walking

Built for walking – Made to walk! Low back pain and exercise

Wondering about low back pain?

Why does it hurt?

Why do so many people in Melbourne have low back pain?

Human beings are designed to move! It may sound simple, but think back to your high school science classes. Apart from making all sorts of misuses of the Bunsen burner, do you remember learning about all those muscles attached to the bones of the human body? They’re everywhere! Unfortunately in the smartphone age, the most commonly used muscle is our adductor pollicis (ie. scrolling up with your thumb). But do you know what the main intended uses of your muscles is for? That’s right, you guessed it: walking! Plain and simple walking.

Now, many of us use our bodies in ways that it is not made to be used (think: sitting at computer nine hours a day then spending the evening scrolling through overwhelming Netflix options). What this does is put abnormal stresses on our body, in particular your lower back, which can result in low back pain. So actually, in most cases of low back pain, there’s not a lot of mystery involved in why it hurts. Backs just simply are not made for the sustained stresses that we put them through.

So if walking is the most basic movement that our bodies are designed for, then it’s no surprise that walking is an excellent remedy for low back pain. Research shows that a simple walking program can be the most effective way of reducing low back pain.

Of course there are limits to abide by, and low back pain is different for everyone, so guidance from your physio in starting a walking program is essential. If you are having trouble, our Physiotherapists  can guide your exercises and address work with you on your low back pain issues.

When it comes to low back pain, most people are looking for a quick fix. Well, this is it! Strap on those Nikes, and take to one of the many lovely tracks Melbourne has to offer.

You won’t regret it!

Daniel Zeunert

Physiotherapist

Daniel is passionate about achieving the best outcomes for his patients by keeping up with the latest evidence-based research in physiotherapy. He uses a combination of exercise and manual therapy, operating under a biopsychosocial approach to patient care.

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Masterchef 2019 has kicked off to a delicious start!

Continuing with the successful format from last year, our in-house Masterchef comp has a “lucky dip” for the budding chef to pick the feature ingredient. Each dish is judged on taste, presentation, and how well they showcased the feature ingredient.

For an additional twist this year, some new ingredients have been added to spice things up- anchovies, olives, and lemongrass (yummm!)

As the reigning winner from Masterchef 2018, I kicked off the season with the ingredient almond, and made a ‘Chinese almond jelly with goji berries and lychee’. Unfortunately, this did not turn out to be as delicious as I hoped, so it looks like the Masterchef title is up for grabs!

We have had delicious savoury dishes such as Billy’s ‘Mini Baked Potatoes with Mushroom Topping’ and Adriane’s “Cheese Sable Biscuits’.

Some current front-runners are Debbie’s ‘Passion Fruit Slice’, which was the perfect balance of sweet and tart. Ali’s ‘Lemon Sensation Tart’ (pictured) let lemon be the star. Brendan E also dished up a ‘Salted Caramel Brownie Slice’, which was demolished within seconds. Amanda’s ingredient mint was creatively used in a ‘Mint Slice Cheesecake’, which was presented as a giant replica of a Mint Slice! A mint and chocolate lover’s dream come true!

Strong contenders so far, everyone’s waistlines are looking suspicious and we are looking forward to the upcoming delicious creations!

 

Sonja Tun 

Physiotherapist

Pilates instructor

Masterchef CHP/CHPR/INP Champion 2018

LEAP

Persistent buttock pain- its probably not sciatica.

A PAIN IN THE BUTT

The most common cause of persisting deep buttock pain or lateral (on the outside) hip pain is not sciatica, but caused by tendinopathy of the gluteal tendons: usually Gluteus Medius and Gluteus Minimus tendons. It’s also often misdiagnosed as bursitis, and treated (ineffectively) with cortisone or other injections.

This very common condition, also called greater trochanteric pain syndrome, is irritated by lying on either side at night. This puts pressure on those tendons between the greater trochanter ( ateral hip bone) and the bed surface when lying on the painful side, or pressure from the position of the top thigh as it crosses the midline when lying on the good side. It’s also made worse by sitting too low and getting up from sitting, crossing the legs, walking up hills and when climbing stairs. Lunges and Clam exercises can aggravate it. It can get so bad as to disturb sleep, create a painful limp and prevent walking & exercise altogether!

