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Pelvic health physiotherapy

We rarely talk about problems in your nether regions i.e. “poos, wees and sex” and that needs to change, says Tauranga-based pelvic floor physiotherapist Claire Baker.
“We’ll talk about lower back pain problems, but pelvic problems are regarded as ‘just’ affecting pregnant women or the very elderly, rather than the 80 percent of the population they do affect.”

At the beginning of her TedX Tauranga talk ‘Common… NOT normal’ Claire explains that when she began studying to be a physio, she had envisaged rubbing down the All Blacks or travelling to the Olympics with a team.
But then she had children. While she had what many would call an enviable water birth with no instrumentation, she tore from back to front, and then the importance of the pelvic floor became very real to her.

“I knew not to wait and see what might happen in the future and went to physiotherapists about it. I learnt that the health of your pelvic floor affects the most essential areas of your body, and physiotherapy can, if not fix these issues, help you manage them and subsequently lead a fuller life. I then went on to retrain to help people manage their pelvic floors.”

She says keeping “private parts private” is detrimental to our health, with some suffering from faecal leakage, for example, and not even telling their GP because they are so ashamed of a condition actually affecting one in eight New Zealanders.

“The silence means we don’t realise that pelvic issues like leaking from your bladder, needing to wipe hundreds of times to feel clean, pelvic floor prolapse where your organs are falling outside your body, or erectile dysfunction are affecting so many of us.”
She explains that what we don’t know can hurt us and that the not knowing means people put up with discomfort and pain thinking it’s normal – when it’s common but it’s not normal.

The tragedy of pelvic floor issues is that people begin to withdraw from their own lives to manage quite common and manageable issues, says Claire.

“People are not going to say, ‘Oh my vulva pain is really playing up today’ or “Yeah, I’d love to play netball, but I’m scared my uterus will fall out on the court” or ‘I would go on a date with you (but I can’t get it up)’.”

Transformative treatment

Physiotherapy can help people to learn to manage a problem and work with it, says Baker; it can be that transformative.
“We can help prevent and manage incontinence; resolve pelvic pain or pain during sex; do bladder retraining and help with problems during pregnancy.”

Assessment and guidance can include a vaginal examination and tailored pelvic floor exercises, education, bladder and diary analysis, and core strengthening.
“A big part of this is helping clients get to know the body they have NOW. Listen to your body, where it is at now – not pre-baby, not pre-menopause – and if you have anything that impacts negatively on your life, seek out a pelvic health physiotherapist.”

Holistic osteopathy

Osteopathy is quite different. Osteopathy is a form of manual therapy that looks at the way that different parts of the body are connected, and how they can affect each other.
Jessica Gamblin, vice-president of Osteopaths New Zealand, is a UK-trained osteopath with her own clinic, Align Osteopaths, based in Tauranga.
“Often people don’t realise how gently we can work,” she says.

Tailored treatment

Rather than dividing the body into parts, says Gamblin, osteopaths view the person as a whole and tailor each treatment to each person individually.
“Osteopathy is quite unique in that way, because we acknowledge that everything in the person’s body functions together.

“For example, somebody might come in with back pain and we also end up treating the foot. We look at their injury history, their levels of stress, their lifestyles… If there is something wrong with your foot, your body will compensate for it elsewhere, whether it be in your hip, your back, or even right up into your head.”
Gamblin says osteopaths can work quite gently or quite firmly, and “we all have our preferred style of treating”.

“It’s interesting because you can see different osteopaths who will use different approaches, but by using the same osteopathic principles they all have the same goal – to get your body working better.”

She says osteopathy is a “hands-on” tradition.
“Everything we do, we feel through our hands. Patients can be surprised by what we pick up on! This is also a skill unique to osteopathy, as we develop a fine-tuned sense of touch which is over time.

“When we’re working on people, we’re not just feeling for the movement within the joint – we’re also assessing the quality of the tissues around the joint. Tissues can feel firm or soft, hot or cold, and these qualities help us to understand the state and nature of an injury.”

