Your Lifestyle Is Your Medicine

Episode 33: Postpartum muscle dysfunctions and Postnatal recovery with Peter Lap

November 09, 2023 Peter Lap Season 2 Episode 33
Your Lifestyle Is Your Medicine
Episode 33: Postpartum muscle dysfunctions and Postnatal recovery with Peter Lap
Show Notes Transcript Chapter Markers

Pregnancy and childbirth are life-changing experiences for parents; bringing a healthy baby into the world is a wonderful gift. However, this experience alters women forever, emotionally, spiritually, and physically.

In the podcast episode with Peter Lap, the founder of the Super Affordable Healthy Postnatal Body Program, we delve into the crucial aspect of postnatal exercise and recovery. 

With his wealth of experience and expertise, Peter is here to shed light on the role of postnatal exercises and how to recover from common muscle dysfunctions associated with childbirth.

Peter provides valuable insights into accurately measuring and rehabilitating diastasis recti, glute and pelvic floor weakness, urinary incontinence, and back pain.

This episode is a treasure trove of invaluable insights for those contemplating pregnancy, currently pregnant, or in their postpartum stage.


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Speaker 1:

Welcome to the your Lifestyle is your Medicine podcast, where we do deep dives into topics of mind, body and spirit. Through these conversations, you'll get practical advice and effective strategies to improve your health and ultimately add healthspan to your lifespan. I'm Ed Padgett. I'm an arse chipath and exercise physiologist with a special interest in longevity. Today we are speaking to Peter Lab. He's the founder of the super affordable healthy postnatal body program. He's a true believer that high quality postnatal rehab is a right, not a privilege. He spent years in the personal training world and took specialist training in postnatal exercises, and now he runs his courses globally. What's interesting about Peter is he really does feel as though everybody should have access to his course. He actually has a course and he gives it away for free for three months. If you want to continue, it's a nominal fee for five months and then it's yours for life. Today we're going to find out more about how to measure and rehab diastasis recti, which is a common splitting of the stomach muscles that people get when they're pregnant. Mummy butt now, those are my words, not his, but that's a common switching off of the gluteal muscles, which means the butt can get a little bit smaller than it was when, prior to pregnancy, we're going to look at common back and neck problems that can happen once a person is pushing a buggy or breastfeeding or doing all the things that come with having a baby. This is going to be really interesting for those of you who are contemplating getting pregnant. I've got pregnant, have a baby or even having another baby, because if you don't address things after baby number one, they can actually get worse with baby number two, three, four and five. Enjoy this episode. You'll learn a lot and Peter has some great take home advice for you. Okay, peter, welcome to the show.

Speaker 2:

Thank you very much for having me out.

Speaker 1:

All right, some people listen to this. Might think it's a bit strange that they can listen to two guys talk about postnatal exercises for women, but, as you've said in your podcast, it's worth seeking a specialist to help with special issues. So, with that in mind, I want you to tell us what are the most common injuries that a person may get after birth that need rehabilitating?

Speaker 2:

Yeah sure, and you're completely right. It can come across as a little bit strange, but you know, like I said, I just happened to have studied this and this happens to be the world I've fallen into, so to speak. So I see the most common cases and most women and most of your female listeners and maybe some male listeners will be familiar with this as well Our pelvic floor weakness that is quite common obviously been carrying a tremendous amount of pressure for six, seven months. Diastasis rectus is a separation of the stomach muscles, generally speaking, a slightly weaker core. Postpartum back pain is incredibly common. Postpartum neck pain A lot of your listeners will be very familiar with from basically just being out of position a lot when you start breastfeeding and all that sort of stuff. When you push buggies and prams up a hill all the time, especially, that's especially common where I live up in Scotland. Thalvegurtal pain is a very common problem as well and, just generally speaking, for any healthcare professionals listening out, there's just some muscle dysfunction, the glutes not doing quite what they're supposed to, one or two alignment issues that can lead to increased pressure on the core and all that sort of stuff. Those are the most common things that I see.

Speaker 1:

What about incontinence? Is that something that you see as well?

Speaker 2:

Yeah, pelvic floor weakness and incontinence, urinary incontinence, are extremely common, especially the early postpartum stages, because we do find that a lot of the time urinary incontinence is kind of resolved after six weeks when the pelvic floor gets a bit stronger and women can do some basic keg or exercises and all that sort of stuff again. But yeah, for anybody listening to this, it is extremely common to have it happen, especially for the first few weeks.