Affecting women much more than men, one study from Scandinavia (1) showed one in four women have got underlying Gluteal Tendinopathy, often becoming symptomatic with a spike in load. An event like overseas travel, extra walking or new impact exercise can trigger it, especially if the gluteal muscles (the buttocks) have weakened. This is so common, can last for years and its a pain in the butt !! However unlike sciatica, the pain will usually not refer below the knee or cause any nerve symptoms like tingling or numbness.

The good news is that clinical research (2) proves the right exercise program and advice on sitting and sleeping posture can resolve the pain and prevent it becoming chronic. Clifton Hill Physiotherapy / CHPR Physios Dr Henry Wajswelner and Dr Sallie Cowan were involved as treating physiotherapists in a landmark study called the LEAP trial, published in the British Medical Journal in 2018, that proved a physiotherapy program was the most effective form of management both in the short and long term. Education on the right ways to sit, stand, lie at night and move to minimise tendon compression is a key early component of the physiotherapy treatment program. Then a very gradual build-up of the right type of exercises to restore the gluteal, thigh and trunk muscles is the main form of longer-term management.

If you have persisting buttock/ lateral hip pain that is not responding: you probably have gluteal tendinopathy !!! Make an appointment with one of our physios to be assessed and get the right advice and exercises so you can get rid of this annoying pain in the butt!!

 

Dr Henry Wajswelner FACP* APA Specialist Physiotherapist (As awarded by the Australian College of Physiotherapy 2007)

Henry is one of the first Specialist Sports Physiotherapists in Australia, passing his College exam and gaining his Fellowship in 2007. He has over 35 years clinical experience at the highest levels including the Australian Olympic Rowing Team and the Australian Institute of Sport in Canberra.

Henry specializes in using Physiotherapy and Clinical Pilates for persistent spinal and joint problems. His experience comes from using Pilates in managing athletes’ injuries & through his doctoral research studies into Pilates for Chronic Low Back Pain. Henry also works closely with Orthopaedic Surgeons and Rheumatologists for all types of clients to develop specific Pilates programs to optimize recovery from surgery, pain and injury. Henry often works with other physiotherapists to co-manage difficult problems to achieve outstanding results.

Henry is also a researcher involved in studies investigating the best way to manage hip pain caused by Gluteal Tendinopathy. He is a Senior Lecturer and Course Co-ordinator at Latrobe University, where he leads the Master of Sports Physiotherapy Course for Graduate Physiotherapists from all over Australia.

 

 

Clinical Research Studies mentioned in this blog :

  1. Segal NA, et al (2007) Greater trochanteric pain syndrome: Epidemiology and associated factors. Archives of Physical Medicine and Rehabilitation 88:988-992.
  2. Mellor R, Bennell K Grimaldi A, Hodges P, Kaszka J, Nicolson P, Wajswelner H, Vicenzino B (2018) Effects of education plus exercise versus corticosteroid injection versus no treatment on patient rated global outcome and pain among patients with gluteal tendinopathy: a randomized clinical trial ( LEAP trial ). British Medical Journal; 361:k1662

 

Osteitis-pubis

Osteitis Pubis- Where did it go? Billy Williams Clifton Hill Pilates & Rehab

Passionate supporters in the AFL community will more than likely be familiar with the once frequently used diagnostic term, ‘osteitis pubis’. In the early 2000s, it seemed every second player was reported to be suffering from this troublesome injury of the hip/groin which was responsible for significant amounts of missed game time and a complex, challenging recovery period.

However, in recent times you may have noticed that it is very rarely being reported in the media by elite sports clubs. But why is this? Are therapists better at managing groin pain in sport? Is the term extinct? The answer might surprise you…..

Leading into 2014, there was a large amount of disagreement and uncertainty regarding the use of diagnostic terms for hip and groin pathology within the sports medicine and physiotherapy industry. Osteitis pubis, or OP, was often used as an umbrella term to describe a number of injuries which were potentially co-existing, and as such became easily recognisable by the public. It was widely accepted that an athlete with OP would require a lengthy rest period and a graded rehabilitation back into training and sport.

