A graded return to exercise after any illness is always a good idea and from what we do know about Covid-19 there is certainly not a one size fits all approach.
The severity of the illness, your recovery rate, other co-morbiditiesand any residual breathlessness all need to be taken into consideration.
So what should you do to get back to exercising safely and where should you start?
Although you might feel anxious about meeting others or getting back to classes there are lots of precautions now in place to help you make that transition with more confidence, talking to your trainer about their new safety measures will help get you going and have a better understanding of what to expect.
From the start it’s important to get a thorough health screen so your trainer knows where and how to help you begin exercising again safely. This will help decide whether it’s safe for you to start back and what sort of a graded return would be appropriate for you. It also gives a good opportunity to benchmark your current state so that you can get a measure of your progress in the weeks to come.
Exercise tests can be used to measure your flexibility, your aerobic fitness and your muscular strength and endurance. Similarly to the health screen these tests are really useful to both measure your current fitness and help decide how to implement your individualised training plan.
‘Ready for Exercise’ means:
Asymptomatic for at least 7 days
Adequately screened and risk stratified (no signs or symptoms of long covid)
Motivated and psychologically ready to participate in exercise (no PTSD for example)
Any other pre-existing co-morbidities are under control and stable
If you still find that you are experiencing breathlessness it’s important to be able to quantify this and your trainer can help you do this using the Rate of Perceived Exertion (R.P.E or The Borg Scale) or Talk Test, another is the Visual Analogue Scale to help you understand and develop a self awareness of breathlessness. Your trainer can also help you with breathing coping strategies for when you need to get your breath back in a session or during your day at home – this will build your confidence and help you feel more in control.
Other considerations you might want to include in your training are longer, slower warm ups and cool downs to prepare your body more thoroughly for exercise. You might also try interval sessions (sub-maximal!) so that your can have active recovery rather between bouts of aerobic work to help you manage your oxygen requirements.
Lastly doing a little bit everyday and keeping a diary is a really helpful way to quantify your progress. Managing fatigue with adequate sleep, nutrition and rest is vital.
I have had an enlightening few weeks studying Munira Hundani’s new course ‘Diastasis Rectus Abdominus and the Postpartum Core’ which for me, presented a fascinating new framework for both assessment and exercise prescription of the post partum core.
Diastasis Rectus Abdominus (DRA) is a widening of the linea alba (the midline of the abdominal wall) experienced by women during and after pregnancy. Whilst it is normal to experience some degree of separation it should generally resolve naturally postnatally however in approximately 1/3 of women the excessive and prolonged widening prevails adding to a sense of disconnection and dysfunctionality .
Commonly the protocol for fitness instructors, like myself, for dealing with DRA is to present a long list of things to avoid to prevent further widening of ‘the gap’. These might include lifting heavy weights (e.g children), sit-ups, plank, boat pose (Navasana) jack knives, russian twists etc for fear of causing too much Intra Abdominal Pressure (IAP) and worse still increasing the gap. The assessment of the DRA would usually be conducted primarily in supine using a head lift protocol and exercise prescription would typically be progressed dependant on the inter recti distance (or width of the gap)
Hudani’s work paints a much more positive picture for the treatment of DRA as well as a much bigger focus on the individualised journey that success should take accessed via the initial assessment. Crucially she demonstrates how clinical research shows that there is little to no correlation between the DRA itself and formally associated issues such as lower back pain or indeed the ‘type’ of exercise a woman should do. Rather than point the blame at ‘the gap’ she explains that the inter recti distance is just a another part of the abdominal wall that has widened as a whole, coupled with altered breathing and core connection strategies resulting in a mis-management of IAP. She goes on to emphasise the importance of IAP and how harnessing it using the diaphragm and the Transversus Abdominus (TVA) is the key to success.
So what does this mean for women with DRA? Well, by assessing the DRA in positions which prompt more IAP (i.e standing or sitting as opposed to supine – which, she explains, is particularly unproductive for those with increased circumferential laxity) it helps to illicit a better provocation of TVA’s true ability to activate and therefore a ‘way in’ to strategise a stepwise approach for that individual. The idea of using and creating IAP to strengthen the core automatically reduces the fear factor around creating too much IAP. Once the re-training of the diaphragm and TVA has successfully been achieved the list of formally avoided exercises are the very ones which need to be integrated in to optimise core and indeed whole body strength. This means your favourite yoga class, HIIT workouts or Pilates classes are once more back on the table.
If you have been affected by diastasis and are looking for ways to help progress do get in touch via the contacts page for more information.
