is if you can still talk, but not sing. Examples of moderate intensity activities include brisk walking, water aerobics, riding a bike, dancing, doubles tennis, pushing a lawn mower, hiking.

What counts as vigorous activity?

Vigorous intensity activity makes you breathe hard and fast. If you’re working at this level, you will not be able to say more than a few words without pausing for breath. In general, 75 minutes of vigorous intensity activity can give similar health benefits to 150 minutes of moderate intensity activity.

riding-a-bikeMost moderate activities can become vigorous if you increase your effort.

Examples of vigorous activities include jogging or running, swimming fast, riding a bike fast or on hills, sports, skipping, aerobics, martial arts.

 

What activities strengthen muscles?

muscle-trainingTo get health benefits from strength exercises, you should do them to the point where you need a short rest before repeating the activity. It is best to get a chartered physiotherapist or qualified personal trainer to advice you on this.

There are many ways you can strengthen your muscles, whether you’re at home or in a gym and this includes lifting weights, using resistance bands and body weight exercises (such as press ups).

Always gain advice from a qualified professional before starting a new exercise programme or if there is a change in your health status.

How we can help

lisa
Stay Healthy
Lisa

Blog post by Lisa
Senior Physiotherapist
MSc MACP MHCPC MCSP 

Emma James Physio

For all new mums that love to run!

In this blog, I am going to talk through a recent publication which is rare its in context; providing guidelines for women wanting to return to or begin running after giving birth. It aims to serve as a guide for all new mums that love exercise or want to start after having a new-born.

Let’s dive in!

There is little guidance provided to healthcare professionals on how to transition runners back to activity postpartum; so, it’s easily understandable why new mums themselves may run into trouble (pun intended; apologies). There are three stages within the postpartum phase; lasting up to 6 months, but there are still intrinsic factors such as hormone level changes that are still adjusting even longer than this – so we need to be considerate for a significant period of time when returning to exercise.

Barriers that may affect women when returning to running postpartum may include;

  • new-muminadequate quality and quantity of sleep
  • fatigue
  • learning to care for a new-born
  • a changing schedule
  • physical changes

During pregnancy and postpartum the pelvic floor muscles (PFM) undergo significant change, including stretch from the increased weight gain and postural changes, increased muscular demand because of these changes, possible tearing during childbirth and then ultimately recovery through the pregnancy and postpartum period.

These changes may lead to decreased core stability, pelvic floor weakness, urinary incontinence, stress urinary incontinence (SUI) while running, lower back and hip pain and other musculoskeletal injuries.

See more info on PFM and the affects of pelvic floor weakness in our previous blog here.

There is an association with the intrinsic changes above and altered running gait post-partum. Therefore, it may be important to modify frequency and intensity of running with the guidance of a healthcare professional.

So, when is it safe to return to running?

new-mum-running

There is currently no guidance available for women who want to return to running or begin to run postpartum.

There are some recommendations for exercise in general. Return to exercise gradually when it is medically safe, when physical stress is tolerable.

The recommendations outlined in the aforementioned study are as follows;

  1. Clearance to exercise by physician
  2. Evaluation by healthcare professional specialising in pelvic health
  3. Comprehensive assessment of physical function and biomechanics
  4. Initiation of running and strength programme

Walking is a great way to begin safely exercising immediately postpartum. It provides many of the psychological benefits of exercise while preparing the body for running. Despite the overwhelming changes that occur postpartum, many women progress or start with running much sooner than their bodies are ready to.

If you do suffer from incontinence, diastasis recti abdominis (DRA) or any other associated post-partum issues; it doesn’t mean you cannot return to running, it may just mean modifying activity and completing specific exercises to address any issues. Many women are under the misconception that leakage while running is normal and it is not.

To summarise

Many women return to running between 6-8 weeks post-partum, without guidelines or instruction from a healthcare professional, with biomechanical and physiological changes that occur during pregnancy and remain postpartum potentially increasing risk of injury.

Currently, there is no gold standard for the management and care of women returning to running postpartum. The reviewed article highlights changes that occur during pregnancy that may alter the way women walk, run, lift and move postpartum.

