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Achilles tendinopathy

achilles tendinopathy shockwave therapy the body refinery new farm

The Achilles tendon is the largest and strongest tendon in the human body. However, it is prone to injury, with Achilles Tendinopathy being one of the most common overuse injuries.

How does it occur?

It was previously thought that Achilles pain was due to inflammation. However, recent studies show that Achilles Tendinopathy involves little or no inflammation. We now understand that Achilles Tendinopathy occurs when the Achilles tendon is overloaded, either in a single episode or gradually over time. It has been described as a continuum with three phases: reactive tendinopathy; tendon disrepair; and degenerative tendinopathy.

Reactive tendinopathy is usually seen in younger people and results from an acute overload such as a burst of unaccustomed physical activity or a direct blow to the tendon. In response, the tendon thickens but if the load is reduced, the tendon will return to normal. If the tendon is not allowed to rest however, it will progress to the next phase – tendon disrepair. In this stage, the collagen fibres that make up the tendon become disorganised but it is still possible to reverse these changes with treatment. Things become more difficult in the final stage – degenerative tendinopathy. This stage generally affects middle-aged, recreational athletes who have a history of Achilles pain. At this stage, there are degenerative changes in the tendon that are difficult to reverse.


What are the symptoms?

People with Achilles tendinopathy will report pain, stiffness and swelling in the Achilles region. There are two types of Achilles tendinopathy depending on the location of pain– mid portion and insertional Achilles tendinopathy. Pain in the middle region of the Achilles tendon is typical of midportion Achilles tendinopathy whereas pain, where the Achilles inserts onto the heel bone, suggests insertional tendinopathy.


What are the risk factors?

There are certain factors that can increase the likelihood of developing Achilles tendinopathy. These include: 

  • male sex
  • age >30
  • diabetes
  • high BMI
  • calf weakness and/or tightness
  • foot/ankle stiffness.


Other common causes of Achilles tendinopathy include:

  • change of footwear
  • poor, unsupportive footwear
  • change of training surface (e.g. grass to road)
  • increase inactivity


How is it managed?

Physiotherapy is highly effective for the management of Achilles tendinopathy. Your physiotherapist will usually provide advice about reducing the load on the tendon and use manual therapy, massage and taping techniques to help relieve your pain. They will also prescribe a specific type of exercise called eccentric exercise. With eccentric exercise, the muscle is lengthening as it contracts. For example, when you do a calf raise over a step. Eccentric training has been shown to not only reduce pain but also improve the structure of the tendon.

Shockwave Therapy The Body Refinery new Farm Brisbane


If you experience ongoing Achilles pain despite these treatments, please talk to your physiotherapist about shockwave therapy.

Shockwave therapy has been investigated as a potential adjunct to physiotherapy treatment. Studies have shown that shockwave can help to improve pain and function in people with Achilles tendinopathy, especially if it is combined with eccentric exercise. Shockwave uses an acoustic wave which increases blood flow to the injured tendon and stimulates healing.

The Body Refinery’s shockwave machine is made by EMS Swiss DolarClast, the world leader in Shockwave therapy and technology.

The initial appointment is 45 minutes long and will include a full assessment and a minimum of 15 minutes of treatment. Following sessions can go from 15 to 60 minutes depending on the type of injury. Shockwave appointments are only performed once a week to allow the injured area to rest.

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Book today to experience the benefits of Shockwave Therapy. Call 07 3358 3915 or follow the link below.

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My Pain in the butt – Coccydynia

Coccydynia, or pain in the coccyx (tailbone), is commonly experienced by women after a traumatic childbirth.  Symptoms generally include (sometimes excruciating) pain around the tailbone and hip when sitting or standing, especially after certain exercises.  It can be very unwelcomed by new mothers, who are often already looking after one or more young children and sometimes returning to work.

Pilates and general physio treatments can help to relieve pain, however, they are not likely to provide a complete and lasting solution.  However, more specific treatments by a Women’s Health Physiotherapist can provide life-changing results and eliminate the symptoms.


Coccydynia treatment includes manual therapy to release the gluteal muscles and pelvic floor – externally at first and, if indicated, internally.  Treatment may also include mobilization of the sacrum and correction of muscle imbalances through stretching and muscle strengthening. Women’s Health Physiotherapists are trained to treat a range of pregnancy-related matters and to undertake internal examinations, which are sometimes required for the assessment and treatment of certain conditions.

