Family Physiotherapist Albert Park | She Physio & Pilates
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Physiotherapists who work in continence and women’s health are special.

Annette offers expert physiotherapy for women with conditions effecting pelvic organs: bladder, bowel, prolapse, and issues with sexual intimacy, women with problems related to pregnancy and post-natally.

Your experience at She Physio Pilates is based on a detailed assessment of your condition. Treatment includes physical techniques, education, and advice that will help you in your daily life and exercise. Your program includes review as necessary.

Physiotherapy connects research, evidence, skill and practice.

Annette is confident that her background will help you. She was a registered nurse for 10 years before studying physiotherapy. She chose the field of continence and women’s health for post-graduate study and work.  A comprehensive graduate university education, skills training and experience are essential to thorough assessment and treatment of your problem.

‘I love helping women achieve their best.’ says Annette.

PREGNANCY

PELVIC GIRDLE PAIN

(also called PGP Sacro-iliac joint pain, Pubic joint pain, Coccyx Pain / coccydyhia (coccyx = tail bone))

What is it?
The pelvis is 3 bones with dense joints and minimal movement.
The 2 sacro-iliac joints are at the back -between the sacrum and the ilium/pelvic bones. The pubic joint is joined with a dense fibrous disc.
The coccyx is made of 5 bones which may or may not be fused to one another. The joint between the sacrum and the coccyx has a disc.
All these joints are supported with thick ligaments.
Pregnancy hormones increase laxity (looseness) of all pelvic joints. Most women, experience a mild discomfort only, however some women experience pain and movement.

Usual Presentation
Discomfort or pain occurs during walking, getting in and out of seats, beds, cars rolling in bed and when in the one position for too long – at the computer, or lying on your side, walking up or down stairs, walking for a long time.
The pattern of pain varies from woman to woman. Some women may feel a burst of pain early in pregnancy. This often goes away and may return in the last weeks of pregnancy. Usually there is quick improvement following birth.

Coccydynia
Pain is felt near the coccyx and/or in the perineum.
It can be sharp when you move, and achy when you are sitting. It can increase when walking, in bed, getting in and out of a chair or the car. There can be pain with bowel movements.
There can also be spasm in the muscles in the area (muscle knots).

What can SHE do?
SHE will complete a full assessment to determine your problems and create a personal management plan.
Physio Management
Annette will treat the cause of your pain and help with symptoms. SHE will use a variety of techniques: massage, dry needling, joint mobiliisation, and taping.
You will learn a variety of exercises:
To relieve tight muscles,
To strengthen weak muscles around the hips and bottom,
To stabilize the pelvis when you are moving.
SHE may use:
Pregnancy pelvic belts,
Taping,
Massage to tight muscles and tendons,
Dry needling.
You will learn helpful activities for the birth.
SHE will arrange crutches or wheelchair if necessary.

What can I do before I see the SHE Physio?
Advice
Do things in moderation.
Avoid or limit activities that cause pain.
Have good posture.
Avoid crossing your legs.
Move around – Don’t stay in the one position for long periods.
Use ice packs or heat packs over painful areas – for up to 20 minutes at a time.
Do your physio exercises to improve muscles in the core and pelvis.
Use inexpensive shapewear from the major retailers, or tubigrip from the physio to begin with.
More expensive shapewear is available – but talk to Annette before investing in this.
Pelvic support belts may be of benefit.
SHE can advise you on various pillows you can use in bed.

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ABDOMINAL SEPARATION (DRAM)

What is it?
DRAM is the diastasis/separation in the rectus abdominus muscle – along your midline.
It occurs in pregnancy and can persist after birth.
It is measured across the navel, above and below the navel.
The abdominal muscles lengthen and widen to accommodate the growing baby. The weakest point of the rectus muscle is the tendinous midline.
DRAM is associated with back pain and pelvic girdle pain,abdominal and pelvic muscle weakness, urinary incontinence and prolapse.

What can SHE do?
SHE will complete a full assessment to determine your problems and create a personal management plan.
Annette will assess your abdominal muscles for separation.
SHE will teach correct techniques and exercises for closing the muscles.
SHE will show you exercises that you should do.
SHE will show you exercises to avoid during your recovery.
SHE will show you how to assess yourself.
Learn how to move to limit the DRAM.

What can I do before I see the SHE physio?
Advice
Lift and carry baby correctly.
Avoid heavy household tasks: sweeping, mopping, vacuuming.
Reduce the size of your loads –
Nappy buckets baby bath: remove the water first.
Smaller washing loads.
Shopping bags – bring in perishables; Leave the rest for your partner to carry in when he returns.
Wear supportive underwear until you see SHE.

WARNING:
Some exercises worsen DRAM. Avoid sit-ups, planks, rowing machines and burpees.