I’ve just spent the last couple of months updating my Pilates for orthopaedic conditions knowledge with FutureFit and wanted to focus a bit on exactly why Pilates is so helpful in the treatment of common orthopaedic conditions. Whilst I don’t solely use Pilates in my movement sessions but instead use a range of functional movement protocol the traditional Pilates principles certainly embody and underpin the main focus of exercise prescription for rehab thereby providing a safe and effective recovery.
Common Orthopaedic Conditions –
Back pain (non specific, specific, root nerve pain, disc herniation and piriformis syndrome)
Arthritis (osteoarthritis and rheumatoid arthritis)
Osteoporosis and osteopenia
The Pilates mat repertoire gives a great range of exercises which allow for enough regression or progression to take participants with very limited movement capabilities and progress them in a sustainable way. The incorporation of the Pilates principles which are taught alongside each exercise help to integrate the breath with core co-contraction, increase body awareness (and therefore autonomy) and focus on the quality of movement.
A tailored programme can offer you many things – principally better alignment and mobility of the spine but also increased muscle strength and endurance, reduced stiffness and improved flexibility, reduced pain, better balance along with improved well-being.
If you are affected by any of these conditions it’s important to seek out an effective exercise programme which meets your needs and minimises your symptoms. Due to covid-19 I am not currently able to offer sessions but feel free to contact me for further advice.
If you travel a lot for work it can be hard to prioritise your own movement let alone specific exercise. This post is an aid to those trapped in their hotel rooms (!) and in need of some body maintenance to cancel out all the sitting, screen watching, suit and work shoe wearing (that also ‘cast’ your body into unhelpful postures).
Chest stretch: Arm at 90 degrees (i.e. bent at the elbow) with your forearm against a wall or door frame the stretch the chest open, away from the wall. One arm at a time then switch.
Door frame: Reach up to a door frame and try to extend your arms whilst breathing deeply lengthening on the exhalations. Try to create space from your ears to your shoulders.
Back extensions: Lying prone, chin slightly tucked – on an exhale raise your chest of the floor a tiny bit whilst lengthening your arms/fingertips towards your feet. Also try to draw your shoulders back as if opening your chest.
Childs pose: Sit back on your heels stretch your arms forward onto the floor.
Hamstring stretch: lying supine stretch one leg up – use a belt or tie around the foot to get leverage (keep the other knee bent and try not to press/flatten your lower back) Switch legs.
Sit ups: support the head if necessary, deep exhale as you come up.
Plank: On your elbows – keep breathing, back of the neck long don’t drop your chin.
Childs pose: same as before but with the palms up.
Note: Written descriptions of exercises and movements can be lost in translation! So if these do not translate easily for you do get in touch via the contact form. Readers who have had been having sessions will recognise the cues!
After a bit of an end of pregnancy slow down (!) on the blog front I thought it would be an opportune time to write some post natal exercise posts to both remind myself & give some direction to anyone beginning the journey of reconnecting with their non-pregnant selves!
With any exercise programme, post natal or otherwise the ability to breathe correctly during exercise is essential to having a fully functioning core. Reconnecting with your breath will provide the foundation to both your core’s recovery rate & help you to progress with bigger more integrated core movement patterns (A.K.A sorting out the mummy tummy!). Whatever birthing experience you had or however fit you were/are post partum reconnecting with your breath is where you need to begin. The nature of pregnancy – with the baby in the tummy thing (!) – can create a disconnect with the way we breathe due to the expanding uterus squashing the diaphragm resulting in there being less room for your lungs to expand – so it is vital to relearn this essential function.
Try this – find a quiet space to practice lying down with a neutral spine & pelvis.
Inhale (the expansion): Breathe wide into your ribs, try to do this 3 dimensionally so use the floor against your back as a reference, don’t just flare the ribs outward. Your abdominal wall will expand. Try to relax your shoulders, neck & jaw.
Exhale (the compression): As you breathe out feel your ribcage contract & lower, your abdominal wall & lumbar/thoracic muscles (see the pic) will tension. Think about connecting with your pelvic floor by drawing it up (think picking up a tissue with your vagina) from your vagina to your anus.
Once you feel you have the full core connection try this sitting & then standing making sure to integrate the pelvic floor contraction on each exhale & fully relax/release it on each inhale.