Women suffering from the pain of coccydynia can experience dramatic pain relief after only one or two treatments with an experienced Women’s Health Physiotherapist.  We understand the pain and frustration that conditions such as coccydynia can cause and the relief that is experienced when new mums are correctly diagnosed and successfully treated.  To ensure our clients don’t have to endure a long search for a solution, The Body Refinery team includes Women’s Health Physiotherapists.

Coccydynia treatment women's health physiotherapist brisbane

If you are experiencing pain in your tailbone, hips or buttocks that isn’t improving, especially if you are a new mum, we recommend seeing our Women’s Health Physio.  Internal exams may not be the preferred course of action you are seeking, but many consider this a small inconvenience to have an accurate diagnosis and relief from the pain of coccydynia. Our Women’s Health Physio is considerate and will talk you through any courses of action they consider may be appropriate help you.

Book your appointment today by calling 07 3358 3915. Make sure to request our Women’s Health Physiotherapist, Charmion Bevan.

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What is a pre-pointe assessment and why do I need one?

pre-pointe assessment

Starting to dance en pointe is one of the most exciting times in a young ballet dancer’s life. However, it is important to remember that dancing on the toes is not a typical function of the human foot. If a dancer does not have adequate range of motion, strength and or/stability, it can place excessive stress not only on the foot and ankle, but also on the leg, pelvic girdle, and trunk. A pre-pointe assessment is designed to assess a dancer’s readiness for pointe in order to prevent pain and lifelong injury.

At the Body Refinery, our physiotherapist Courtney has been trained to conduct in-depth pre-pointe assessments and prepare dancers for the demands of pointe work.

The Initial Pre-Pointe Assessment is one hour long. This allows our physiotherapist time to obtain a detailed history and assess posture, ballet technique, range of movement, strength and core stability in a friendly environment. Courtney will then develop an exercise program for the dancer to take home to address any weaknesses in these areas and ensure a safe progression onto pointe.

Dance Pre-pointe assessment physiotherapy The Body Refinery Brisbane

Clients will also have time to ask questions so that they understand every step of the program that our physiotherapist will tailor for them. After the assessment, a report will be provided to the dancer’s teacher outlining the results and exercises prescribed.

Follow up sessions may be required to monitor the dancer’s progress and ensure all of the requirements are met prior to going en pointe.

Depending on each dancer’s goals (and whether there are any existing injuries), Courtney may recommend clinical exercise sessions including Pilates. Clients may choose between private sessions, where they will have 100% of Courtney’s attention, or experience the benefits of joining one of our classes.

Whether you are training to be a professional dancer or taking dance classes for fun, we can help you reach your goals.

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Book your pre-pointe assessment today with physiotherapist Courtney. Create your profile to book through our online system or call 07 3358 3915!

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Plantar Fasciitis

The Plantar fascia is a crucial length of tissue playing an important role in foot structure and biomechanics in weight bearing. Plantar fasciitis or Plantar Fasciopathy results from repetitive excessive tensile loading of the plantar fascia that can gradually build up over a long period of time or arise from a sudden increase in weight-bearing activities.

This can occur both within the athletic population such as long distance runners and dancers, however, obesity is also a risk factor due to increased load through the foot with comparably less activity. The pathophysiology of plantar fasciitis is similar to tendinopathy with evidence of collagen disarray in the absence of inflammation, increasing the thickness of the tissue and regional loading during gait.


What are the symptoms and who is the most touch?

The incidence and prevalence of plantar fasciitis are unclear. However, it has been estimated that 7% of people aged over 65 years report tenderness in the region of the heel and that in the USA plantar heel pain accounts for a quarter of all foot injuries relating to running. Over 1 million people per year in the USA present to their Doctor for the treatment and diagnosis of Plantar heel pain. The condition affects both athletic and sedentary people and does not seem to be influenced by gender.