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ABDOMINAL WEIGHT & STRETCH MARKS

What is it?
Abdominal weight:
Women gain weight around the middle during pregnancy and often maintain it while breastfeeding. It is the body’s way of protecting the growing baby when you are pregnant, and of maintaining enough energy for both mother and baby during breastfeeding. It is due to hormonal changes.
Women lose weight and change shape differently to one another.
Concentrate on being healthy and maintaining a reasonable weight rather than on regaining your pre-pregnant size quickly.

What can SHE do?
SHE will complete a full assessment to determine your problems and create a personal management plan.
Annette will advise on aerobic activity for weight reduction, strength, flexibility, aerobic endurance, abdominal and pelvic floor, muscle strength safely.

What can I do before I see the SHE physio?
Advice
Stretchmarks:
Studies over the last 30 years conclude that no particular product helps with resolution of stretchmarks.
Information is inconclusive on whether massage or corsetry will reduce stretchmarks.
Stretchmarks do fade with time.
Massage should be gentle.

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POST NATAL

PELVIC GIRDLE PAIN

(also called PGP Sacro-iliac joint pain, Pubic joint pain, Coccyx Pain / coccydyhia (coccyx = tail bone))

What is it?
The pelvis is 3 bones with dense joints and minimal movement.
The 2 sacro-iliac joints are at the back -between the sacrum and the ilium/pelvic bones. The pubic joint is joined with a dense fibrous disc.
The coccyx is made of 5 bones which may or may not be fused to one another. The joint between the sacrum and the coccyx has a disc.
All these joints are supported with thick ligaments.
Pregnancy hormones increase laxity (looseness) of all pelvic joints. Most women, experience a mild discomfort only, however some women experience pain and movement.

Usual Presentation
Discomfort or pain occurs during walking, getting in and out of seats, beds, cars rolling in bed and when in the one position for too long – at the computer, or lying on your side, walking up or down stairs, walking for a long time.
The pattern of pain varies from woman to woman. Some women may feel a burst of pain early in pregnancy. This often goes away and may return in the last weeks of pregnancy. Usually there is quick improvement following birth.

Coccydynia
Pain is felt near the coccyx and/or in the perineum.
It can be sharp when you move, and achy when you are sitting. It can increase when walking, in bed, getting in and out of a chair or the car. There can be pain with bowel movements.
There can also be spasm in the muscles in the area (muscle knots).

What can SHE do?
SHE will complete a full assessment to determine your problems and create a personal management plan.
Physio Management
Annette will treat the cause of your pain and help with symptoms. SHE will use a variety of techniques: massage, dry needling, joint mobiliisation, and taping.
You will learn a variety of exercises:
To relieve tight muscles,
To strengthen weak muscles around the hips and bottom,
To stabilize the pelvis when you are moving.
SHE may use:
Pregnancy pelvic belts,
Taping,
Massage to tight muscles and tendons,
Dry needling.
You will learn helpful activities for the birth.
SHE will arrange crutches or wheelchair if necessary.

What can I do before I see the SHE Physio?
Advice
Do things in moderation.
Avoid or limit activities that cause pain.
Have good posture.
Avoid crossing your legs.
Move around – Don’t stay in the one position for long periods.
Use ice packs or heat packs over painful areas – for up to 20 minutes at a time.
Do your physio exercises to improve muscles in the core and pelvis.
Use inexpensive shapewear from the major retailers, or tubigrip from the physio to begin with.
More expensive shapewear is available – but talk to Annette before investing in this.
Pelvic support belts may be of benefit.
SHE can advise you on various pillows you can use in bed.

DOWNLOAD PDF

ABDOMINAL SEPARATION (DRAM)

What is it?
DRAM is the diastasis/separation in the rectus abdominus muscle – along your midline.
It occurs in pregnancy and can persist after birth.
It is measured across the navel, above and below the navel.
The abdominal muscles lengthen and widen to accommodate the growing baby. The weakest point of the rectus muscle is the tendinous midline.
DRAM is associated with back pain and pelvic girdle pain,abdominal and pelvic muscle weakness, urinary incontinence and prolapse.

What can SHE do?
SHE will complete a full assessment to determine your problems and create a personal management plan.
Annette will assess your abdominal muscles for separation.
SHE will teach correct techniques and exercises for closing the muscles.
SHE will show you exercises that you should do.
SHE will show you exercises to avoid during your recovery.
SHE will show you how to assess yourself.
Learn how to move to limit the DRAM.

What can I do before I see the SHE physio?
Advice
Lift and carry baby correctly.
Avoid heavy household tasks: sweeping, mopping, vacuuming.
Reduce the size of your loads –
Nappy buckets baby bath: remove the water first.
Smaller washing loads.
Shopping bags – bring in perishables; Leave the rest for your partner to carry in when he returns.
Wear supportive underwear until you see SHE.

