The Blessing & Curse of Slow Change Over Time

“The chains of habit are too light to be felt until they are too heavy to be broken”

– Samuel Johnson

Today we are going to talk about two sides of the same coin: change. More specifically, how insidious seemingly small actions or symptoms can build over time to the point where we wonder what and where things went wrong. Yet on the flip-side how we expect everything to revert back to its previous state in the matter of days or weeks.

As you read through this article there is one concept I want to really sink in and that is that the habits and changes that happen slowly and consistently over a long period of time are the ones that stick. These are the changes that we don’t see coming until one day we can no longer deny them.

This is a truly important and empowering concept because it means we have a whole lot more control over our own health than we may think. And the sooner we can understand this, the sooner we can come face-to-face with our own habits, then the sooner we can recognize how they may be influencing our life and make long-lasting, positive change.

Insidious Change Over Time

I am a pelvic health physiotherapist so I will speak often about issues women face when it comes to the pelvic health, but the concepts I’m speaking about today can be true for other aspects of behavioural change.

I’m so fortunate to work with and be able to help incredible, strong, powerful women who come to me for help with a variety of health issues ranging from minor to quite debilitating. In my years of working with these amazing clients one reoccurring story keeps coming up that sounds something like this:

“I don’t remember when it started. There was no one event or one memory I have of leaking/pain/discomfort. But somehow along the way it has become my normal. It has become something I now deal with everyday.”

OR

“If I think back I can remember small incidents of leaking/pain years ago. But I just brushed it off. And then yesterday I completely emptied my bladder unexpectedly while I was at work and I could not stop it. It was so embarrassing and it was the last straw. I’ve waited long enough for help, enough is enough.”

OR

“I skipped going to the gym when I was slammed with work while on deadline for a big project and somehow never got back in to my old habit again. That was seven years ago.”

These statements (or similar versions) may sound familiar to you. The truth is we’ve all likely said something to ourselves along these lines. I think it is almost some sort of invincible fallacy – we simply don’t appreciate how much things will effect us. If we experience something negative (leaking when coughing, pain during sex, or a tweak in your knee) or make a choice to skip something positive (going to the gym, going to sleep at a reasonable hour) we try to logically justify why it happened or why it wouldn’t matter for us, because we’re different! We say things like:

“Oh, my bladder must have been REALLY full just then, and wow, that was one STRONG cough. Anyone would have leaked a bit with that one!”

OR

“I know I shouldn’t really strain hard to lift up this box or really push to have this bowel movement, but I’m in a hurry and it won’t make a difference if I do it just this one time, right?”

OR

“I’m beat. I’m going to skip the gym just this one time. Don’t they say that sleep is more important, anyway?”

It’s logical. It makes sense to us. And it really will be just this one time (or so we tell ourselves). But then after we brush off that one time (that first episode of leaking, that first episode of pain, the first time we go against what we know we should do) then the second time seems easier to justify too. Then the third.

See where I’m going with this?

It’s insidious.

We either do it entirely unintentionally (whether it be because we don’t notice or we don’t think it matters), or we do it intentionally but ignorantly – not realizing just how much of an effect over time these choices can have on our health and wellness habits.

This is the curse of small, slow change over time because we simply don’t recognize how important each individual decision, or each individual warning sign our body is telling us, is. And when we finally realize, when we finally take an objective look at what we are experiencing, what our body is telling us, or how we are feeling, when we finally are ready to do something about it, to improve our health, our habits, that is when we need to take a hard look at the flip-side of the coin.

Positive, Long-Term Change Takes Time Too

Have you ever dropped a behaviour after only a few weeks (or days) because it just wasn’t leading to the results you wanted as quickly as you expected?

I think the truth is we all have. But remember, you didn’t lose your shoulder mobility in a week so it is going to take longer than a week to get it back. You took 9 months to grow your beautiful baby girl so it is going to take longer than 6 weeks to look like your pre-pregnancy self.

The magic pill doesn’t exist. That vibrating chair you sit on for 30 minutes that claims to make your muscles contract to the equivalent of “11,000 Kegels” isn’t going to cure your incontinence. That crazy restrictive diet you’re going on isn’t going to be sustainable. Going so hard at the gym you injure yourself and can’t continue is only going to set you back.

The truth is the magic pill to success really isn’t all that sexy. It’s doing things that are good for your body day in and day out. Making positive choices and working with a coach (like a pelvic health physiotherapist, an orthopaedic physiotherapist, or a fitness and nutrition coach depending on your goals) who can guide you, progress you, and support you as you consistently work towards your goals.

I’m not saying this is easy. It most certainly is not. You may go through periods where you think it isn’t working, where you think that nothing is changing and that all of your hard work has been in vain. But then, one day (just like we talked about earlier), you will realize just how far you’ve come and wonder when exactly it all happened. But this time you won’t be sad and frustrated, but proud and empowered.

