New Research in the prevention of pelvic floor injury:

As you may be aware I travelled to Brisbane recently for the 37th conference of the International UroGynaecological Association (IUGA) and the Continence Foundation of Australia (CFA) national conference. As well as hands on workshops delegates were treated to presentations of new scientific research papers from all over the world. The conference was the first time that any of this research has been presented or published…….and there is some outstanding research that has major implications for preventing pelvic floor injury and pelvic organ prolapse in women.
New developments in ultrasound technology have made it possible to produce images of the pelvic floor from a Translabial approach. Research using this method has identified an injury caused during childbirth that may have gone undetected until now. This injury is an avulsion of the Levator Ani muscle. It is caused by the inability of the muscle to stretch enough as the head of a baby is delivered in some situations. The effect is that in some cases the muscle can avulse or pull away from its attachment at the pelvis. 

The identification of this injury has lead to more research into specifically who might be at risk of these injuries and how we can help to prevent them. As the research is still quite new at present there seems to be more questions than there are answers. However, there are some theories and initial basic research:
In major muscle groups such as the quads or hamstrings etc the resting muscle length can be extended or stretched by 25% before it will tear, rupture or avulse. In the levator ani muscle the mechanical challenges of childbirth demand that the muscle stretches between
150% and 200% of it’s usual resting muscle length.

As you can imagine this is a huge amount of structural load and stress on a muscle (which many of us did not need research to identify). The major questions are who is at risk of this injury and how can it be prevented? It was suggested by several research papers at the conference that women having their first baby after the age of 31 seem to be more at risk from this injury – due to a reduction in flexibility within muscle tissue.
Of major relevance to physiotherapy and particular women’s health physiotherapists is the new thought that pelvic floor stretching, and stretching to the perineum and levator muscle in particular in the 4-6 weeks before birth, could reduce the risk of levator avulsion. This is due to the adaptability of muscle tissue that occurs in the final stages of pregnancy which will allow the muscle to attain more flexibility. It was also stated that a relaxed muscle will stretch far more than a tense muscle and so it makes sense that if a woman can learn to relax her pelvic floor then there is less risk of levator injury.
There is now much more investigation taking place into how we can reduce strain and tension throughout the full thickness of the perineum at delivery. All of this information will help decrease injury and therefore decrease the incidence of pelvic organ prolapse later in life. In physiotherapy you should expect to see a shift in education of women during pregnancy. I personally have already started to advocate more focus on pelvic floor stretching in the last 4-6 weeks of pregnancy and our practice is investigating the stretching devices that are available for women to use at home. Many of these devices have been available for a long time but have not been thought to be terribly useful…… this space for new developments!!!!
Emily Shiel, APAM

Important Notice:

Unfortunately due to safety and security issues with the hospital pool, we will no longer be using it on a Saturday morning. We have approached the hospital to request a week time spot. This request will be reviewed in Janurary 2013. We appologise for any inconvinience to our patients.

Pilates Classes:

Term 4 Pilates Classes available online from 1st October!!
Watch this space to see what the new Pilates theme for Term 4 is!!
The timetable is available online at
Spaces are limited so get in quick to secure your spot in a class. Also, if you are having trouble booking into classes online, please give the office a call on 98423020 or let the girls at reception know when you come in next!

Exercise of the Month:

Working your Pelvic Floor

To identify your pelvic floor muscle: try to stop the flow when having a wee.
Once you have identified the correct muscle then practice using it each day. This should be at another time, NOT when sitting on the toilet!
Squeeze and lift the muscle as hard as you can - while making sure you are keeping the tummy muscles as relaxed as possible. Try to hold the pelvic floor squeeze for 10 seconds, then relax for 10 seconds. Repeat 10 times.

Attention: Price Rise!!!!

We would like to inform all of our valued customers that we have an annual price rise in effect from
1st October.
(We have not had a price rise since October 2011).  
Initial Appointments now - $90.00
Standard appointments now - $70.00
All of our class prices will remain the same!

Craig's Joke of the Month

Paddy and Mick worked together in the factory and were both laid off. At the unemployment office, Paddy was asked his occupation, 'Panty stitcher... Istitch de elastic in ladies panties,' he replied.
Being unskilled labour, Paddy was given 100 Euros a week. When Mick was asked the same question, he replied 'Diesel fitter', and since this is skilled work he was given 200 Euros a week. When Paddy found out Mick was getting 100 Euros a week more than him he was furious. He stormed back into the unemployment office and demanded to know why his mate was getting more dosh. 
The clerk explained that panty stitching is unskilled work, whereas diesel fitting was skilled work. 
'What skill????' yelled Paddy... 'I sew the elastic on the panties. Mick puts them over his head and says, 'Yep diesel fitter'. 
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