Ideally you know what a Women's Health Physio is, have already seen one and continue to work together through the different stages of life. But this isn't the case for many women. Alycia Hatzi explains why it's so important to see a WHP and highlights some really important questions to ask them.
A Women’s Health Physiotherapist (WHP) or pelvic floor physiotherapist is a physiotherapist that specialises in women’s health particularly related to the pelvis and abdominal areas. This extends to but is not limited to pelvic pain, bladder/bowel incontinence, hip pain, pelvic floor weakness, core rehabilitation, stretching, posture, pregnancy related back/pelvic pain, post natal recovery, sexual function, pelvic organ prolapse and much more.
Ideally you know what a WHP is; ideally you have already seen a WHP in your life; and ideally you continue to work together through all stages of your life to optimise your health and body function.
Unfortunately this is not the case for many women I speak with. Most of them are unaware that a WHP even exists let alone have gone to see one.
Part of my job training women in safe return to exercise postpartum is to educate them about their body, muscles, movement and injury prevention. I believe a WHP assessment is a vital tool to every woman’s very individual journey of health, exercise and understanding her own body.
Finding the right WHP for you is also equally important because the relationship you form with your WHP is quite a personal one based on the amount of information you will share with them over your lifetime. Just like having your own GP, I believe having your own WHP is essential in your journey through life as a woman due to all of the changes we go through (for example pregnancy, birth, peri-menopause, menopause and so on).
Your WHP will go through a series of questions with you such as bladder habits, pregnancy or birth history, sex, lifestyle habits such as exercise and diet to name a few. This will extend to your exact purpose of the visit and obviously you will go over more individual things during the session as well such as if you have a specific injury or concern.
The general format regarding your Pelvic Floor will go similar to this; you will be asked if you feel comfortable with a physical assessment which can be a selection or combination of:
- abdominal wall assessment checking for diastasis recti, tension of the linea alba, activation of the abdominals, particularly the transverse abdominals
- pelvic floor assessment through an internal vaginal examination checking tone of the PF; some WHP will also do further assessments here such as a Genital Hiatus + Perineal Body (GH+PB) measurement to further assess tone of the PF and can help with understanding the risk of Pelvic Organ Prolapse
- pelvic floor activation through Real Time Ultrasound to check the movement and lift of the bladder
They may also check:
- body tension
- specific area/muscle you are concerned about
During your assessment you should not be afraid to ask your WHP questions about what she is checking and why. Ask her what everything means so that you have an understanding of what she is finding out about you and ask her to comprehensively relay that back to you. As a MumSafe™ trainer, I am constantly bridging that gap of information from WHP to my clients because a lot of the people I work with simply don’t know enough about what they should know.
Things to ask your WHP could include:
- What sort of tone does my PF have (high/low)? And what does that mean for me exactly? E.g. do I need to focus more on relaxation or contraction of my PF?
- Am I at risk of pelvic organ prolapse? E.g. what things to look out for, what exercises to do/avoid for now?
- Do I have any abdominal seperation? If so, where exactly? E.g. What is the depth like? What is the width like (in all spots)? Do I have tension in my linea alba? Is my core functional? What core exercises are recommended?
- Am I correctly activating my PF? E.g. Am I contracting and lifting on exhale?
- Can I activate my transverse abdominals correctly? Am I over using my obliques or rectus abdominals? What do I need to do in this area (if anything)? E.g. Do I bear down or hold my breath when activating ‘my core’?
- What exercises or breathing techniques do you prescribe and why? How does this translate into my current training program? Do I need to avoid or change anything I am doing? E.g. Ask about 360 breathing techniques.
- Am I cleared for HIGH IMPACT exercise such as running or HIIT classes? If not – what sort of plan do we have in place? E.g. Do we schedule a review for 2, 4, 6 weeks time?
- Can you send a report of my assessment to my trainer (if you are training with someone) so we can ensure a safe exercise selection going forward? E.g. What exercise should I do for now and work up to etc.
- What is my posture and breathing like? E.g. Do I belly breath, chest breath, do I have any rib expansion on inhale, does my belly flatten on exhale?
- Do I need to work on releasing any areas/muscles? E.g. Release work for chest or strengthening exercises for back muscles.
- What is the infrasternal angle of my ribs? E.g. Do I flare my ribs on standing or during certain exercises?
These questions may seem overwhelming, but don’t worry! Just talk about what you feel comfortable with – this is an extensive list for those of you who are delving a little deeper into their WHP appointments. For me, I like to ask EVERYTHING but for a lot of people just simply learning how to properly activate their PF or being told if they are ready for high impact exercise yet or not is enough information.
Why not give your local WHP a call and check out their website for more information so you can make your next appointment with confidence. Click here to find a Women’s Health Physio in your area.
Alycia runs Strongest U Fitness in Bendigo, Victoria. To find out more about her and get in touch, click here.
You can also find her on Instagram.