WARNING:
Some exercises worsen DRAM. Avoid sit-ups, planks, rowing machines and burpees.

DOWNLOAD PDF

BREAST FEEDING PROBLEMS AND MASTITIS

What is it?
Mastitis is inflammation of the breast tissue. Symptoms include redness, swelling, local heat, discomfort or pain and reduced milk volume.
You may feel unwell and experience “flu-like” symptoms.
Problems with breastfeeding arise at anytime. Typically, it happens with baby’s growth spurts. It may happen when introducing solids, and weaning. Sometimes, there is no obvious reason.What can SHE do?
SHE will complete a full assessment to determine your problems and create a personal management plan.
Ultrasound and laser reduce the inflammation and improve symptoms within the next 1-2 feeds.
Annette will show you the correct way to massage your inflamed breast.
It is very helpful to have ultrasound or laser as soon as you suspect mastitis.

What can I do before I see the SHE physio?
Advice
Have plenty of rest and adequate fluids. Relieve your symptoms with simple analgesia and anti-inflammatory medications.
Do NOT massage your breasts strongly.
Use gentle warmth and cool packs to help with discomfort.

When to make an appointment
If the symptoms of mastitis have not resolved following a breast feed.
Please ring Annette early in the day.
Antibiotics: Ultrasound and laser speeds recovery and can be given with antibiotics.

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PERINEAL TEARS & EPISIOTOMY

What is it?
The soft tissues around the vaginal opening may tear or, your doctor or midwife may perform an episiotomy to reduce the tension on the pelvic floor during the birth.
You may notice swelling, discomfort or pain and redness. You may be aware of stitches.

What can SHE do?
SHE will complete a full assessment to determine your problems and create a personal management plan.
Ultrasound and Laser reduce swelling, discomfort and soften scar tissue.
SHE will show you techniques to soften the scar.
You will learn better toileting techniques to reduce pain and swelling.
You will learn how to return to more comfortable intimacy and intercourse.

What can I do before I see the SHE physio?
Advice
Have adequate fluids, fruit, salad and vegetable to ensure bowel motions are soft and regular.
Use corsetry and sanitary pads to reduce swelling and pain.
Ice packs against the perineum are helpful in the first week.

When to make an appointment
You can be seen within days of the birth for physiotherapy.

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BLADDER PROBLEMS
Stress Urinary incontinence.
Urge Urinary Incontinence Overactive bladder.
Frequency and urgency of urination, (that is voiding too frequently or with an overwhelming urge).
Changes in urination following childbirth or surgery.
Recurrent urinary infections.
Difficult or painful urination.
Painful bladder syndrome.It is normal to pass urine about 6-8 times within 24 hours if you are drinking a normal amount of 1.5-2.0 litres (You should drink more when pregnant and postnatally).
Symptoms include increased frequency of passing urine.
Leakage of urine at any time, or with any activity.
An overwhelming urge to pass urine at any time, for example when arriving home or turning on taps.

What can SHE do?
SHE will complete a full assessment to determine your problems and create a personal management plan. You will learn techniques for passing urine and for reducing unwanted urinary urges.
You will learn muscle exercise for strength and endurance if necessary.
You will learn how to relax the pelvic muscle if necessary.
You will learn how to reduce infections if necessary.

What can I do before I see the SHE Physio?
Advice
Do drink adequately.
Do not pass urine just-in-case.
Respond to signs of urine infection. Get medical advice as soon as possible.
Be aware how some fluids and foods may effect your bladder –commonly coffee, alcohol and energy drinks increase urgency.

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BOWEL PROBLEMS

Constipation.
Leakage of wind or bowel motion.
Urgency with bowel motions.
Irritable bowel.
Obstructive constipation.
Painful bowel motions.
Tenesmus.
Fissures.
Haemorrhoids.

What is a bowel problem?
Please make an appointment if passing a bowel motions in difficult or painful, or too fast.
It is normal to pass a bowel motion easily and quickly – in less than 2 minutes.
Frequency of bowel motions is less important than how easy it is to pass a motion. You may pass a motion as often as three times a day or as little as three times a week. It is more important for the action to be soft and easy and well controlled.

What can SHE do? 
SHE will complete a full assessment to determine your problems and create a personal management plan.
You will learn the correct techniques for passing a bowel motion.
You may learn how to schedule your bowel actions.
You may learn muscle exercise for strength and endurance if necessary.
You may learn how to relax the pelvic muscles if necessary.
You may learn how to improve your diet to control your symptoms.
You may learn how to use simple bowel medications to help control your symptoms.

What can I do before I see the SHE Physio?
Advice
Aim for soft, regular bowel motions.
Have adequate fluids.
Have adequate fibre: fruit, vegetable and salad, and other fibre – seeds, nuts, grain-based fibre.
Watch for reactions to specific foods and fluids.