Following the 4 stages of returning to running above should reduce the risk of complications and increased injury risk, whilst being under the guidance and care of a healthcare professional.

mummy-mot-certified-logoAt Emma James Physio we pride ourselves in offering specialist women’s health, biomechanical and strength and conditioning services. So, come and see us and we will get you back to where you want to be, or for you new mums; help you take those first steps after your new-born!

Adam 😊adam

 

Blog post by Adam
Senior Physiotherapist at Emma James Physio

Reference: Edwards, Kate. (2019). Considerations for the Postpartum Runner. Strength and Conditioning Journal. Publish Ahead of Print. 1. 10.1519/SSC.0000000000000453.

The importance of pelvic floor health in a sporting population

What is your Pelvic Floor?

Your pelvic floor is the group of muscles and ligaments in your pelvic region. The pelvic floor acts like a sling to support the organs in your pelvis – including the bladder, rectum and uterus or prostate.

Contracting and relaxing these muscles allows you to control your bowel movements, urination and for women particularly, sexual intercourse.

The importance of Pelvic floor health

What issues can you face with a dysfunctional pelvic floor?

Pelvic floor dysfunction is the inability to control the muscles of your pelvic floor. This term refers to a range of issues such as:

  • urinary issues, such as the urge to urinate or painful urination
  • constipation or bowel strains
  • lower back pain
  • hip pain
  • pain in the pelvic region, genitals, or rectum
  • discomfort during sexual intercourse for women
  • adductor pain

The importance of pelvic floor health in a sporting population

weight-lifting-womanAthletes are at greater risk of stress urinary incontinence due to their continued exposure to increases in intra-abdominal pressure throughout training.

What does this mean? Well, most sports involve one of two exercise forms; jumping and landing (eg. running, athletics) or the Valsalva maneuver (eg. weight lifting).

These two activities exert different deformations upon the pelvic floor due to their distinct direction and type of pressure loads.

Hip & Adductor injuries in a sporting population

hip-pain
Did you know that your pelvic floor muscles are directly attached you your hip muscles?

That’s right, the hip bone is connected to the pelvic bone and the pelvic floor muscles are connected to the one of your hip muscles: the obturator internus (OI)! It is reported that 64-72% of patients with hip dysfunction also experience pelvic floor dysfunction. This is largely due to weak lateral rotators and tight adductors.

 

How can we help you?

Personal Training
A personal trainer can help you to strengthen your lateral rotator muscles to help prevent hip dysfunction.

Sports Massage
A deep tissue massage of the adductor muscles can help to relieve muscle pain and tension, as well as overloading the pelvic floor.Pelvipower_magnetic_field_training_EJPhysio

The PelviPower Chair
This non-invasive method involves sitting on a chair as the pelvic floor muscles contract up to 25,000 times by the magnetic waves in the seat. One to two training sessions per week are adequate to effectively strengthen the pelvic floor.

Pelvic Floor Trainers & Toners

pelviva-logo-ejphysio
My Pelviva

Pelvic Floor muscle trainer with reactive pulse technology

Pelviva is an award winning, life changing, Pelvic Floor muscle re-trainer that uses a specially developed stimulation programme to treat the symptoms of bladder leakage in women.

Receive 10% off purchase price when you use the code EmmaJames at checkout when you purchase online.

Visit the Pelviva Website for more details and how to buy.

Secret Whispers

secret-whispers-logo-web

Secret Whispers ™ is a pelvic floor toner for women. Its 6 Step Pelvic Floor Exercise Strengthen & Tighten Your Pelvic Floor Fast. It helps with – pregnancy, childbirth, incontinence and bladder control.

Secret Whispers ™ pelvic floor packs are available to purchase from our main Emma James Physio clinic or online:

Click here to Purchase Secret Whispers Products

india-wayland
Bye for now 😉
India
x

Blog Post by India
Sports Therapist at Emma James Physio

Pilates for Men

It is 2020, and we know people now realise that Pilates isn’t just for women. You can almost hear the collective sigh of relief from us physios – partly because we can finally (almost) move on from the long-overplayed “so you think Pilates is a girls’ thing? well then let me tell you about Joseph Pilates…” rhetoric, but mainly because we are finally seeing the benefits of Pilates being recognised by the wider public and how it is becoming increasingly common across different demographics.

