Pelvic Floor: Part One

Pelvic Floor: Part One

Don’t Forget Your Pelvic Floor!

If you or someone you care for experiences bladder or bowel control problems, you’re certainly not alone. In fact, over 4.8 million Australians experience bladder or bowel control problems.
Urinary incontinence affects up to 13% men and 37% of women in Australia alone and 70% of these people do not seek advice or treatment.

The most common risk factors of developing urinary incontinence are:
-Pregnancy (pre and post natal)
-Urinary tract infections
-Surgeries such as prostatectomy and hysterectomy
-Reduced mobility due to neurological or musculo-skeletal conditions
-Health conditions such as heart disease/diabetes/stroke

Incontinence of any level is nothing to be embarrassed about, this is a real problem and it is very important to seek help and advice.

Your pelvic floor is a secondary control of your bladder. The urethra sphincter (muscle that controls amount of urine expelled from the bladder) is stretched during childbirth and so we rely heavily on the pelvic floor to take the rest of the slack. Strengthening your pelvic floor is a must pre and post pregnancy.

We are lucky enough to have access to Real-time Ultrasound and use this as a tool to assess your ability to activate your pelvic floor. From here we are able to prescribe the right exercises for you and we can teach you how to improve your pelvic floor for prevention or treatment of urinary incontinence.

Next week we will post more information on how to go about improving your pelvic floor and what not to do! So stay tuned!

Don’t forget to ask one of our Physiotherapists or Exercise Physiologists about a Pelvic Floor assessment.

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Article by Beth Chiuchiarelli, Exercise Phsiologist at MD Health

The Biomechanics of Running

The Biomechanics of Running

The Biomechanics of Running

How to improve your running gait

Nick Adkins, one of our Exercise Physiologists, recently attended a course on running technique and the importance of bio mechanics to improve running gait. Many people want to run and so they give running a go, however they usually will not have had proper training or technique focus and therefore injury usually occurs. The way in which we run is very important and this is dependent on a number of different factors for example strength, mobility, cardiovascular fitness and technique.

Overall, if you improve your bodies efficiency in running you will be able to run further and faster!

So how should we be running? E.g. forefoot vs. heel strike

Interestingly, the hype over barefoot running has caused much controversy over the last few years and according to Dr. Christian Barton the optimal foot strike is actually highly dependent on the patient’s injuries and current abilities.
Forefoot running is technically more ideal (if done correctly) because there is less load through the joints due to better weight distribution when landing compared to heel striking. However, many people trial running in a way that their bodies are unable to cope with such as barefoot running which predominately will force you to run on your toes. This ‘fad’ is great if you have the right bio mechanics for barefoot running and have good strength, mobility and technique. If you don’t you will pull up sore or provoke an injury.

When teaching people to run it is best to assess their overall strength and current running gait and then put together an integrated exercise program that not only includes strength training but specifically breaks down the running technique and educates them for a long term change.

running gait analyses

valgus in running

Overall there is no ‘one size fits all’ for running technique it’s actually best to prescribe a program that suits the particular person. For example forefoot strike is much better for knee pathologies as there is less load distributed through the knee but more work through the ankle, however heel strike is better for patients with Achilles pain or plantar fasciitis yet is harder on the knees.
If you think about it no one is there to show us how to walk and run properly as toddlers and so we have all developed different ways in which we move. This is why an individual, structured program that includes strengthening as well as education on how our joints should specifically move is the best way to transition to running or improve current running. Even minor changes to technique can have a drastic effect on performance and injury prevention.

We will be going over some practical applications next week. If you have an interest in running we may be assessing your running gait during your sessions over the next few weeks!

Article by Beth Chiuchiarelli,
Exercise Physiologist at MD Health

Staff Exercise Tip

Staff Exercise Tip

This Months Staff Exercise Tip

By Nick Adkins, Exercise Physiologist

Like everyone who comes to MD Health, I love my exercise. What I love best is the variety of exercise that can be done. Throughout my daily life, I complete a mix of pilates, heavy resistance training, cardiovascular training and plyometrics.

Out of all the exercises I do, there are two which are my absolute favourite and I prescribe these to almost every single client I see at MD Health because they are so effective.

1. Four Point Kneel – Single Leg Hip Extension on the Reformer:

My favorite pilates exercise, it is a great exercise to stimulate activation of the Gluteus Maximus muscle as you start from the hips in a flexed position and push to a neutral position (the Gluteus Maximus is the main buttocks muscle, Beth wrote a great article explaining the importance of this muscle (
Many electromyography (EMG) studies have shown that Gluteus Maximus muscle is most active when going from Hip Flexion to Neutral. It is also a level 3 core exercise, so it is perfect for beginners.
How to complete this exercise:

– Start by selecting the appropriate resistance, either two red springs or one red and one blue for beginners.

– Put yourself in what we call the 4 point kneeling position on the reformer.

– Your hands should be directly under your shoulders for best upper body support, the heel of one foot should be resting against the foot bar, with the opposite knee resting on the carriage.