Comprehensive chiropractic care

Chiropractic care is a whole lot more about adjusting the spine gently and specifically than it is about major manipulations, says Dr Cassandra Fairest, vice-president of the New Zealand Chiropractors’ Association and the NZCC Alumni Chiropractor of the Year 2018.
“Chiropractors help people reach and maintain greater health and wellbeing through the care of the spine and nervous system. Chiropractors adjust the spine to correct nerve, muscle and joint dysfunction.

“We do a five-year, full-time degree covering a huge range of health science subjects from neuro-musculo-skeletal anatomy to neuroscience. Not many people know that we do radiology papers as well, as part of our training, so we are all licensed to take X-rays and to own X-ray machines.”

She says a chiropractor’s strength is in their indepth knowledge and understanding of the nervous system and the spine.

“I was drawn to chiropractic when my baby couldn’t turn her head one way and was developing a flat head on one side. A GP recommended a chiropractor, who, with incredibly gentle and subtle pressure, adjusted my child and she immediately moved her head that way. Not only could she turn her neck, but she also seemed more settled and slept better.

It changed our lives.

“I see and hear time and again patients calling what we do a miracle. But for chiropractors we’re often more puzzled when we don’t see miraculous things happen with what we do.”
Spine central to good health

Fairest reiterates how chiropractic is not “bone crunching”, rather it’s dealing with whatever issue the person presents with, and then empowering the person to get back into the world again.

“Generally, we deliver adjustments with hand-activated instruments or with our hands. There are many different ways to adjust a patient depending upon their preferences and requirements.

“Many of us do cranial work as part of checking the full spine. We always assess the nervous system, do a physical exam, and inspect the patient’s history when deciding upon the type of care needed.

“If the spine works well, then your nervous system will function well. The healthier your nervous system, the more accurate the information it sends to your brain. The more accurate the information your brain has to work with, the healthier you are as a person.”

Physiotherapy

1. What is physiotherapy?
Physiotherapy uses proven techniques to help restore movement and function to anyone affected by an injury, disability or health condition. A physiotherapist uses indepth knowledge of how the body works, combined with hands-on clinical skills, to assess, diagnose and treat patients.
2. It started as a women-only profession
Begun in the year 1921, partly as a response to World War I, the first professional association was a women’s physical therapeutic association in America. The New Zealand Physiotherapy Act was passed in 1949 and the national membership organisation (now Physiotherapy New Zealand) established shortly after.
3. There are different types of physiotherapy
For example, acupuncture; cardiorespiratory; hand therapy; manual therapy; mental health; neurology; occupational health; older adults; paediatric; pelvic, women’s and men’s health; and sports and exercise.
4. Find a physio
Physiotherapy New Zealand (PNZ) is the national membership organisation for physiotherapists. Being a PNZ member reflects a commitment to their high standards of practice and professionalism. You can find a member at physio.org.nz.
5. Physiotherapy is good for vertigo
Positional vertigo is when someone is experiencing relatively brief instances of dizziness when they move their head or change physical position. A vestibular system dysfunction in the inner ear, this annoying and unsettling sensation can be successfully treated by physiotherapy.

Osteopathy

What is common to all osteopaths is a holistic, patient-centred approach that is governed by the main tenets of osteopathy:
The body is a unit.
Structure and function are reciprocally interrelated.
The body has capacity for healing/self-repair.

Chiropractic

Chiropractic care began in 1895 in Iowa
The inventor of chiropractic care was Daniel David Palmer, who proposed the practice in 1895 in Davenport, Iowa. Palmer believed that spinal adjustment would have a positive ripple effect, helping heal many other parts of the body.
Chiropractic is a combination of the Greek words cheiros and praktikos (meaning ‘done by hand’.)

Never let your untrained friend ‘adjust’ you
Chiropractic isn’t just ‘popping your back’. It’s a scientific process that requires thousands of hours of training. If you have an untrained friend who wants to ’help you out’, they may actually hurt you very badly.
In 2001 a man in India developed severe spinal cord and brainstem problems after receiving a neck adjustment from his barber. Adjustments aren’t as easy as they look – leave them to the professionals.

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