Remember the power of small change over time. How negative habits can creep in without us realizing, or how the positive ones can overcome. “The chains of habit are too light to be felt until they are too heavy to be broken.”

Are you always Kegel-ing during exercise? Find out two reasons that may not be the best idea

As a Pelvic Health Physiotherapist I have the privilege of working with and helping so many awesome women, many of whom are struggling with incontinence during activities such as running, weightlifting, or sports.

When I first meet these women, I’ve found that so many employ various strategies in order to reduce their leaking during exercise. Some empty their bladder frequently between sets, some squeeze their legs together, and others try to hold a Kegel while they perform each exercise. Though each of these strategies are not ideal, today I want to speak specifically about the strategy of holding a Kegel during an exercise. Let’s take the squat for example: many women I have met will try to perform and hold a Kegel for the entire duration of their squat in order to reduce the amount of leaking they are experiencing.

Is this an effective strategy?

Squats are an awesome exercise but can be a little less fun if you have to think about your pelvic floor the entire time you do them!

Honestly – the answer is no.

Sure… it may do something. It may help some depending on your level of incontinence, pelvic floor strength, and body awareness. Or it may more help by easing your mind, because you feel you are doing something to help. But the truth is this is almost always an ineffective strategy to both treat and manage your exercise incontinence.

Why?

Because it fails to train two very critical aspects of how our pelvic floor should work during activity: descent and relaxation, and unconscious competence.

1. Descent and Relaxation

Our pelvic floors are meant to both contract and relax. For the most part when these muscles contract they ascend upwards and when they relax they descend downwards. Going through relaxation and contraction throughout the day, or throughout an activity, is very important for how effectively and efficiently our muscles can work, especially when extra stress or load is applied to them.

In order to think about this ascent (contraction) and descent (relaxation) of our muscles, I want you to think about catching a baseball for a minute.

When you go to catch a baseball, you don’t just stop your hand abruptly when you catch the ball, nor do you punch your hand forward in to the ball (aka ascend/contract). No, instead you actually absorb some of the pressure, or cushion some of the force by allowing your hand to move backwards with the ball (aka descent/relax). This allows a much smoother catch, doesn’t lead to pain or discomfort, but most importantly makes catching the ball EASIER! It means we actually exert less effort AND have more success.

Now, let’s go back to the example of incontinence during squatting. If you employ the strategy of performing and holding your pelvic floor throughout the entire squat then you are contracting the muscles the entire time… but remember, we need to allow descent of those muscles to cushion the pressure created during the exercise! So, if you aren’t allowing for this your muscles cannot actually work optimally. And though this may perhaps help to some degree in the immediate moment, it will not allow your muscles to work as effectively and efficiently as they should. What this usually translates to is a ceiling effect where maybe this strategy works “a little”, but will never entirely correct the incontinence.

2. Unconscious Competence

This topic – unconscious competence – is something that is very, very important to me. As a pelvic health physiotherapist I am constantly meeting incredible women who almost never stop thinking about their pelvic floor because they are always trying to manage their symptoms. They do Kegels during exercise, try to manage their abdominal pressure in any way possible, are nervous of doing certain exercises, and are basically always thinking about their pelvic floor.

One of my goals for each and every client I work with is getting to the point where you don’t have to THINK about your pelvic floor AT ALL!!! Constantly thinking about what your pelvic floor is doing during activity or exercise is EXHAUSTING! Not only that, truthfully it is not healthy and can drive pretty much anyone to feel anxious, nervous, scared, or even a bit obsessive.

Now, I’m not saying there isn’t a place to think about your pelvic floor during exercise – there absolutely is, especially in the beginning when you are learning about your pelvic floor, what it does, and how it should work. But, this is not a long term solution! This thinking is more short term and is geared to help you learn about your body!

Depending on your symptoms, pelvic floor coordination and body awareness, we will often go back to the basics at the beginning of your pelvic floor rehabilitation and ask you to consciously think about and control your pelvic floor. This is known as conscious competence, simply meaning that when you consciously think about it, you can contract and relax your pelvic floor as desired. However after conscious competence is achieved we must, must, must transition to training unconscious competence!!

This is a critical piece of rehabilitation that I often see skipped: training your pelvic floor to work when and how it should when you are NOT thinking about it!! Holding a Kegel during an exercise, like the squat, does not help you train those muscles to be unconsciously competent.

What to do Instead

I wish I had a cookie-cutter answer for this, but the truth is you need to work with a pelvic health and fitness professional who can guide you, will as we can guide you, give you exercises and techniques to make sure you don’t have to always think about your pelvic floor and can instead start enjoying activities and exercises again!

Once we assess your pelvic floor coordination and general movement we will be well equipped at walking you through the steps to go from conscious incompetence –> conscious competence –> unconscious competence!

