Now that we are halfway through the year ( yes it is June!) it is a good time to reflect on those New Year resolutions you made way back in January, especially the get fit, get active ones. The New Year brings out all manner of enticements and admonishments to shatter your self -esteem and tell you that you are too fat, not eating or exercising properly, that it is time to make changes because what you are doing is wrong. We are told we need flat abs, our hormones need balancing and all kinds of other scary things.

What sort of message did this send you?

These so-called motivating people are invariably thin, ripped and make out that they have the perfect body and hence the perfect life (for those interested in the world of statistics, this is known as a post hoc fallacy (ie one causes the other)
They are also making money either via being an affiliate pushing someone else's program or directly from signing you up to their program which they promise will fix all of your problems if only you become as perfect as them. They have the key, the answer to all your worries if you send a monthly payment.

It is also likely if it is an online program that what they tell you to do may be bad for you - they have no idea what your current status is, what level you are starting from and whether their program will work for you just because it works for them. The enthusiasm of face -to-face classes can be motivating but again, there are many that have no idea what is happening inside for you and as a physiotherapist working in pelvic health, I also see the consequences of these bootcamps and programs in my clinic if you are not adequately assessed before and supervised during them.

So now that we are half way through the year and you may have started a program, my question is are all your bits in the right places? are they held there securely ? or is the bootcamp you are being told is the only way to fix your life causing your bits to fall out?
Now that in itself is an inflammatory statement and one I see/hear a lot - organs falling out. Like they are one minute snugly in place, the next whoomp they are dangling near your knees.
There is nothing more horrific than those images in your head. Again, you can be sold a program saying it will stop this from happening to you .
The end result may be a sudden apperance or sensation of a prolapse but the process is gradual - months and years of the fascial tissue just hanging in there - if the pelvic floor is weakened OR the pelvic floor hanging on if the fascial / elastic tissue is weakened. Therein lies the other fallacy - prolapse is not all about the pelvic floor, in fact you can have a good, strong, reactive pelvic floor and still have significant prolapse if the fascial tissue has failed.

So back to bootcamp etc. Yes it is good that you decided to get fit and active. Any exercise or movement is good but a variety is better. Movement or activity that excites you and is what you enjoy doing is what you should aim for. But you need to know that your organs are securely in place with a combination of good pelvic floor muscle tone and endurance, and strong fascial tissue before you embark on any high level activity, which is what bootcamp usually is - harder, higher, faster and you will be perfect.

If you don't feel quite right, feel heavy or bulgy in the vagina or have to run for the loo before skipping or burpees then please see a women's health phyio for a proper assessment before taking on an exercise regime or continuing with what you are doing.

There is an activity solution for everyone, and this may include looking at :

  • a pessary to support the organs if your pelvic floor and elastic tissue is unable to fully do so
  • lower impact 
  • shorter bouts of higher level
  • consider another activity
  • mix it up 
  • a reactive pelvic floor is just as important. Are you co-ordinating intra-abdominal pressure with a pelvic floor contraction or are you bearing down on exertion?
  • EXHALE on exertion is a good mantra as this reduces the downward forces in the form of intra-abdominal pressure (IAP)
  • feel what happens in your pelvis when you do certain activities - if it doesn't feel right then it isn't right for you, it may just be an adjustment of co-ordination that you need.
  • the holy core - many programs are based on this  but muscles are designed to work together, including the pelvic floor . You may need to start some isolated pelvic floor contractions to get activity there but the aim is to progress to integrated activity of all the abdominals
  • situps aren't always bad (although pretty non- functional) planks aren't always bad 
  • think what you do in every day life - pick up kids, washing basket, shopping.
  • Carry a kid who hurt knee at the park, with stuffed nappy bag over shoulder whilst fumbling keys to open car and then think about the very regimented "do it this way not that way, must be aligned " exercise class that is supposed to be fixing your body. Is it teaching your body to cope with everyday functional demands?
  • your program needs to involve functional movement challenges 


So before you keep going, before you fall for the slick campaigns of people telling you what they think you should look like - what do YOU want to look like , how do YOU want to feel? what do YOU enjoy doing ? and please think about how YOU feel down below - do you feel weak? bulging or heaviness in the vagina? do you leak with activity ? 

Are your organs securely strapped in or do they need some help? You can exercise, you just need to know what will work for YOU right now and how to progress .


If you want ot read more about pelvic organs have a look at my last blog The Story Of the Organs Part 1  and keep an eye out for Part 2 which is on its way!