While Pilates is hardly a gender-specific/focused exercise routine, it is worthwhile mentioning how its application can benefit men nonetheless. From the amateur weekend warrior to professional athletes, principles of Pilates have been firmly incorporated in their weekly schedules, training, and recovery sessions; here are some of the reasons why.

kelvin-on-reformerFlexibility

Reformer Pilates involves various three dimensional movements, working the length and elasticity of your muscles and encourages your joints to be able to move through the biggest possible range, thus reducing your likeliness of injury.

Improving Posture

The origin of most aches and pains is bad posture. Every Pilates exercise you do will have a postural benefit due to the combination of challenging your strength and flexibility. Pilates will develop muscular balance in your joints which will improve your posture.

Core Strength

Your core is the combination of muscles that support your spine and torso, forming the foundation for all movements. A weak core causes instability and reliance on dominant muscles, which over time inhibits flexibility, reduce range of movement and ultimately cause injury. Pilates promotes core activation and engages all of your postural muscles leading to more stable and powerful movements. Consider a tennis player who has to return a powerful serve while moving and contorting their bodies: for them to be able to generate the adequate force on their return they must have good core strength.

Addressing Muscular Imbalances

Some of your muscles, like those that dominate your daily movements, are stronger than others, and a huge emphasis of Pilates is focusing on those muscles that don’t typically get a lot of attention. Pilates requires you to consciously move in certain ways to challenge muscles that you don’t hit while lifting heavy weights in the gym, running or in your daily life.

Awareness, Concentration and Focus

mens-health-pilatesPilates forces you to pay attention to your body, you’ve got to focus on your breath while working through each movement and concentrating on proper form and activating the correct muscles. This significantly enhances your body control and awareness (Thus improving your balance as well) which are both fundamental skills to maintaining sporting performance.

The reason that Pilates is fundamentally such an all-encompassing, well-rounded approach to exercise and body movement is precisely the reason why it could – and should – be incorporated in most people’s routine. Its minimal requirement of equipment and space makes it a very versatile option for a quick, mobile workout, and the gains from Pilates almost always translate across to other aspects of one’s wellbeing as well. More and more men are slowly realising its benefit and the conversations with their physios are certainly a lot different to what it was a few years ago.

It is 2020. It is no longer a misunderstanding, and it is no longer just a trend.

kelvinKelvin

Blog post by Kelvin
Senior Physiotherapist at Emma James Physio

More Information:

Pelvic Floor and the Menopause

The menopause and perimenopause can bring with it problems associated with pelvic floor dysfunction. The menopausal years can span any time from 45-55 years. The perimenopause can occur for many years before this while women are still having their monthly cycles. Some women who go through an early menopause could experience symptoms at a much younger age.

Reduced levels of oestrogen starting around menopause can cause thinning of the lining of the urethra, the short tube that passes urine from the bladder out of the body. In addition, the surrounding pelvic muscles also may weaken with aging, a process known as “pelvic relaxation.” As a result, women at midlife and beyond are at increased risk, or an exacerbation of pre-existing, stress and urge incontinence.

What is your pelvic floor?

Your pelvic floor muscles are a broad sling of muscles, like a trampoline, stretching from your pubic bone at the front of your pelvis to your coccyx (tail bone) at the back. They form the floor of your pelvis and are responsible for:

  • Supporting your pelvic organs – your bladder, bowel and womb
  • Controlling your bladder, bowel and sexual functions

Experiencing urinary incontinence (leakage) should not be accepted as normal at any point in a woman’s life. Below are the different types of incontinence.

exercise-and-pelvic-floorStress Incontinence

Stress incontinence is the most common type of incontinence and is when urine leaks during activities such as coughing, sneezing, lifting and during exercise. It occurs because the pelvic floor muscles become weak and are unable to cope with the rise in abdominal pressure associated with these activities. Weakness of these muscles can happen because of childbirth, chronic constipation, persistent coughing and around the menopause and perimenopause.