In November 2014, 24 experts in groin pain from a number of backgrounds and countries (including surgeons, sports physicians and physiotherapists) attended Qatar for a meeting to discuss the inconsistencies in hip and groin diagnostics. Prior to the meeting, each expert was given the same two case study examples. These included descriptions of relevant clinical symptoms, results of clinical tests and imaging findings for an athlete who was experiencing groin pain. They were then asked to independently provide their expert diagnosis.

For case study one;

NINE different diagnostic terms for primary diagnosis were used!

For case study two;

ELEVEN different diagnostic terms were used!!!

Across the two case studies, 22 different clinical terms were used to describe primary, secondary or tertiary injuries of the same two case studies! This clearly highlighted the need for an agreement on what should be considered accurate terminology when describing hip and groin pain. This would be critical in understanding the anatomical details of each athlete presentation and facilitating clear cross-referral between practitioners.

This meeting is known as the ‘Doha Agreement’. It advocated that long standing groin pain be classified under the following clinical entities;

  • Adductor-related groin pain
  • Iliopsoas-related groin pain
  • Inguinal-related groin pain
  • Pubic-related groin pain
  • Hip-related groin pain
  • Other conditions (including non-musculoskeletal diagnosis)

These clinical entities are often broken down with further more anatomically descriptive terminologies for deeper accuracy. However, many terms, including osteitis pubis, were not recommended for clinical use by the group of experts.

Since the Doha agreement clinicians are gradually becoming less comfortable with using the term osteitis pubis, and as such the public are hearing it less often. It is still occasionally used as it is easily recognisable by many sports fans, and this helps with honest translation of information from clubs to their fans.

Next time you hear OP mentioned in the media, understand that it is likely an injury related to one or more of the many tissues around the hip and groin such as the adductor muscles, the pubic bone, the hip joint or other physiological structures. An accurate and correctly descriptive diagnosis of a hip or groin injury can be obtained by collaborating information from reported symptoms, high quality clinical assessment and then complemented by diagnostic imaging findings. Once an accurate diagnosis is achieved, an appropriate rehabilitation and return to activity plan can be prescribed.

This accurate diagnosis is relevant if you are an athlete, if you enjoy non-competitive exercising or even to improve your ability to complete common daily tasks such as walking or shopping. The fantastic physiotherapists at CHP/CHPR/INP are experienced in working with sporting and non-sporting patients, and are your perfect first stop to work towards getting the answers to your troublesome hip or groin…. Hint; It’s not osteitis pubis.

Billy Williams, APAM

Bachelor of Physiotherapy

Graduate Certificate of Sports Physiotherapy

REFERENCE:

Weir. A., Brukner. P., Delahunt. E., et al. (2015). Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine. 49(12). 768-774.

sleep

SLEEP FOR GOOD HEALTH-Rosie Purdue

Are you getting enough sleep?

More and more research is coming out about the importance of sleep, yet almost a third of us get less than 7 hours quality sleep each night. Sleep takes place in three stages and deep sleep actually allows your brain to clean itself. Put scientifically, during deep sleep, the spaces between our brain cells expand by up to 60% allowing cerebral-spinal fluid to remove toxins such as beta-amyloid (a protein that can negatively affect memory). Also, research shows links between poor sleep and increased pain, as well as a correlation between lack of sleep and diseases like stroke, diabetes and depression.

The following tips may help improve your sleeping:

  • Set a nightly routine.
  • Dark, cool room.
  • Warm bed.
  • Relax and prepare for sleep before getting into bed; read a book, listen to calming music, do a puzzle.
  • No smoking and alcohol close to bed time (both can cause waking during the night).
  • No screen time 1-2 hours before bed; this will help your natural body clock.
  • If your partner snores, try different ear plugs.
  • Avoid a heavy dinner/dessert, but a light snack may help if you are hungry.
  • Avoid stimulants in the afternoon and evening.
  • Keep the bedroom for the two S’s.
  • Try practising mindfulness; it can decrease the effort of sleep.
  • If you are having trouble, don’t stay in bed worrying about it, get up but stay in a low-lit room.

If you’d like more help finding ways to improve your sleep quality, I recommend the 21 Day Sleep Programby Smiling Mind. Go to the App store, download the free App, create a login, go to ‘All Programs’ and it will be at the top of the page. Good luck and sleep tight.

 

JH

Women in Sport – A Growing Force!

Sport Australia recently released the latest AusPlay data which details sports participation across the nation.