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PELVIC ORGAN PROLAPSE

Vaginal Prolapse.
Cystocoele.
Rectocoele.
Anterior Wall Prolapse.
Posterior Wall Prolapse.
Vault Prolapse.
Rectal Prolapse.

What is it?
Prolapse is the descent/dropping down of organs into the vagina (and occasionally through the rectum).
The organs and associated structures include the bladder, urethra, bowel, rectum, anus, uterus and vagina.

Why does it happen?
The organs lose their physical support: the ligaments and/or pelvic muscles weaken and stretch. They are also supported by the pelvic muscles below.
The supporting ligaments and tissues can weaken and stretch.

What can SHE do?
SHE will complete a full assessment to determine your problems and create a personal management plan.
You may learn pelvic muscle exercise for strength and endurance as necessary.
You will learn how to protect your pelvic floor.
You will probably learn a better technique for passing a bowel motion.
You may learn how to schedule your bowel actions.
You may learn how to relax the pelvic muscle if necessary.
You will get advice on exercise that is beneficial and harmful for your pelvic floor.

What can I do before I see the SHE Physio?
Advise
Think about your daily activities and exercise and the impact on your pelvic floor.
Do not take up running, jogging or heavy weights if you suspect prolapse until you have been assessed and advised.

INTIMATE PAIN

DYSPAREUNIA – VAGINAL PAIN – INTIMATE PAIN
( vaginal pain, intimate pain, vestibulodynia, vulvodynia, vaginismus)
Some women experience pain with sex. There may be factors which led to this such as infections, an unhappy sexual experience, or it may have developed without any real trigger.

What can SHE do?
SHE will complete a full assessment to determine your problems and create a personal management plan.
SHE will assess your abdomen, back and external pelvis, pelvic floor and vagina.
You will learn how to relax your pelvic floor. This is sometimes called down-training.
You will be given advice on how to have sex more comfortably.

What can I do before I see the SHE Physio?
Advise
Drink and eat well.
Get adequate exercise – don’t overtrain.
Get adequate rest.
Talk to your partner about this problem. Partners are often very supportive.
See your local doctor or specialist about any suspected infections.

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OSTEOPOROSIS

(Osteopenia, low bone mass, brittle bone in Adults)

What is it?
Bone density changes with age.
Low bone density is name according to the degree of bone density.
Osteoporosis is when the bone density is reduced to the point where there is risk of fracture from a minor bump or fall.
Osteopenia in women and Low Bone Mass in men are the terms used to describe bone density that is lower than normal, but not as low as osteoporosis.
It is diagnosed with DEXA (dual energy x-ray absorptiometry).  This is an x-ray that takes multiple images of the lumbar spine, hip and wrist to determine your bone density compared to an 18 year old’s bone density. The score is a number from 0 and below.

What can SHE do?
SHE will complete a full assessment to determine your problems and create a personal management plan.
A comprehensive exercise concentrates on:
Posture and balance
Muscle strength
Co-ordination
General bone density
Bone density at the vulnerable sites: hip, wrists, lumbar spine.
Standing and walking capacity.
Learn to get down to and up from the floor safely.
AVOID activities that increase flexion in the spine (forward bending) -sit-ups, spine curls, rowing exercise.

What can I do before I see the SHE Physio?
Advise
Make your home safe.  Prevent unnecessary falls: Remove loose rugs and tape down or remove electrical cords that are lying on the floor.
Wear shoes with good grip in the house – not soft-soled slippers or socks.
Sit down to put your shoes and socks on.
Sit down to dry yourself after a shower.
Avoid walking in the dark. Turn on the house lights at night if you are going to the toilet.

Additional Notes
If you know of a family history of low bone density, ask your GP when you should have a DEXA scan.

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CHILDREN BLADDER AND BOWELS
MEN BLADDER AND BOWELS

Men’s Pelvic Problems:
Prostate surgery – rehabilitation for the pelvic floor
Pelvic Pain
Bladder problems: please read the general entry for bladder problems
Bowel Problems: please read the general entry for bowel problems
Prostate Surgery is usually done to remove a growth within the prostate gland.
It is important to see your local doctor or urologist/surgeon regarding your prostate for accurate diagnosis before seeing Annette.

What can the Physio do for me?
SHE will complete a full assessment to determine your problems and create a personal management plan
You will be assessed before and after surgery. This includes internal assessment.
You will learn to exercise your pelvic muscles correctly.
You will also learn to relax to pass urine.
Any other urine or bowel problems will be assessed.
You will learn exercises and procedures for your hospital stay and for your recovery at home.

What can I do before seeing the Physio?
Drink and eat well. Get adequate exercise and rest.
See your local doctor if you suspect urinary infection.
Please bring your blood test results with you.
Please think about the level of effort required to pass urine or bowel motions before you come to see the physio.

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