For some women, it will come as a relief knowing that all is required on the exercise front is a bit of breathing to get started but for others wanting to just get the running shoes back on & pick up where they left off, it may pose more of a frustration or perceived limitation to getting their bodies back. Understanding why we need to start with the breath is key to accepting your journey to hot mumness (technical term!) – safe in the knowledge that you’re going to reclaim (& maybe even improve on) the body you want both aesthetically & functionally without having to pee your way through a kettlebell workout because you haven’t addressed proper pelvic floor & core restoration!
So – at a glance list of ‘Why’s’:
Costal breath patterns (as directed above) will help take pressure away from healing abdominal & pelvic floor tissue.
Develops your MUCH NEEDED pelvic floor reconnection.
Increases your oxygenated blood to help healing abdominal & pelvic tissues.
Strengthens & supports your post partum abdominals, back & pelvis.
Helps aid valuable relaxation which in turn will help balance the hormone levels that control weight.
For more info on Pilates & women specific exercise click & follow the blog for updates!
If you have tight shoulders & are looking for relaxing ways to ‘unstick’ them here’s a few ideas that we use in the classes that also work really well particularly as transitions from one exercise to another. If you imagine where your arms are hanging most of the day & the range with which you mostly use them in you can see that these 3 variations on a shell stretch really take them into much more of an unused plane thereby freeing up all the stuck tissue around pectoralis & latissimus dorsi.
The picture above shows how you should anchor the stretch. Arms are pushing away into the mat & sit bones are pulling down, so you’re flexing the lumbar/lower spine by engaging the abdominals & pulling the ribs up (in the direction of the second smaller arrow). By drawing the ribcage up you will tension the stretch better through the shoulders instead of over extending into the thoracic spine – have a go with the ribs up & then down on your thighs & you’ll feel the difference.
If you want to optimise the stretches try to work with the breath by directing it into the ribs & underlying diagram in a 3 dimensional way (think like an accordian). You’ll be able to feel the skin stretch around the rib cage & so try to emphasise that expansion as you inhale & breathe out the tension from the stretch as you exhale.
In the first variation the arms are straight out in front, trying to keep the hands in line with the wrists, elbows & shoulder. Head is relaxed, toes are tucked under for an extra, bonus plantar fascia stretch! There are many variations on the specifics of this pose for example Yoga’s Child Pose comes with a different emphasis but here as we are trying to specifically release the fascia around the shoulders I’ve selected these teaching points.
In the second picture the arms are externally rotated with the palms up & correspondingly the forearms are also rotating outward – you will feel how this tensions the stretch differently & you’ll probably find it more of a challenge. See how far round (or not!) you can get your thumbs/backs of the hands flat to the floor! Head relaxed & breathing wiiiiide! Keep thinking about the same anchor points, this is not a flop-on-your-thighs-&-go-to-sleep kind of stretch, you want to be actively working on the position both with the breath & with the anchor points. As the intensity of the stretch dissipates you can try to reach a little further.
Lastly we’re working more laterally into the sides of the back by bringing one arm all the way across & anchoring onto the the other side. This time we breathe into that side – feel the skin stretch & try to expand it with each inhalation.
Different Pilates teachers put different amounts of focus on the breath & whilst it can add to the seemingly endless checklist of things you are trying to get right in an exercise. For me, it is key to the success of any core restoration & here’s why.
Once you understand the body’s breathing apparatus & functionality it becomes quite clear that we get an intrinsic core contraction (tensioning) with each exhale & an intrinsic expansion (or opening) with each inhale so only by harnessing this inherent bodily function will we truly get the core working optimally. Working against this pattern will help facilitate back pain, exacerbate a diastasis recti & generally leave you vulnerable to injury.
But as well as providing an intrinsic support system for the body, breathing correctly also helps reduce stress – controlled breathing can cause beneficial physiological changes that include:
lowered blood pressure & heart rate
reduced levels of stress hormones in the blood
reduced lactic acid build-up in muscle tissue
balanced levels of oxygen & carbon dioxide in the blood
improved immune system functioning
increased physical energy
increased feelings of calm & wellbeing.
Conversely when a person is under stress, their breathing pattern changes. Typically, an anxious person takes small, shallow breaths, using their shoulders rather than their diaphragm to move air in & out of their lungs. This style of breathing disrupts the balance of gases in the body. Shallow over-breathing, or hyperventilation, can prolong feelings of anxiety by making the physical symptoms of stress worse as well as facilitate adaptively shortened muscles along the neck & shoulders.
Try practising the breathing exercise described above whilst lying on your back in a quiet area – then begin to introduce some gentle core exercises as you do so & see how well incorporating the breath helps engage the whole core system.