A recent review into the clinical practice guidelines for Plantar Fasciitis stated patients are likely to present with the following:

  • Plantar medial heel pain, worse in weight bearing, especially initial steps after periods of inactivity, as well as prolonged activity in weight bearing
  • Sudden increase in long-term weight bearing activities especially on a surface with minimal shock absorption
  • High body mass index (non-athletic population)
  • Tenderness/pain on palpation of the proximal attachment of the plantar fascia
  • Positive windlass test
  • Decreased active/passive dorsiflexion range of motion
  • Decreased longitudinal foot arch height


The most notable risk factors for the development of plantar fasciitis are decreased ankle dorsiflexion range, a high percentage of their daily activities/work on their feet and a BMI greater than 30kg/m2.

Plantar Fasciitis


What treatment for Plantar Fasciitis?

Plantar Fasciitis is commonly described as a self-limiting condition. A systematic review, in which heal pain resolved within 12 months regardless of treatment strongly supports this. However, clinically plantar Fasciitis is a painful, disabling condition which severely impacts the quality of life.

Ultrasound-guided corticosteroid injection for Plantar Fasciitis is increasingly popular in the medical treatment of plantar fasciitis. Studies show that ultrasound-guided corticosteroid injection reduces abnormal swelling and pain however significant pain relief did not last longer than four weeks. Some studies are showing that corticosteroid injections do cause degenerative effects for tissue in animal studies if used more than once.

Physiotherapy treatment of plantar fasciitis is dependent on its acuteness or chronicity and level of pain/discomfort but is generally directed at decreasing tensile load on the plantar fascia, increasing foot and ankle mobility, pain management and activity/lifestyle modification.


Physiotherapy treatments include:

  • Education on activity modification
  • Deloading by anti-pronation taping or foot orthoses (either over the counter or customised), along with shock absorbing footwear and gel heel inserts
  • Increasing the extensibility of the musculotendinous units and associated connective tissue of the plantar fascia;
    – Soft tissue release of gastrocnemius, soleus, toe flexors, tibialis posterior, plantar fascia itself using dry needling and trigger point therapy. Dry needling provided statistically significant reductions in plantar heel pain.
    – Mobilisations of talocrural joint, inferior tibiofibular joint,
  • Addressing biomechanics of aggravating activities

In addition to rehabilitation exercises, Pilates can be used effectively to increase the extensibility of the musculotendinous units and soft tissue along with mobilization for the talocrural and tibiofibular joints. Pilates can address poor biomechanics and establish new movement patterns in a non-weight bearing environment making it an ideal choice of exercise to rehabilitate plantar fasciitis, in addition to a home management program.


At The Body Refinery, our physiotherapists are extensively trained in Pilates and dry needling, along with the traditional musculoskeletal physiotherapy skills making them an ideal choice to rehabilitate plantar fasciitis.

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Book an appointment with one of The Body Refinery’s Physiotherapists today on 07 3358 3915 or at info@thebodyrefinery.com.au

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Movements and Activity: a pathway to improve


It is generally believed that when our body hurts we should stay still and avoid any painful movements to avoid worsening the symptoms. This is true only after an acute injury so that our body can heal the damaged tissue. However, excessive rest can have an adverse effect and make things worse in patients with musculoskeletal disorders.


Movement to treat your pain/injury

Not only because the body suffers from the effects of a de-conditioning process, but also because some people may become scared of moving and lose the awareness of the motion of the affected area. So consequently we move less, get stiffer, our muscle weakens and we have secondary pain due to inactivity.

In addition, it has been shown that pain-related fear has an important role in the transition from an acute injury to chronic pain in low back patients. Some patients perceive movements or stimulus as a threat, increasing the stress/anxiety towards specific activity and as a result, creating a fear-avoidance behaviour which leads to further misuse of the body and long-term disability.

Furthermore, the pain experience can be influenced by stress, excessive attention to pain and unhelpful believes. Consequently, the pain of that initial injury has become bigger and bigger due to other factors even though the healing time of the injury has been already finished.


So how can we break down this vicious loop?

A good start is moving, recovering that lost awareness of your body and re-learning how to move adequately, improving the confidence during activities, breaking down the pain-movement association in our brain and decreasing that perceived threat.

You may think “but how if it’s hurting?” The answer is pacing, little by little with the help of health professionals to support you and reassure you through this process. You cannot win a marathon if you didn’t train it before, so after prolonged inactivity due to pain is similar, it is important to build up the strength and movement little by little, to promote the tissue adapt to the new activity, settling goals to finish your own race to get out of such loop.