Speaker 1:

Yeah, okay, well, let's go into a deep dive into some of those so that we can learn a little bit more about what they are, what the normal progression is and how seeing a postnatal exercise expert can help. But I'm also interested just quickly, can you tell us how you became you know who you are and how you came to run the healthy postnatal body program?

Speaker 2:

Yeah, sure. So I used to have a proper job, as I always say, I used to be a project manager and I hated my life as it was. So I had to be trained and do something else. I was working, I was doing the standard 18, 90 hour weeks, my wife was miserable, I was miserable, so I had to do something else, and personal training, kind of, was one of those things that came up. And when I started, for some reason a lot of my clientele were between the ages of 24 to 30. About 80% were women, and one of my personal training friends in America said that he had this exactly the same client base but he kept losing them all. We said as soon as they felt pregnant, he couldn't train them anymore and postpartum he had no idea what to do. And I spoke to my clients who were indeed trying for families and they were saying, yeah, but we'd like to train with you, so why would we leave? I said, well, I bet it gets some qualifications then, right At first, I need to make sure I know what I'm doing, and this was about 10, 12 years ago, something like that. And the more I more qualifications I got, the more women I trained, the more I wrote about postpartum physical health, the more it became obvious that it wasn't really that big a thing. At the time. There weren't that many people doing it, let alone people making it affordable. So even if so, I was getting emails from people all over the world because I wrote a lot on my personal training website and people were sending me emails saying, yeah, but how does this work and how does that work? I mean, if you look at the dialysis recti, it's three centimeters or three fingers wide. It's four fingers wide. I'm a year postpartum. I don't know what to look for in a personal trainer, and that surprised me because I thought 50% of the population is female. Roughly a lot of them will have kids at some stage. Why is this not a bigger thing? And, of course, as now middle-aged white men, but just as a typical white guy sort of thing, I hadn't considered that there was a gap in the market that just wasn't being catered to at all. And then I started seeing one or two other programs come out and they were very expensive, as in those part of exercise became one of those. You know the average weight loss program. If you do an online one, you buy a 12 week program. It's about $60, 50 quid, maybe 50 pounds, and the postpartum ones were gone for 500. And for that doesn't make sense because if we accept that most postpartum women will have some issues, it doesn't make sense to charge them that much for what is essential, what I view as an essential service. This is something everybody should have access to, not just people with 500 pounds to spend or 500 dollars to spend. That's a tremendous amount of money for most people to spend on any sort of, let alone an online, program but even for personal training. That is quite pricey and, don't get me wrong, my personal training package, one on one, is a bit more expensive than that. But I still feel that everybody should have some form of access to completely affordable if not free, free postpartum advice. And you know I tried at the time. I wrote emails and messaged the NHS, trust and all that sort of stuff saying listen, guys, I have a program, you can have it for free, I'll give it to you, just do something with it. And nobody was really interested. So this was before Healthy PostnatalBodycom was the thing. So I just thought, okay, I'll just build it myself. You know, build it and they will come type deal. So four or five years ago I started building the website myself and a year later I was very lucky that one of my clients said okay, we need to make this look a bit better and a bit smoother, because I like what you're doing giving extra amount of access for free and all that sort of stuff and therefore let's see if we can get this going a little bit, which is why the website looks a lot better now than it did five or so years ago.

Speaker 1:

Okay, with that in mind, let's get into the problems that commonly occur. So my ex-wife now she had two children and one of the things that she noticed was that diasterecetà, and that's what a lot of my clients for osteopathy come to me, and they come because of that. All they happen to have it. We pick it up on their sort of health screening. So what is it and what can we do about it?

Speaker 2:

So fundamentally, diasterecetà and this really depends on who you're talking to a little bit I have a slightly different definition for most. But so for most, most physios will tell you that diasterecetà is separation of the stomach muscles along the linealba, and that is that midline that runs roughly from your sternum to your pubis, along the line of your belly button, and those muscles of course think of your belly like an inflated balloon when you're pregnant, right? So those muscles kind of move apart a little bit and that sheet that connects those two muscles get stretched, or that connects those two sides of the muscles get stretched a bit and not everything falls back naturally into place afterwards. So for diasterecetà, 100% of women will have this during pregnancy, right? That is completely normal and there's nothing to worry about. Then that separation, in a lot of cases, in about 80% of cases, that closes within a year, right? So that, for instance, there was a study done by the Journal of Sports Science that said that 20% of people who have women still have issues a year postpartum. Now the reason I say I have a slightly different definition of diasterecetà is because I include muscle functionality in them, because when you hear a lot, postpartum is oh, she bounced back so quickly, right, when you look at someone six weeks or two months later, their shape appears to be completely normal from what it was, completely the same as what it was before. They even felt pregnant in a lot of cases. You know, catherine Middleton, our princess royal, is one of those prime examples that people always say that she bounced back so quickly. The issue is quite often that, yes, everything is back in its place, but not everything is working properly at that stage, not necessarily and that means that you still have muscle weakness, you still have some muscle dysfunction, and that can lead to or then, when I say can, it will lead to problems later on if you don't address that. So I much prefer to include that in the definition of diasterecetà. So I say it's about the width of the gap, the depth of the gap, and then it includes muscle functionality.

Speaker 1:

Okay, and so how can a person measure it on themselves?

Speaker 2:

Right, that's an excellent question. So, basically, what you can do is and there's a video of this on my YouTube channel for how I like people to measure it. I say always measure it yourself, because for some reason, diasterecetà tends to be measured in fingers, because we use our fingers, and this is something that drives me nuts. But we use our fingers to measure it. So you lie on the floor and if you imagine me lying on the floor now for anybody looking at this, for anybody watching this, and you place a finger along, just say about an inch or two above your belly button, that's where you start. You press it down and then you lift your head up and you see whether you get the sensation that a little baby is gripping your finger. That's kind of what we go for, for that, you know. Anybody who's a mum will remember that first moment where you had your pinky in your child's hand and it ever so slightly tightened. So we're looking for a bit of resistance, so a bit of pushback and a little bit of a grip in an ideal world.

Speaker 1:

These are the two muscles coming together.

Speaker 2:

Yes, those are the two muscles coming together and the TVA, your transfer of dominance, or one of the deeper core muscles, pushing up a little bit. That is kind of what we're hoping for. If that doesn't happen with one finger, you kind of just put the second finger next to them and then you try again, and then a third and a fourth even. In some cases you do this above the belly button and below the belly button about an inch inch and a half. So what is that? Three or four centimeters above and below the belly button. Now you can have several different kinds of disasters right. Some people have it just above the belly button, some people have it just below the belly button and in some cases it's what we call open and that is kind of along the line of, and that's the most common one. It's okay, then, to say what I then do is, instead of just measuring with fingers, I then say, okay, look at your fingers, how far apart they were, how many fingers you choose, and place them on the measuring tape, because I like to know centimeters. I think it's really odd that we measure something in fingers, especially when you go to a GP, and most women will be familiar with this. You go to a GP for your six-week checkup and they check the baby and they check yourself, and then they measure with a disasters recta. But if they measure for it and your GP happens to have sausage fingers or big manhands, like I do, and then you come home and you do your exercises and you work really hard and a month later you measure yourself and you have, let's say, more lady-like fingers, then you think your disasters recta has gone up, whereas actually it hasn't. You just don't have a suitable, you don't have a reliable way of measuring. So always I like to measure in centimeters. Now and this is important because disasters recta is classed as anything above, say, 25 millimeters, so two and a half centimeters. Anything below that is classed as completely normal. So one finger tends to be roughly that completely normal, whereas for some people that might. No-transcript.

Speaker 1:

Okay, now, if someone has this, they say they measure themselves and they've like okay, I've definitely got this. I guess one of the first things to think about is what they shouldn't be doing and then what they should be doing. So let's think about what they shouldn't be doing.

Speaker 2:

Well, first of all, what they shouldn't be doing is panic. It is completely normal because a lot of people do right. They have some sort of stuff feels loose and stuff feels weak, and they think, oh my God, this is never going to be normal again. Dianastasis Recta is fundamentally a muscular problem, and with what any personal trainer, any physio, anybody in the world can tell you, a muscle getting stronger resolves muscle weakness. It is just that simple. No muscle problems tend to be permanent, unless you have some sort of degenerative illness. So what we then find is we don't need to panic, and what we then want to do is not so much what you don't want to do as what you do want to do is learning to breathe. What a lot of people tend to do is my dog snores in the background. The public is with him. What a lot of people tend to do is, when they exercise, they tend to hold their breath and you've probably come across this a lot as well. They start bracing the core when they pick something up. That is the one thing you want to avoid. Technically, dianastasis Recta is caused by increased pressure on the abdominal wall and therefore any sort of increased pressure that you add to it, and it can be by running high impact exercise in general, or holding your breath tends to make the problem at least, if not worse, then more difficult to heal. And then what we do want to do is first learn how to breathe properly, and that's a different way of breathing than what most people are used to. So I use the core breath rather than say diaphragmatic breathing, and by that I mean exhaling whilst being aware of what your core muscles are doing. So for anybody listening to this and watching this, if you place your hand on your belly button completely so that, say, the fingers are below your belly button and the rest of your hand is above your belly button and then you exhale, try to exhale with the lower part of your belly first, so that you can pull that in and up, rather than what most people do. When they exhale, they collapse in on themselves. They get that deep sound. If I get most people to do a deep breath, take a deep breath and they exhale, they almost collapse in on themselves, and that is kind of the non-ideal way to breathe. When you're talking about Dianastasis Recta, we want to learn how to contract those muscles, and then it just becomes a case of strengthening the right muscles, bringing the body back into alignment. So working on the glutes a little bit, because that's quite often what one of the issue, what one of the problem muscle groups is and then you know if you're breathing your way through it. You can pretty much recover quite quickly in a lot of cases.

Speaker 1:

You know people ask me about doing sit-ups and whether that pulls the muscles apart more or not. What do you think about that?

Speaker 2:

Yeah, that's an interesting one, because 10 years ago we all thought so. 10 years ago we were all convinced that doing a sit-up or any crunching motion or holding a plank was a problem in itself. The issue that what we found since is that as long as you exhale through the motion, with a crunch for instance and I've written about this quite extensively when you do a crunch, if you exhale through it properly, there is no reason why there would be increased pressure on the abdominal wall. Issue, therefore, is not so much whether a crunch will hurt your diastasis if executed properly. A poorly executed exercise is always going to hinder any sort of progress. It goes for planks, it goes for anything that is. Even glute bridges wouldn't help. However, a crunch is not useful for bringing the muscles together, because when we think about a crunch is a very lateral movement. The top, basically the top two abdominal muscles get squeezed together. Those top two, first of all, are hardly ever the problem and also the way they're squeezed together doesn't do anything to bring the muscles together. So I really like to look at. There is no such thing as a bad exercise, necessarily, unless your body isn't ready to do the exercise properly. Your body doesn't know how to do the exercise well. I mean, the muscles don't know how to respond or you are not executing it correctly, and that can be an issue. So a sit-up isn't necessarily a problem, other than the sit-up won't do you any good whatsoever even if you execute it well.

Speaker 1:

Okay. So what's the biggest bang for the buck? Exercise-wise for dastis recti, or is there not just one?

Speaker 2:

Well, yeah, that's a good question. So, because we have so many different kinds of dastis recti we have, like I said, above the belly button, below it and then completely open and various kinds of muscle dysfunction. I tend to say two things First of all, you work on the breathing, the core breath, like I mentioned, and secondly, you work on your glutes much more than you work on, say, your transverse abdominis, your TVA, which a lot of your listeners will have heard about and they'll focus on that, mainly because all the exercise you do especially for your glutes. So we're talking glute bridges, we're talking glute kickbacks with a resistance band, we're talking squats, we're talking lunges. They will also work your core if you breathe through them. Well, yeah, right, you exhale on the way up out of a squat. Everything tightens up. If you do it well, you get much more from that than you would do from, say, any sort of transverse abdominis exercises that squeezes a relatively small muscle group together, or any sort of plank even and I'm a big fan of isometric plank, like exercises. But bang for your buck. We're talking the glutes pretty much all day long, combined with good breathing. Okay.

Speaker 1:

So with the glutes in mind, then a lot of my female clients talk about mummy, mummy, but they call it when they used to have a shapely bottom and now it's not so shapely. Can you explain that like? Is that a real thing? Yes, absolutely.