Splints and Orthotics of No Benefit for Achilles Tendinopathy

A recent systematic review with meta-analysis (for those non-science folks reading one of the highest quality studies you can have!) looked at a common treatment options for Achilles tendinopathy: exercise, orthotics and splinting.

What they Measured:

Researchers measured function, pain and quality of life for managing Achilles tendinopathy, and analysis 22 studies with over 1100 participants.

What they Found:

Exercise improved pain and function while splinting at night and wearing orthotics provided no benefit to pain, function, or quality of life.

What this Means:

If you’re dealing with Achilles tendinopathy then seek the guidance and assistance of a physiotherapist who can coach you with the best exercises that are appropriate for you and your injury to get you feeling and moving better!

Don’t waste your money or effort on things like orthotics or splints that make no difference in your pain, function, or quality of life !

📖Study Link HERE

Should you exercise during pregnancy? Yes!

Pregnancy is an incredibly exciting time of life, but it can also be a time where you feel unsure about all of the things you should and should not do. A lot of women who have always been active wonder if they can continue to train the way they have previously, while others who have been more sedentary feel they cannot start anything new as their changing body isn’t yet used to it.

It’s time to clear some things up for you!!

Unless you have a high-risk pregnancy exercise is not only a good idea, it is actually so incredibly important for both your health and the health of your baby!!

Due to all of the misconceptions out there on exercising during and after pregnancy, an Expert Committee from the IOC was formed to specifically look at exercise and pregnancy in both recreational and elite athletes. Their recommendations are as follows:

In absences of maternal or fetal contraindications, exercise prescription in pregnancy includes the same principles and elements used for the non-pregnant population.

BUT it is important or remember and work with someone who understands the changes associated with pregnancy, which the IOC committee list as “significant anatomical, hormonal, metabolic, cardiovascular and pulmonary changes/adaptions.”

What does this mean?

That pregnant women should continue to incorporate exercise (or start to exercise)! In fact, the article continues on to state that there is very strong evidence that strength training both in general and of the pelvic floor muscles during this time can both prevent and treat urinary incontinence during pregnancy and after birth. It is also associated with a shorter first stage of labour.

Are there any signs you should slow down?

The IOC Committee explains that women without contraindications should exercise regularly during pregnancy while being regularly assessed. They indicate the following signs to indicate it may be time to stop exercising:

  • Vaginal bleeding
  • Regular painful contractions
  • Amniotic fluid leakage
  • Dyspnoea (shortness of breath) prior to exertion
  • Dizziness/syncope (fainting)
  • Headache
  • Chest pain
  • Muscle weakness
  • Calf pain or swelling

What about Post-Partum?

The birth of your child is a wonderful moment, but it also can very much impact Mom’s musculoskeletal system, with delivery being likened to an acute sports injury. Therefore, deciding when and how to return to exercise can sometimes be more complex and multifactorial. This is why it is important to seek the help of a pelvic health physiotherapist who can guide you based on your needs and your rehabilitation goals.

The IOC committee encourage exercise in the post-partum period should start gradually with a pelvic floor muscle first focus.

Key Take-Aways:

– Exercise before, during and after pregnancy is so important for both the health of you but also for your baby

– In the absence of high-risk pregnancies, exercise is safe and beneficial as long as the anatomical and physiological changes that mom undergoes are considered

– Monitor your body during exercise and be followed/assessed regularly by a skilled coach or practitioner who is experienced in working with pre and post-natal clients.

– Begin exercise post-partum slowly and under the guidance of a professional who can help you take a pelvic floor first approach to strength training

Find this awesome research article, here.

And to find out more about exercise during pregnancy, follow the amazing @coach_vanessagiguere on instagram (she is the one above in the photo, rocking the prowler while in her third trimester!)

Remember, it’s OK to Walk Before You Run.

Today I just wanted to remind you that its okay – in fact not just okay, but necessary – to walk before you run. To slow things down and master the basics before trying to get to the advanced stuff. To recognize that just because you aren’t achieving your end goal at this moment in time, it doesn’t mean you won’t get there. And most importantly to appreciate that its your habits over time that make the biggest impact on your results.

I once had a goal of doing a pull-up. So, in an effort to achieve my goal I would jump on the pull-up bar and try with all my might to do a pull-up. My legs kicked everywhere, my neck got all tense, and I pretty much just shrugged my shoulders instead of using any sort of useful strategy to lift my body upwards. Oh, and then I would always have to let go of the bar because I didn’t actually have the grip, back or core strength to hold on to it for long.

I was trying to run before I walked.

I was trying to perform my end goal before developing the strength and movement patterns needed to successfully execute this goal. And in my effort I ended up just creating a number of compensations that were harder to break later when I focused instead on learning the fundamentals.