At the Body Refinery, you can find physiotherapists to help manage your discomfort and start getting active in a safe way, with small movements. Start decreasing the threat of movement with progressive exercises, safe environment and reassurance to recovering progressively the normal motion of your body.

When you feel ready, Pilates is an unparalleled, whole body-conditioning program. The Body Refinery offers a variety of different Pilates classes to help build:

  • Flexibility
  • Muscle strength
  • Endurance throughout the whole body
  • Postural alignment
  • Core strength and stability
  • Healthy breathing patterns, and
  • Improved coordination

If you want to move with strength, flexibility, power, vitality and ease, join our Brisbane Pilates studio. Going on holidays? Take your Pilates Instructor with you anytime… anywhere with The Body Refinery Online’s Studio – www.thebodyrefineryonline.com


HIIT Express Reformer pilates


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Take advantage of our intro offer: $200, 1 Month Trial. It includes:

To register your interest, contact us at info@thebodyrefinery.com.au or call 07 3358 3915

Make use of your physio or instructor


How your physiotherapist or Pilates instructor can assist you to achieve your goal.


Movement is a skill

We often forget that movement is a skill and that we have ‘learned’ it. Along with internal focus, external feedback is an important component of how we learn. One of the primary roles of your physio or instructor is to provide feedback. Beyond the instruction of ‘what’ to do they can often provide valuable feedback on ‘how’ to do something. An experienced physio or instructor would have accumulated hundreds if not thousands of hours studying, teaching, practising and observing movement. Why not take advantage of it?


One instructor vs. a variety of instructors

As a general rule, we recommend finding somebody that you connect with and have some consistency initially. The benefit is it allows a relationship to develop. The instructor will get a better idea of your body, movement and tendencies. You will get a deeper understanding of their teaching style and process. This helps reduce confusion while learning the foundations.

Once you have established a foundation (focusing on the principles) go experience other instructors and be open to their different perspectives and experience their different styles. You may find another favourite!

Pilates Principles


Group versus private sessions

Group settings are more economical and provide some social interaction. Private sessions allow for individual attention throughout the entire session.

Through our experience, nothing works well for ‘everybody’. In a group setting, we instruct for what works for ‘most’ people. We will try to make corrections for the individual as much as possible but by the nature of the class environment, our attention has to be divided. If you are finding you need a bit more attention a private session is a great option.


Some great times to consider working one-on-one with your physio or Pilates instructor would be:

– Pain*
– New to Pilates
– Specific goals
– Performance & technique

* The presence of pain especially if increased during Pilates needs to be discussed with your physio or pilates instructor.

At The Body Refinery, our physiotherapists or Pilates instructors are here to ‘guide’ you and help with technique. It is important that you combine the external feedback with your internal experience to get the most out of your Pilates. The more you understand your body, the more likely you will be able to apply this knowledge to activities and goals beyond the Pilates setting.


Some key ways to make good use of your physio or Pilates instructor:

– Find an instructor you connect with and have some consistency initially
– Listen to their feedback and apply it to your inward experience
– Private or small group sessions are available if more individual attention is required
– If you have a question ask!

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Recurrent calf tightness

calf tightness

Calf tightness is a very common complaint in runners and is often a recurrent issue. After stretching the calves or releasing them with massage, a trigger ball or foam roller, they may still feel tight, which can be very frustrating. A common reason this occurs is when runners spend a large amount of time trying to release tight muscles, when this time may be better spent focusing on strengthening them.

It may be hard to believe, but tight calves are usually weak. Studies have found that a high level of strength, and associated endurance, in the gastrocnemius and soleus muscles will prevent recurrent tightness.


Some other factors that can contribute to recurrent calf tightness:

  • Running technique: low cadence (amount of steps per minute) can lead to over-striding, and a greater impact force onto the lower limbs on landing/foot strike. An ideal cadence is said to be about 180 beats per minute. Running at the correct cadence will lead to your foot landing closer to your body’s centre of gravity. The focus should be on faster, shorter steps.
  • Foot and ankle mobility and conditioning: decreased ankle and foot mobility and foot muscle strength will lead to poor push-off or forward propulsion, reduced shock absorption and greater impact loading. The calves will have to work harder to compensate for this.
  • Decreased strength in the hip muscles and core: it is important to evaluate any deficiencies in the rest of the kinetic chain that could increase the stress on your calf muscles when you run. Decreased strength in your gluteal muscles and hamstrings, which are necessary for hip extension and help propel you off the ground, will cause you to rely more on your calves for forward propulsion. Good core control and pelvic stability are important for efficient activation of the gluteal and other lower limb muscles.