Speaker 2:

And this is this is part of the problem why what you'll see with your female clients when they come to you, their alignment isn't quite right, and that is basically because, during your pregnancy, your center of gravity shifts right. The baby sits in the belly and the baby grows Before you know it. You get that pregnancy waddle almost. You get that duck like sort of movement that a lot of women have, and the problem with that is that if, if you, for instance, stick your bum out every time In the same way that, say, beyonce does, every time Beyonce goes out on stage, her bum moves out a little bit. She's really, really, really good at it. Look at all her videos. That always happens. If your ribs are in front of your hips, you can always feel your glutes Right, right, you always in the. Inevitably they, they activate a little bit. I call it and I know some physios will lose their mind when they say activate, but that is just what I call it. People understand that. If, however, you have a pelvic tilt which is what you'll come across a lot as well I call it. They disengage a little bit, and when you get that center of gravity shifts, everything is a bit easier for a woman if she leans back a little bit, and that means that those glit muscles don't get used as much for, say, for five months during the pregnancy. And then we have the whole six week recovery period. And anybody in the world will tell you that if you don't use muscles as much as you usually do for a prolonged period of time, those muscles will get a bit weaker, they'll get a little bit softer, so to speak. In the case of the bottom, they get a little bit softer. So what we then do, what I then do, is say, for all the glue bridges and the glue kicks and all the sort of stuff, you pull, essentially you pull the body back into alignment. That's fundamentally what it's about and you strengthen those muscles up and all of a sudden the bottom that they used to have before they had a child comes back. This is, it's just fairly basic strengthening of the glitz. All of a sudden, the bottom is a bit firmer again.

Speaker 1:

So it's mainly an alignment issue. Then there's no damage to the muscle or anything like that.

Speaker 2:

No, no, not at all. It's like you said. It's an alignment issue and just a bit of muscle weakness, and this is why I always say there's nothing to worry about. There's fundamentally nothing wrong with the muscle. It's just not being used in the right way for it. But we just need to train up back up Now.

Speaker 1:

you mentioned that the six week recovery period post birth. Should a person or should a lady be doing exercises in that six week recovery period, or should they wait and then they say, oh, this didn't recover like we thought it would. Now it's time to exercise.

Speaker 2:

Yeah, the the the six week period that. The reason I mentioned the six week period is because that's usually when you go to your GP. Out the six weeks you get a sign off from your GP. The rule tends to be that as soon as you feel comfortable you can start doing your pelvic floor exercises right, your Kegels and all that sort of stuff. That's usually around the two week mark for most women who've had a had a normal and a non C section birth. Now for women who've had who then go to their GP, I think weeks this GP usually then says, yeah, there's fundamentally nothing to stop you going back to exercise Now. For people who've had a C section, that will be usually the seven to eight week mark because it takes a little while longer for everything to heal. But what you start to do then, exercise wise, is just very gentle, building it all back up right. When the GP says you're good to start exercising again, they don't necessarily mean you can run a 10 K again tomorrow. Yeah, even if you were able to run a 10 K before you were pregnant and you know, I know some people class walking is excellent. Exercise early on in the pregnancy I always say you have to get out of the house anyway. So you know, walking is great, walking is very useful and I like walking as a form of just getting out and about and keeping the body moving, but they don't class that as a separate form of exercise. Postpartum.

Speaker 1:

Right, okay, and you mentioned their C sections as well. Is there something more common that happens with people who have a C section then, versus a normal vaginal delivery?

Speaker 2:

Not really, other than people who have C sections tend to have fewer and this makes complete sense fewer pelvic floor issues. Yeah, and that just makes makes sense to. Recovery process is different though. So for anybody going through a C section you'll end up with a little scar, and in some cases you end up with a big scar and that can be tender for quite a while. So you have to be a little bit more careful and a bit be a little bit more aware of that. And one thing that I do always recommend everybody who has had a C section do is start scar massage pretty much whenever you feel everything is somewhat on its way to recovery, and when it doesn't hurt anymore, so start massage in the scar so it doesn't tighten up too much. But fundamentally, from a postpartum recovery perspective, other than it taking a little bit longer, there is nothing particularly you need to worry about when you've had a C section that you don't need to worry about when you've given birth without having a C section.

Speaker 1:

Okay, all right. So we've looked at diastasis recti, we've looked at the glutes. Let's get into the posture aspect of things. You were talking about back pain and neck pain, and that can commonly happen when people are doing these new positions breastfeeding, pushing prams and so on. How does exercise help with that?