Netball has retained its position as the leading team sport for women and girls in Australia, with over 1 million actively participating in netball and choosing netball as the sport they most closely identify with.

It is fantastic to read that female participation is on the rise in many other sports as well- in particular there has been a surge in women participating in AFL since the introduction of AFLW. In the 2017 survey there were 31,542 women participating in AFL once a week .  This number has risen to 59,504 in 2018.  The number of women participating in AFL twice a week or more has risen by 154% growing from 19,005 to 48,225!

We are also seeing an improvement in the professionalism of women’s sport, and it is fantastic to see so many role models emerging.  As young girls are able to see more and more high level women’s sport, hopefully we will continue to see participation rates increase and girls will be more likely to continue playing sport as they grow through adolescence to early adulthood.
Athletes such as Jo Weston (Australian Diamonds netballer), Alyssa Healy (Australian cricket player), Erin Phillips (AFLW player), and Samantha Kerr (captain of the Matildas soccer team), are becoming more familiar names championing women’s sport and demonstrating high performance behaviours for young girls to aspire towards.  The benefits of sport and physical activity are well known, and the more we can foster our young girls and young women to participate the better.

Netball, as a female dominated sport that has been around for a long time, has a well established pathway for participants.  From NetSetGo for 5-10 year olds, through to club netball and pathways for elite performance, there are also avenues for recreational participation for all ages.  There are many social netball competitions around Melbourne as well as Vic Health and Netball Victoria’s “Rock Up Netball” initiative which enables people to play when they like without the weekly commitment of a club or team.

Hopefully over time we begin to see these similar pathways across many other sports to help bring more young girls and women into sport and keep them involved across their lifespan.

Jane Higgs

Physiotherapist and Pilates Instructor

References
https://www.clearinghouseforsport.gov.au/research/smi/ausplay/results
https://www.sportaus.gov.au/media_centre/news/australias_top_20_sports_and_physical_activites_revealed
www.rockupnetball.com.au
www.netsetgo.asn.au

DRAM

DRAM (Abdominal seperation) – an update from Ali Harding

Abdominal Separation: What is it? Can we prevent it? And what to do about it!

 

Ali recently headed to Sydney to update her skills and knowledge on DRAM management and the function  of the abdominal wall.

Abdominal separation or DRAM (Diastasis Rectus Abdominal Muscle separation), happens commonly during pregnancy, and, to a degree is a normal change in a woman’s body.  As your baby grows, the increase in abdominal pressure has to be transferred somewhere.  The fascia or Linea Alba (strong tissue holding our six pack abs together) softens and widens and the abdominal muscles elongate and stretch, resulting in these muscles pulling away from the midline and the characteristic ‘separation’.  Research states that up to 66% of women will have a diastasis in the third trimester of pregnancy, and other literature found 100% of women included in their study had a diastasis at 35 weeks!  So – it is certainly common, and to some degree we would expect it.

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Why do we care?

Our abdominal muscles are important in maintaining the function and support of our abdominal wall and are involved in all movement of the trunk.  They help to maintain and contribute to intra-abdominal pressure which can affect the pelvic floor and lower back.  This is particularly important during the post-natal recovery phase as our bodies are recovering.

Furthermore, women are often concerned about the appearance of their belly post-natally and we know that treating and undergoing rehab for an seperation can help improve this.  DRAM has been linked to low self body image due to this fact.

Recovery:

We do know that there is a period of natural self recovery in abdominal separation, usually until 12 weeks post-partum.  If your separation remains wide following this time it is a good sign that you should seek an opinion from your women’s health physiotherapist, in order to ensure full functional recovery.

How do we assess it?

Your treating physiotherapist will use the real time ultrasound to visualise and measure the separation, assess superficial and deep abdominal muscle function, strength and endurance, and provide appropriate exercises based on this information.

How do we treat it?

Commonly used and researched treatment methods include, abdominal binding (Such as compression garments or tubigrip, load management, postural education and retraining, and appropriate exercise rehab.  The key to successful management of these conditions is to retrain and improve the function of the abdominal muscles and strengthen the fascia.  This is achieved by exercising the abdominal muscles in the right way and allowing your body time to retrain this function in a safe and load appropriate manner for your recovery.

And finally, can we prevent it?