Effective management of recurrent calf tightness must include exercises to address the above factors, and not just focus on stretching and releasing the calf muscles.


The physiotherapists at The Body Refinery will assess your gait and running technique (Runity), to help determine the cause of your recurrent calf tightness. They will then develop a comprehensive rehab program to address the underlying factors and optimise your function and performance. Book a session with Aga or Kristen by calling 07 3358 3915.

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Written by Agnieszka Biniek

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What is Myotherapy


Myotherapy, or Musculoskeletal Therapy, is a method of hands-on exercise therapy to treat musculoskeletal pain and associated conditions such as:

  • Neck and shoulder pain or stiffness
  • Lower back pain and discomfort
  • Hip pain
  • Sports, stress, and work-related tightness.


What can I expect

Our Myotherapists have completed a Bachelor of Health Science (Myotherapy) and use varied evidence-based assessment and treatment techniques, which are tailored to each presenting condition. Our Myotherapists’ approach will typically involve an assessment, treatment and re-assessment format, where we will discuss a suggested treatment plan depending on your symptoms, as well as self-management education to ensure a successful outcome.



Assessment will take a few minutes at the start of the appointment and involves a discussion – listening to your description; discussing your symptoms, as well as any injuries or surgeries that may contribute to them, and how you are affected by them. This will be followed by an assessment of how you are moving, to see where you may be restricted, experiencing discomfort, or lacking stability – this will often involve assessment of nearby joints, muscles and tissues also. Additionally, we will feel the texture and quality of the affected muscles or structures to gain a further understanding of what is causing the symptoms. Taking time to do a thorough, holistic assessment is integral for informing a quality, effective treatment.




The aim of each myotherapy treatment is to reduce the severity and intensity of your symptoms, help you understand what is happening in your body and why these symptoms have occurred, and to get you feeling and moving better.


Our Myotherapists may use a variety of treatment techniques including:

  • deep tissue and pin and stretch massage
  • joint mobilisation
  • neural mobilisation such as flossing
  • trigger point therapy
  • dry needling
  • electro-stimulation dry needling
  • specific stretch techniques such as MET (Muscle Energy Technique) and PNF (Proprioceptive Neuromuscular Facilitation)
  • myofascial techniques, including cupping


Myotherapy can be helpful in filling the gap between remedial massage and physiotherapy. If you would like to book an appointment, please contact our friendly admin team on 07 3358 3915.

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Written by Sarah Holloway

Pilates for Neurological conditions

Neurological conditions

Neurological conditions such as Parkinson’s Disease, Multiple Sclerosis (MS), Stroke and Traumatic Brain Injury (TBI) disrupt normal neural system function and create significant challenges to movement and day to day functioning. Pilates provides an excellent environment to retrain movement and create new neural pathways.

Parkinson’s Disease and MS are both degenerative conditions, whereas stroke and traumatic brain injury occur due to an injury to the brain. For people with neurological conditions, there is a blockage in normal transmission of neural signals from the brain to the rest of the body. This can be due to the lack of a neurotransmitter (dopamine) as in Parkinson’s, problems with conduction of neural signals due to demyelination of neurons with MS or neural cell death which occurs in stroke and TBI.

Thankfully, the brain has the capacity to learn and build new neural pathways in a phenomenon called neuroplasticity. A nice way to think of it is when there is an accident on the freeway and you need to take a detour through the back streets to reach your destination. Blockages opposing normal movement may involve weakness, spasticity (heightened stretch reflex), rigidity and problems with coordination and motor planning. Treatment and exercise need to be targeted towards each symptom and in a specific order for new neural pathways to develop.

For those with neurological conditions, it is imperative to start treatment and exercise sooner rather than later. It is essential to improve function and strengthen weakened muscles to delay the progression of symptoms. Pilates provides an excellent form of exercise due to the supportive nature and the ability to challenge balance, coordination and strength.

parkinson's disease rehab Neurological conditions

How can The Body Refinery help you?