Speaker 2:

Yeah, that's again. That's a good question, because a lot of the time, what we find is that the advice given to women is to stop doing the things that make the posture worse. Right, that is the go-to. So what a lot of women will be aware of. A lot of men will be aware of this as well. If you have a child, you still have things to do. You've got the baby on the hip a little bit right and therefore you lean to one side and the baby sits on the hip, so your body's out of alignment and what most of the advice and scissors? Stop doing that, which is not the most useful advice, because you have to carry a child around anyway. You have to push your pram up a hill. From a very practical perspective with regards to prams, try to find one that keeps your hands in a neutral position. So and you'll be very familiar with this so if your hand is like this, your hand is relatively neutral. If your hand is like this, your shoulder blades out of position and this is how most people start pushing prams right, yeah, so try to find one in an ideal world where it's a little bit lower and you can push it with that fist in that position that helps keeping your shoulder blades in place. Failing that and let's be honest, most of the times people will fail that, because most prams are designed.

Speaker 1:

And not designed like that.

Speaker 2:

Yeah, not designed like that. It's something I've tried to work on, but I can't quite figure it out myself how to fix this. So there's an idea for any entrepreneur listening to that Make a device that can fit onto those handles and press them. Like that You'll be saving women tons of back pain. Basically, what we want to do is we want to stretch the muscles at the front a little bit, especially those pectoral muscles that because you cave in on yourself and as soon as you cave in on yourself a lot, then it sounds more drastic than it is. But when you're breastfeeding you need forward a bit those muscles, much like hamstrings for people in sedentary positions. They just tighten up a bit. They're not this long anymore, so we want to stretch them out a little bit. Just some 30 minute back stretches will really help. And we want to strengthen the muscles in the back up a little bit, especially the muscles underneath your shoulder blade, basically your posture muscles. And we find that, or I find that when you do that and you train the core and the glutes up sufficiently, the lower back problems kind of go away. I find that in a lot of cases postpartum lower back pain is hardly ever caused by problems in the lower back, it's always the surrounding areas. Yeah, that's that that caused the problem. So what I've used to come across a lot is people used to say I've done a ton of lower back exercises, I'm doing all the Superman exercises in the world I'm doing, I'm going to the gym to have those fancy machines where you can do those back raises and all that sort of stuff, and they said it just doesn't help. I said yeah, because the problem isn't so much that the muscle isn't strong enough. Lower back muscle groups aren't strong enough. It's that they're overcompensating for other things that aren't necessarily doing what they should be doing. Other muscles aren't strong enough to do what you want them to do.

Speaker 1:

Exactly. Yeah, this is something we look at an osteopathy as well, that if you're someone has lower back pain, it's usually not the lower back, that sort of fall. It's usually something in the hip that's asking the lower back to do too much. Or if we look above the lower back, it's something in the upper back. And what I've noticed with my clients is when they're breastfeeding their upper back gets very stiff and it could be a positional thing. But someone once explained to me that also it could be a neural thing, that the nerves that come from the back and then they go around to the front of the breast because they are sort of working so hard to produce the milk, there's a reflexive stiffening of the vertebrae in that area. There's something that I've thought about. So I always try and loosen off the upper back, work the hips and then, like you say, give these postural exercises. But I haven't thought about the vertical handles on the pram before. You would have thought someone would be able to sort of put a little clamp and a little tube pointing up.

Speaker 2:

I know it Well. That's basically what I thought of coming up with. The easy thing, I would just say to make a universal sort of clip it on to any sort of pram. Get it done, because all you need is one on each side. And I am not great with design, there's a reason. I'm a personal trainer. I used to be a project manager, right, I'm just not good at building stuff, but that would basically solve that issue for me in quite a lot of cases, and I care much more about getting the issue addressed than so. Anybody else who likes it and listens to this wants to work on it. You're free to have it. But yeah, because it's essentially a lot of the issues we find postpartum are a form of repetitive strain injuries, right, constantly doing the same thing in a less than ideal position. So it's not that different from fixing people's issues if they're used to sitting behind a desk all day and using a mouse in that same hand position and all that sort of stuff. It's exactly the same solution applies. And then, like you said, you do have one or two specific issues where, with breastfeeding is not the most relaxing thing in the world. Contrary to what we're told in the movies it's not magic and unicorns and rainbows and all that sort of stuff. It's quite stressful for a lot of people. It's not the you know. You sit at Costa Coffee having a chai tea and you just pop the baby on and you can just relax in a way of conversation. It's quite a tense sort of like you said exchange of things. You notice it in any person who is breastfeeding. You'll notice a change in their demeanor. Even if they are trying to be quite relaxed through it, it's not as relaxed as sitting on a light sofa watching a bit of Netflix.