Urgency and Urge Incontinence

Urgency arises when your bladder needs to be emptied in a great hurry. Sometimes the urge to pass water is so strong that leakage happens before you get to the toilet. This is called urge incontinence. This relates to the size of your bladder, how much it holds, and how it is trained to respond. Mixed bladder leaking describes a combination of stress incontinence and urge incontinence.

Heres just a few ways we can help here at Emma James Physio:

Pelvipower_magnetic_field_training_EJPhysio

 


Special offers:

pelviva-logo-ejphysio
My Pelviva

Pelvic Floor muscle trainer with reactive pulse technology

Pelviva is an award winning, life changing, Pelvic Floor muscle re-trainer that uses a specially developed stimulation programme to treat the symptoms of bladder leakage in women.

The Pelviva treatment programme exercises your Pelvic Floor muscles to prevent bladder leaks when you laugh, sneeze, cough or exercise and to help you hold on when you urgently need the toilet.

Receive 10% off purchase price when you use the code EmmaJames at checkout when you purchase online.

Visit the Pelviva Website for more details and how to buy.

Secret Whispers

secret-whispers-logo-webSecret Whispers ™ was born after its founder Julie discovered that there were no adequate products available to help improve her pelvic floor and a lack of information available. The importance of pelvic floor exercises is often not discussed and crucially women are not given enough information about it.

Secret Whispers ™ is a pelvic floor toner for women. Its 6 Step Pelvic Floor Exercise Strengthen & Tighten Your Pelvic Floor Fast. It helps with – pregnancy, childbirth, incontinence and bladder control.

Secret Whispers ™ pelvic floor packs are available to purchase from our main Emma James Physio clinic. Please ask at reception for details. You can also purchase online,

Click here to Purchase Secret Whispers Products


Heres a useful guide to the pelvic floor, supported by wellbeingofwomen.org.uk

lisaAsk our friendly staff for more information and how to book your place.

Lisa

Blog post by Lisa
Senior Physiotherapist
MSc MACP MHCPC MCSP 

Emma James Physio

Benefits of weight bearing exercise

What is Osteoporosis?

Osteoporosis is a health condition that weakens bones, making them fragile and more likely to break. The stage before osteoporosis is called osteopenia.

Oestrogen, a hormone in women that protects bones, decreases sharply when women reach menopause, which can cause bone loss. This is why the chance of developing osteoporosis increases as women reach menopause.

How can weight bearing exercise help?

Weight-bearing exercise, especially resistance exercise, appears to have the greatest effects on bone mineral density.

Numerous longitudinal studies have examined the effects of exercise training on bone health in children, adolescents, and young, middle-aged and older adults. There is compelling evidence that routine physical activity, especially weight-bearing and impact exercise, prevents bone loss associated with aging.

In a meta-analysis of Randomized Controlled Trials (RCT), exercise training programs were found to prevent or reverse almost 1% of bone loss per year in the lumbar spine and femoral neck in both pre- and postmenopausal women (Wolff et al, 1999).

In addition, exercise training appears to significantly reduce the risk and number of falls and the risk and incidence of fractures is also reduced among active people (Carter et al 2001, Gregg et al 2000).

weight-bearing-exercisePreliminary evidence from a high quality trail indicates that exercise training is effective in improving bone density in older women (75–85 years of age) with low bone mineral density (Liu- Ambrose et al, 2004). In this 6 month trail, 98 women were randomly assigned to participate in resistance training ( n = 32), agility training ( n = 34) or stretching (n = 32). The greatest increase in cortical bone density were observed in the resistance training group, followed by the agility training group. The stretching group experienced losses in cortical bone density.

In Summary:

Regular weight bearing physical activity appears to be important in preventing loss of bone mineral density and osteoporosis, particularly in postmenopausal women.

How we can help optimise your bone health:

  1. Physiotherapist lead assessment, treatment and guidance on appropriate weight bearing exercises
  2. Pain relieving modalities (acupuncture, floatation therapy, manual therapy, massage therapy) to reduce pain to allow the individual to participate in regular weight bearing activity
  3. Personal training

More Information:

Please read the full article for more information. Warburton et al, 2006. Health benefits of physical activity. CMAJ.

lisaStay Healthy
Lisa

Blog post by Lisa
Senior Physiotherapist
MSc MACP MHCPC MCSP 

Emma James Physio

 

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