Maybe, in some cases.  As we mentioned earlier it is most often a normal change that occurs during pregnancy!  However, if we can identify it early, teach postural awareness, load modification and the appropriate type of abdominal exercises, we can often reduce the degree to which a separation will occur!

Ali and all of our female physios are able to help provide assessment and management of these conditions in post-natal women.  If you have any further questions, don’t hesitate to give us a call to discuss further!  

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Enjoy a healthy pregnancy – Guidelines for exercise throughout pregnancy

We are constantly being told these days how good exercise is for us. It can improve our physical fitness, our mental health and reduce the risk of numerous chronic diseases such as diabetes and heart disease.

Pregnant women used to be told to rest or take it easy, as it was believed that exercise might be harmful for the mother and /or her baby. These days there are more and more studies showing us that lifestyle behaviours during pregnancy can have a huge effect on the woman’s health and that of her baby. Physical activity is now being proposed as a therapeutic measure to reduce pregnancy complications and optimise maternal-fetal health worldwide.

Some of the suggested benefits of physical activity for pregnant women include:

  • Improved muscular strength and endurance
  • Improved cardiovascular function
  • Reduced back and pelvic pain
  • Reduced fatigue, stress, anxiety and depression
  • Reduced risk of pregnancy-related complications such as pregnancy-induced hypertension or pre-eclampsia
  • Reduction in excessive gestational weight gain with fewer delivery complications, and
  • Prevention and management of urinary incontinence

What exercise should you do during pregnancy?

  • If you were inactive prior to falling pregnant the recommendations are to start being more active by slowly increasing the duration of gentle exercise, such as walking.
  • Pregnant women should accumulate at least 150 minutes of moderate intensity physical activity each week to achieve clinically meaningful reduction in pregnancy complications
  • This physical activity should be accumulated over a minimum of 3 days/week, however being active daily is encouraged.
  • Pregnant women should incorporate a variety of aerobic and resistance training activities to achieve greater benefits. Adding some gentle stretching, such as yoga or pilates may also be beneficial
  • Pelvic floor muscle training exercises should be performed daily, to reduce the odds of urinary incontinence. It is advised to get proper instruction on technique to get maximal benefits.
  • Women who experience light-headedness, nausea or feel unwell lying on their back are recommended to modify their position and avoid exercising in this position. Do. not exercise on your back in the second and third trimesters.

Some safety precautions for exercising whilst pregnant, include:

  • Avoiding activities which involve physical contact or danger of falling, as this may increase the risk of foetal trauma (such as martial arts, horse riding, skiing, hockey, gymnastics, cycling)
  • Avoid scuba diving
  • Avoid physical activity in excessive heat, especially with high humidity
  • Maintain adequate nutrition and hydration – drink water before, during and after physical activity.
  • Know the reasons to stop physical activity and seek medical advice immediately if they occur.

First trimester: Correct pelvic floor exercises, proper technique for core exercises, fix any postural imbalances and continue exercising.

Second trimester: Correct pelvic floor exercises, no exercising on your back, no heavy lifting, no new exercise (except Pilates), prevent pelvic pain, maintain muscle strength, improve deep core strength.

Third trimester: Pelvic floor exercises, no exercising on your back or tummy, maintain fitness and strength.

Post-natal:  Whether you had a natural or caesarean delivery, the first 6 weeks is gentle. Enjoy being a mum and focus on walking, pelvic floor exercises and correct deep core exercises. It is best to get your tummy and pelvic floor muscles checked by a physio before returning to exercise. When your baby is 12 weeks old and you have been cleared by your health professional, you can slowly return to your normal exercise routine.

If you have any concerns regarding exercising whilst pregnant or have any aches and pains during your pregnancy it is probably best to seek some advice from a health practitioner, such as your doctor or physiotherapist.

The team at Clifton Hill Physiotherapy have a lot of experience in helping women to start and continue exercising during their pregnancy by managing any aches and pains you have.

We also run small supervised group exercise classes at our Clifton Hill Rehabilitation and Pilates site. Here we provide a tailored exercise program for you to help you to achieve your exercise goals.