Speaker 1:

Yeah, when should someone think about seeing a pelvic floor physiotherapist like a specialist in the actual pelvic floor? What symptoms would drive that need?

Speaker 2:

I basically say you should always see one. I personally think, women, if you can afford it, then go see, because these things are private in the UK quite often you'll have to wait a long time before a GP referral will catch you anywhere, if you have the money to do so. Most pelvic floor specialists are about 40, 45 pounds. They're not terribly expensive for a quick examination. They'll at least be able to tell you at the seven eight week stage that's your GP signs you off. Then you go see a pelvic floor specialist and they will be able to tell you whether everything is recovering along the right tracks and they can give you one or two exercises to do, because quite often women have a tendency to put up with things that are Common but not normal and not quite right, such as what you mentioned earlier leakage, a little bit of leakage. You see here to see this a lot. I read an article a while ago by the comedian Shappie Koshandy who said I Can't go to someone else's comedy show anymore because I pee myself when I laugh. But this is just a price I have to pay for having a baby. Yeah, just no, that almost drove me nuts, to be honest, because I just know that is Common. A lot of women complain about this postpartum, but this is it's a muscular issue, so this is something that you can address. I don't do pelvic floor specialism myself, for obvious reason. I am, at the end of the day, just a middle-aged white guy and that's quite an quite a delicate examination that I don't want to be in a room for necessarily. Yeah but it is. There are some excellent available. It's usually called a mommy MOT or something ridiculous like that, right, and like I said, they're about 45 pounds. If you spend your money on any sort of postpartum related thing and About by any I'm including myself and that, spend it on the pelvic floor specialists. Don't spend it with a personal trainer. Spend it on just one visit to Pelvic for specialists. If you can't afford it, again they like said the 45 to 60 pounds. But that's a lot of money for some people to throw in a problem. Get a referral from your NHS. Just go to your GP and say I want a referral and don't take no for an answer, because every single woman's postpartum journey Will start with a physical recovery. But again, contrary to what we're told in the movies, having a baby is quite a traumatic event on the body and Not resolving an issue after child one is what I this, I always say this Will bite you in the bum after child two. Right, but it's kind of like do you remember those auto glass commercials for and this is a bit of a UK reference Listening but you have a little chip in the windscreen and they always say the chip will turn into a crack, but the chip doesn't get better by itself, it just doesn't. You have to resolve that issue, and seeing someone relatively early on who can just say listen, I've done an examination, you're on the right track, just do do x, y and z and you will be fine, will help you by the time you find your second child and you know if you Are listening to this in your second thinking yeah, pete, that's great, but I'm on my third or fourth already and I've never seen one and now have issues. Most of those issues can still be addressed for exercise. Just try to see one now. It's never too late, it's just a bit easier if you do it nice and early on?

Speaker 1:

Okay, all right. So how does the postnatal body program what you offer online? Where does that fit? I mean, if you seem to be saying that you prefer people to see spending their money on a public floor Assessment more than just the exercises, but what do you see like the progression being so from birth? Then you know them. How do they end up in your program?

Speaker 2:

Basically. Yeah, that's that's. That's a fair point. I always seem to steer people in the direction of other people rather myself. But so, as I always say, the the post, the healthy postnatal body program will also help you with your pelvic floor issues, right? It's just one of those things that, if you can afford it, go see, go work with someone. One-on-one, right.

Speaker 1:

Yeah.

Speaker 2:

The. The way any sort of good postpartum program should work is the first four to six weeks I I spend, as say, what I call muscle activation stage. Just make sure everything teaching the body to work again, to work properly again, without having that set up pregnancy wall, all making sure the glutes fire up nicely, everything nice and gentle, because nobody has time for, like, a 45 minute kettlebell session and all that sort of stuff. No one has the time of the energy for that, so it's all nice and steady. And then after that we have a six to eight week period where we really start to strengthen the muscles up a little bit. Now that is the first three months of of the of the exercise program. And that is you. That is when I tell people listen, if at this stage you're feeling like it's going okay, just go do your own thing. You should let that stage be ready, with a little bit of guidance Maybe, to go do whatever you want to do go cycle again, go run again and all that sort of stuff If you want to hang about, because, like, like you come across a lot, a Lot of women will have other issues postpartum that they want to work on. They can choose between three different things In the program and that splits up for like another six months or so and that is the extra. Like 50 bucks or 10, $10 a month, 8 pound a month. I Tell people that you can come to me at that six week stage when the GP says you're good to exercise again. Healthy postnatal body outcome will help, it will do, it will work. I mean that is, I've done this for over a decade. The program is sound as a pound. It is really really quite good at that. That's helping people with that. But, like I said, online is not quite as easy as face to face. So if you can swing a face to face thing, then that's what you're going to do and if you can't, you go do an online program. That is always your second step and for that I like to say you know, and like I said, with healthy postnatal body, you sign up for anybody listening to this. You sign up, you cancel on day one, I don't care, you still get three months, right, right, and the access is there. But that is basically how. That's how that slots in. And we work on things like the Dysosus recti, pelvic girdle pain, pelvic floor issues, back pain and neck pain just through. The program is designed so that all these things get addressed. I just don't mention them all individually because then you're drowning in a sea of information and you know, quite often personal trainers have a tendency and I definitely do have a tendency to over complicate things, sometimes Not deliberately, just because we get excited about certain things. And I'm going to dig into this bit and talk to someone for an hour about pelvic girdle pain when all they asked was will this get better? All the exercises are kind of they work together to address all these things and that's why I always say for three months, and this most exercise programs are three month programs. Right, they tend to be 12 weeks, and for various reasons. First of all, you can get tremendous results in 12 weeks and you can't really get them after like a week. And secondly, I can probably get you to stick out a program for three months and that's a big help. So that and the reason that because we can get good results in three months that's the reason I say everybody should have three months free access to this, because I can get you good results within three months, like and that means that every woman out there that says I have one or two issues and I can't afford to go by a more complicated system Find two days for three months and the benefit of that is that you know you get people, get their well functioning body back, they're more pleasant in the house and all that sort of stuff. Everybody knows about the pain cycle. You know if you're always in pain you're not going to be as pleasant to be around. I've had a chronic knee injury for for ages. I started taking that out on people's heart to get that address, not deliberately, but still it's it's. If you're always grumpy, then you know. So, yeah, sorry, I hope that answered your question.

Speaker 1:

That's perfect. Yeah, I understand. So you're saying you know an ideal world, see one on one. If that's not possible, you've got this essentially a free solution for 12 weeks for everybody globally, and that is over at healthy postnatal bodycom. And where else can people follow you and find out a little bit more about you?

Speaker 2:

I am on. Well, I, we do a little. We do a little bit on Instagram and Facebook. I'm just not a big fan. We just basically say the healthy postnatal body podcast is out there, of course, the current on episode like 230 odd. So I've been, we've been running for a while. People can email me, peter, at healthy postnatal bodycom. You don't have to be a member to email me, and the reason I say that is because it's 230 episodes in and I have expert interviews and all that sort of stuff. But I regularly I do q&a's and after 230 episodes you're sometimes just completely out of stuff to talk about, right? So so I enjoy this emails because I can at least say I have an email in. This is an episode. I am very active on Fred's. You know the new, not Twitter, so just think it's it's it's the Instagram based Twitter version and that's where I'm a lot more active, but it's a very small platform. So emailing me is actually the best way to get in touch with me, to be honest.

Speaker 1:

It sounds like you'll actually get a reply as well. You will reply.

Speaker 2:

I always respond because I love emails.

Speaker 1:

Yeah, perfect. Well, peter, this has been very informative and a lot of fun, and I think what you're sharing there is a huge resource for for women all over the world, and I'm just I'm happy and glad that you're doing it.

Speaker 2:

Yeah, and I'm delighted to come on, like you said, with your YouTube channel is wonderful. I no longer look at your YouTube channel and it's chock full of good information, so I'm just delighted to come on to the excellent podcast. Thank you very much.

Speaker 1:

You have a good day. Yes, Thank you for joining me in my conversation with Peter. If you have enjoyed listening to and learning from this podcast, please leave a comment and what are there? You can also leave a suggestion for a future podcast guest that you would like us to feature Now. I coach people use the principles of lifestyle medicine to recover from illness and injury and how to age with style. So if you want my direct help, send me an email at edpagetcom or visit my website at pagecom. While you're there, you may as well sign up for my weekly newsletter pack full of great advice about using lifestyle medicine to add health span to your lifespan.

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Understanding Diastasis Recti and Measurement Techniques
Post-Pregnancy Exercise and Strengthening the Glutes
Postpartum Recovery and Exercise
Postpartum Recovery and Exercise Program
Podcast and Lifestyle Medicine Discussion