Fast forward to today: I still can’t do a pull-up, but I can hang on the bar with all the right muscles engaged and hold myself there in a solid position. If I have a coach around, with their assistance I can pull-up without those wonky strategies I once used – no flailing legs, sore neck or shoulder shrugs. And I know that this puts me at a much better trajectory towards the end goal of a pull-up than if I had just kept trying to “do a pull-up”.

I think we are all guilty of this sometimes. Of wanting to reach our end goal so badly that we skip steps along the way. But most always the process of learning the skill is so important and doing so properly under the guidance of a coach will help you achieve your goal at a much faster rate AND avoid a lot of frustration along the way.

What This Means in Relation to Our Pelvic Health

When it comes to our pelvic health I find a lot of times women start running before they walk. And to be clear, I don’t mean literal running and walking. I mean trying to do advanced versions of their pelvic floor exercises or advanced exercises (with little to no coaching) that they may not yet be ready for.

The progression of what we work on will differ, of course, depending on the individual, the presence of any pelvic floor dysfunction and the activities they are doing. But to give you a few examples of the most common cases of running before walking I see are as follows:

  • Practicing Pelvic Floor Muscle Contractions (PFMC aka Kegels) when you are not ready to do so (either due to incorrect technique or oversight pelvic floor muscles
  • Holding the contractions longer than you are capable of, leading to compensations
  • Doing other exercises with poor form (holding breath, increasing intra abdominal pressure unnecessarily)
  • Doing exercises your pelvic floor is not yet able to tolerate

Sometimes doing these things can lead to further dysfunction (aka worsening symptoms, which no one wants!), or simply putting forth a substantial effort with little to no results from all the hard work. Either way, it can be incredibly frustrating to work towards something without seeing the results you want.

When this happens, we just need to re-adjust and focus on finding out what it is we need to be doing to see continued progress! And I am here to help you do just that

How Do You Know What is Too Much?

Quite simply, you will know by working with a Pelvic Health Physiotherapist who will assess your body (including your pelvic floor) and determine what is best for you.

You see, during an assessment we look at the whole body (posture, alignment, movement, range of motion, coordination, strength, tissue health) including a detailed assessment of the pelvic floor. When speaking of the pelvic floor we assess your ability to voluntarily contract and relax those muscles (in other words, can you do a Kegel properly? Can you relax those same Kegel muscles?), the strength and endurance of the muscles, the coordination of your pelvic floor (does it contract and relax when it is supposed to? Is the timing right?), and how supportive it is to the organs above/is there a prolapse present.

Based on this assessment we will guide you and coach you on how to train the muscles of your pelvic floor to work on any one or combination of the following: strength, endurance, power, and/or coordination. We will coach you on how to move and exercise effectively to both improve your overall fitness and health, but also to both protect and improve your pelvic health.

When your body starts making compensations, or symptoms start occurring (incontinence, pain) we know that we have to adjust what we are doing. Common compensations related to the pelvic floor include holding your breath (which can sometimes lead to more pressure on the pelvic floor) and recruiting other, bigger, muscles or strategies, such as using the abdominal muscles, glute muscles, squeezing your thighs together and tensing your upper body.

What this Blog is NOT Telling You

I want to be clear: I am here to work with to ensure you experience success when it comes to your pelvic floor muscle training and training in general. I will help guide and coach you on how to progress your pelvic floor muscle training, chat with you about all the lifestyle and behavioural strategies we can use, and work with strength coaches to ensure you are incorporating physical fitness.

When I say you have to walk before you run, what I am NOT telling you is this:

  • You can only walk for fitness
  • Running is bad for you
  • You can’t workout and train
  • You can’t do most exercises
  • You are not doing as well as you should be or you are not good enough
  • Something is “wrong” with you
  • You won’t get better
  • You are alone in this

No. All of these are NOT true.

You can workout. You might be able to run. You can do most exercises, though some may just need to be modified slightly.

You see, it isn’t so much about what exercise you do, but how you do it. And luckily I work with some amazing strength coaches who are highly educated and skilled so they can ensure you can have a great workout doing things you love that will not only not negatively affect your pelvic floor, but that will help!

You are good enough. Nothing is wrong with you. You will get better. You are not alone.

So many people think that whatever they are dealing with – be it incontinence, pelvic pain, prolapse, weakness – is just going to be their new normal. That they just have to get “used to it”. This is absolutely not the case! Regardless of what symptoms or things you are experiencing know this: it is common, but there is SO much we can do and you will see change. Because you are not alone in this. So many other women experience these same symptoms, and they, along with us are here with you. We will guide and coach you and ensure that you can be your best you.

Remember: it’s not only okay, but it is also necessary to walk before you run. Allow yourself to go through the process instead of rushing to the finish line. I promise, it will be worth it in the end.