Pelvic floor, abdominal & back training

1. Presentation Title Pelvic floor, abdominal & back training Presentation title (Date)

2. Lesson Objectives Explain the term core stability & the muscles responsible List the functions of the Pelvic floor Explain and demonstrate how to locate and train the pelvic floor Identify best methods of training the abdominal and lower back muscles

3. Pelvic Floor • Sling or hammock-shaped muscle (floor of the pelvis) • Originates on pubic bone & inserts onto coccyx • Figure of 8 producing sphincters around: urethra, vagina, anus • Muscle is in 3 layers: • Superficial layer is the figure of 8 perineal muscle • Intermediate fibrous layer which is a triangular ligament allowing 2 openings - urethra & vagina • Deepest layer of the levator ani muscles • Due to effects of relaxin and weight of baby these muscles are stretched during pregnancy & delivery • Baby weighs on the pelvic diaphragm • Excess impact can lead to stress incontinence • Contains both fast and slow twitch muscle fibres

4. Function of the Pelvic Floor • Support organs of the pelvis (bladder, uterus and bowel) • Resist rises in intra-abdominal pressure caused by coughing, sneezing, lifting or straining • Plays a significant role in the continence mechanism • Co activate with TA to assist pelvic spinal stability • Has an inhibitory effect on bladder activity

5. Pelvic Floor

6. Weak Pelvic Floor Implications • If stress incontinence a problem then high impact activities contra-indicated • Reduced ligament support for the pelvic organs can increase risk of prolapse • Encourage bracing & lifting of pelvic floor throughout CV session • Consider comfort of the perineum • eg. Upright Vs recumbent cycle

7. Stress incontinence • Loss of urine involuntarily • Caused by coughing, sneezing, straining, lifting or jumping

8. Episiotomy • A surgical incision into the perineum between the anus & vagina to widen the exit route! • Performed: • before a forceps or vacuum delivery • during the ‘push’ phase of delivery

9. Pelvic floor recovery & repair • Episiotomy healing generally within 10 days • Takes 6 weeks for stitches to dissolve • Exercise will: • increase blood flow to area • improve the disposal of waste products from area • likely to reduce pain felt • may assist the cut / tear to close • Start as soon as comfortable

10. Pelvic floor exercises • Contract and release (fast or slow) • The Elevator • Pulses at the top of the movement • Use gravity where possible • Focus on relaxation during eccentric phase • Breath regularly throughout • No limit of amount you want to do • Suggest 2-3 sets of 20 reps daily

11. Presentation Title Core stability training Presentation title (Date)

12. Abdominal muscles 4 layers - working inside to out • Transverse abdominus • Internal oblique (inverted V) • External oblique (upright V) • Rectus abdominus

13. The abdominal wall

14. Group activity • In pairs list all the functions of the abdominals • What are the benefits and concerns for pregnant clients regarding abdominal and back training • 5 minutes task

15. Function of the abdominals • Supports abdominal contents & pelvic contents • Maintains upright posture • Supports lumbar spine • Allows forward & lateral flexion & rotation of spine • Braces body when under stress (cough) • Aids propulsive movements (‘push’ phase of delivery • Controls the movements of the limbs during exercise

16. Benefits and concerns • Benefits: • Supports lumbar spine • Supports internal organ • Supports uterus • Controls movement of trunk • Aids ‘push’ phase of delivery • Potential problems/conerns: • Body position • Breathing • Braxton-Hicks contractions • Doming • Muscles contract over rounded shape

17. Linea Alba • Central connective tissue • joining of the aponeurisis of the transverse & obliques • separation of rectus abdominus at the linea alba is diastasis recti

18. Practical group activity • List all the abdominal and back exercises that you currently use with your clients • Consider Rectus Abdominus, Transverse Abdominus, Internal/External Obliques, Erector Spinea & Pelvic Floor. • Suggest adaptations for the various stages of pregnancies to ensure safe exercise selection- prepare to feedback to the group • Task time 45 minutes

19. Abdominal exercises • Hollowing on all floors • Side bends • 3/4 moving side plank • Hip rolls on stability ball – engaging TVA • Brace and hold standing

20. Lower back exercises • Mobility: • cat stretch (all fours) • fetal position (side) • fetal roll (back) • Strength • single arm raise (all fours) • superman/sand lizards (all fours) • resisted back extension (seated)

21. Summary • Abdominal training should continue throughout pregnancy although adaptations will be necessary to ensure safe exercise prescription. • Most exercises will focus on TVA and pelvic floor activation, rather than rectus abdominus. • Lower back training is essential throughout pregnancy. Although adaption's may be needed. • Consider the usage of pillows, cushions, & resistance tubing to aid comfort, safety and effectiveness for participants.