At The Body Refinery, we believe in commencing your rehabilitation as soon as a diagnosis is made. If you have Parkinson’s or MS and feel like your symptoms are very minimal and not yet giving you great difficulty, we encourage you to start your Pilates journey as early as possible to ensure you are able to keep doing what you love for as long as possible. For Stroke and TBI, the rehabilitation process does not stop once you leave hospital or outpatient rehab, it continues until you are either back to functioning at the pre-injury level or able to do the things you’d like.

All our physiotherapists at The Body Refinery undertake specific training in neurological conditions during their university study. Two of our physiotherapists Luiseach Walsh and Kristen Eales undertook further advanced Pilates training specifically for MS, Parkinson’s Disease and Stroke.

As with all conditions, no one case is the same and everyone presents with a different set of challenges and goals. We, therefore, recommend one on one sessions as well as diligence with a home exercise program set by your physiotherapist to alleviate symptoms and maintain progressions made in the studio. For more information on how The Body Refinery team can help you, please contact our reception team to book an appointment with one of our physiotherapists.

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Seeing a Women’s Health Physiotherapist after giving birth should be the norm

women’s health physiotherapist

In Australia, seeing a women’s health or pelvic floor physiotherapist isn’t a standard course of recovery. But it should be.  Most women will only see a women’s health physiotherapist if they have obvious symptoms, however, there are good reasons why all women should visit a women’s health physiotherapist at least once after giving birth.

A brief check-up with a midwife or obstetrician six weeks after giving birth isn’t sufficient for postpartum care. Generally, this type of check-up only involves a quick look at the uterus, a few quick questions on depression and how feeding is going.

Most women have some degree of pelvic floor or core muscle dysfunction after giving birth. A brief check-up typically doesn’t allow sufficient time to address all the questions surrounding any issues and the risks involved in not rehabilitating fully. Obstetricians and midwives’ main focus is on pregnancy, the birth and also recovery following the birth, however, they’re main focus doesn’t generally extend to the rehabilitation of the pelvic floor and core muscle control.


Childbirth and pregnancy place a huge strain on the body.  

In Pregnancy ligaments become lax, posture changes due to a shift in the centre of mass, and organs are pushed to the side by the rapidly growing uterus. Along with pregnancy, there is also the birth itself.  Regardless of the method of delivery, it involves a baby passing through a relatively small opening or layers of abdominal tissue. After the trauma that is often experienced during pregnancy and birth, returning the mother’s body to normal function and alignment is an important step.

Women place so much pressure on themselves to get back their “pre-baby body” that in many cases this goal is pursued at the expense of their own health, without any awareness of the damage they may be doing… and often under the guidance of a trainer that has no training in postnatal health. Just because a trainer has had a baby, or because a training session is called “mums and bubs” does not mean the trainer knows how to train a postnatal body. Make sure you research your trainer and ensure you have a postnatal check-up with a women’s health physiotherapy prior to exercising. An insufficient postnatal assessment followed by exercise under the guidance of an under-qualified trainer can be dangerous and has the potential to lead to long-term damage.

Your health is important, so make sure you do your research, let your health professional know of any issues you are experiencing, and don’t be afraid to ask your personal trainer, Pilates instructor or physiotherapist what qualifications or formal training they have in postnatal exercise.

Many postmenopausal women present to women’s health physiotherapist with a prolapse that has occurred because they didn’t sufficiently rehabilitate their pelvic floor and core after childbirth, or because they started running too soon after birth.  The body can remain in a postpartum state for around 30 years, so it’s not uncommon for a postmenopausal woman to experience a prolapse after picking up a grandchild or moving some furniture, because their bodies have not returned to full health after childbirth.


Postnatal symptoms that may be experienced include, but are not limited to:

  • pelvic pain
  • low back pain>
  • thoracic back pain
  • incontinence (urinary or faecal)
  • increased urinary frequency
  • pain during sex
  • pain sitting
  • pain walking
  • a sensation of heaviness
  • organ prolapse


Most of these symptoms are due to a breakdown in pelvic floor function and can be relatively easily treated. If you are postnatal, whether it has been 3 months or 40 years since you gave birth, book yourself in to see a women’s health physiotherapist or a pelvic floor physiotherapist – it could be the answer to any of the symptoms listed above, including the niggling back pain you have been putting up with for years.