 

Clare Williamson

Physiotherapist

Pilates instructor

References:

Mottola MF, Davenport MH, Ruchat S-M, et al. 2019 Canadian guideline for physical activity throughout pregnancy, British Journal of Sports Medicine 2018; 52: 133-1346

https://sma.org.au/sma-site-content/uploads/2017/08/SMA-Position-Statement-Exercise-Pregnancy.pdf

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Pilates and health reform -all you need to know.

You may be aware that the Department of Health’s private health insurance reforms for natural therapies will take effect from 1 April 2019. This means private health insurance rebates will no longer be available for a number of natural therapies. Physiotherapists will be the only practitioners who will be eligible to deliver exercises drawn from Pilates within their scope of practice and be eligible for Private Health Insurance rebates.

You are still covered for classes at CHPR when they are conducted by a qualified physiotherapist and you can still claim on your Private Health Insurance as usual.

If you previously claimed private health insurance extras for Pilates classes, you will still be eligible to make a claim for services provided by Physiotherapists at CHPR and nothing will change in that regard.

What will change?
The new rules mean that some wording has to change on receipts and how our classes are described online in MBO and our website, these will now be referred to as  Clinical Exercise Classes. The new rules also make it mandatory for you to have your program reviewed regularly by your physiotherapist. It is essential that you make an individual appointment to have your personal program and goals reviewed at least once every 12 months or sooner as guided by your physio. It is also essential that initial individual assessments are done and programs are designed and taught thoroughly before joining a class or rejoining after a long break or for a new problem.

Not all Private Health Insurers are adopting all the new rules. The reforms can be confusing, and we hope this helps explain the changes and how they may affect you. If you have any further questions, please don’t hesitate to ask us at CHPR.

Kind regards,

The team at CHPR

pessary

PROLAPSE- Forget the taboo girls –talk about it and get help!

There is a taboo topic that women are fearful of discussing but should be discussing…something that everyone likes to ignore because it can be embarrassing and a little awkward. The reason we should be discussing prolapse is that 50% of women over the age of 50 that have had a vaginal birth will experience this issue! But it doesn’t just effect women over 50. And there is something we can do about it!

Prolapse of the pelvic organs; commonly known among health professionals as “POP”.

It will affect many women throughout the lifespan and in fact one in four women are currently experiencing one or more prolapse symptoms. These symptoms can include a feeling of heaviness in the vagina, difficulty emptying the bladder or bowel properly, a sense of a lump or bulge in the vagina. What is a prolapse anyway? How does it happen and what are the symptoms? But more importantly how can I prevent it and what can be done for it?

POP means a weakening of the vaginal walls allowing the organs that sit adjacent (bladder, cervix or rectum) to sit lower in the pelvis allowing them to be felt more in the vaginal walls. This issue commonly occurs after a difficult vaginal birth, particularly those involving forceps. It can also occur from long term (years) of straining on the toilet to pass a bowel movement.

POP is commonly the reason that we see women give up sport. The impact of running, jumping, skipping, lifting heavy weights is that is can worsen the symptoms and severity of a prolapse.

The great news is that pelvic floor physiotherapy can help prevent and treat prolapse! We can identify women that are at higher risk to help them understand prevention. We can treat those that are already dealing with prolapse with exercises, lifestyle advice and now a new service at Clifton Hill Physiotherapy – a support pessary.

Issy is credentialed and trained to fit silicone pessaries. This is a product that can allow women to get back to activities which were previously too symptom- provoking or causing concern about worsening their prolapse.

So what is a pessary?

Well it certainly isn’t a new invention although they have come a long way in the past 10 years. They are a soft, silicone device of various shapes; often a ring or a cube which is inserted into the vagina to help support the vaginal walls. Think of it like scaffolding to help support a building. It can be used for sport, lifting toddlers, or every day. When fitted correctly they are completely comfortable and there should be no way of knowing it is even there.

A pessary can be completely transformative. We have fitted them in women who are now back into their running, basketball, cross-fit or general life activities without the worry of making their POP worse. In fact in some women it can actually improve the POP.

If you’re interested in discussing prolapse or a pessary come in and see one of the lovely physiotherapists in the Pelvic health team who can help guide you through the process.

Our Pilates Teachers are familiar with ensuring prolapse-safe exercise , speak to you instructor if you have symptoms.

Isabella Lees-Trinca 

B Physio Grad Cert Continence and Pelvic Floor Rehabilitation

issy@cliftonhillphysiotherapy.com.au