– Push through the heel resting on the bar, until the leg is COMPLETELY straight, keeping the hips level. The carriage will move forwards with you on it.

– Hold the contraction of the gluteus maximus for about two seconds, and then return to the starting position.

– You may also feel this in the shoulders, as they have to stabilize the upper body during the movement.

If this is too easy, try these progressions!

– When you have pushed out, raise the opposite (contralateral) side arm. This causes one of the Lattisimus Dorsi muscles to be stretched, placing more stress on the thoracolumbar fascia, making the ‘core’ work harder. This makes it a level 7 exercise.

– While completely pushed out, raise the other leg that is resting on the carriage. This forces you to stabilize through your hips and shoulders a lot more as you no longer have the support of the resting leg. This is an advanced level 9 exercise.

PicMonkey Collage

2. The Squat:

My favorite exercise to do at the gym! I love the squat exercise for many reasons. Firstly, it is a natural movement. If you watch a toddler, they have the best squatting technique, unfortunately, as we get older, many of us become lazy and forget how to squat. This can be easily corrected.
Secondly, it is a full body compound movement; many major muscle groups to work together throughout the squat, in particular the Gluteus Maximus, the Quadriceps group and the ‘Core’ (Transversus Abdominus,  Multifidus etc.).

Depending on your exercise goals, the squat has many purposes. Working the largest muscles yields greater kilojoule consumption (ideal for weight loss), improved compound strength will lead to better function and stability (within your daily life or a specific sport). Squatting also stimulates the Central Nervous System (CNS) to allow greater work capacity and if you are lifting heavy, it also stimulates the Anterior Pituitary Gland to release more Human Growth Hormone (HGH) (ideal for putting on muscle bulk).

How to complete this exercise (perfect technique is vital with the squat!):

– Stand with your feet shoulder width apart, chest up, shoulders back and tummy in.

– Lower your hips back and down, while also bending at the knees. Keeping your chest up and looking straight ahead (you can also raise your arms out in front to aid balance if you haven’t squatted before).

– A great cue is to think about sitting in a chair, your bum goes back and down.

– Lower your hips until your upper legs are parallel with the ground, keeping your back straight.

– Throughout the movement, your knees should move out to the side just a little bit (this causes an external rotation bias of the hips, which puts more load through the glutes and also creates better foot posture as the arches are raised).

– Push through the heels of both feet and push your hips forward to raise yourself back up to the starting position.

IMPORTANT!! Your knees should NEVER roll in when squatting; this creates a valgus force through the knees, placing increased and unnecessary load on the MCL (Medial Collateral Ligament) and the Medial and Lateral Menisci (knee cartilage). If your knees roll in, there are a number of ways to correct your technique, you can reduce your range of motion until you have built more strength to control the knees (this is called a half squat – only lower half way down i.e. to a 45° angle at the knees). You can also tie a theraband around your knees, so when you lower, you have to place your knees out so the band doesn’t fall.

When you’re able to squat perfectly with just your body weight, you can progress to the more advanced versions of the squat, the most common is the Barbell Squat, where you have a loaded Barbell resting on the fleshy part of your upper back (upper trapezius fibers) to increase the load on the working muscles. The increased load is also great for working your core, as you have to stabilize your hips under the increased load.

There are great instructional videos for squat technique on the MD Health YouTube channel.

Beginners –


Work Out Tip – How Many Sets/Reps Should I Complete

Work Out Tip – How Many Sets/Reps Should I Complete

The number of sets and reps that you do for each exercise is highly dependent on what you are wanting to achieve out of your training program.

Someone who plays a high intensity, power based team sport such as netball or basketball would ideally want to increase their strength and then progress to improve their power and speed. However, perhaps you enjoy hiking or running marathons where endurance based program is more suited to allow you to continue at a constant speed for longer.

Here is a description of each fitness goal to allow you to select the correct sets and reps for your gym program:

• Endurance- Ability to maintain a certain activity at a constant speed for longer
• Hypertrophy – Increasing the size of a muscle
• Strength – Ability to move a certain amount of weight
• Power – Ability to more a certain amount of weight quickly

The following table demonstrates the required number of sets and reps needed to focus on each specific goal:

Fitness goal Sets Repetitions Rest between sets
Endurance 3 15-20 30 sec
Hypertrophy 3-4 8-12 1 min
Strength 4-5 6-8 2 min
Power/Speed 5-6 6-8 2-4 minutes

Make sure you read our previous article ‘What weight should I choose’ and you will be able to apply this general rule of weight selection:

“If the last 2 reps of each set are hard to complete without losing technique you have the correct weight however, if it was too easy to complete or you could not complete all of the repetitions your weight is too light or too heavy!”

Written by Beth Chiuchiarelli
Exercise Physiologist at MD Health

Core Stability – How It Will Be Even Better In The Future

Core Stability – How It Will Be Even Better In The Future

Core Stability – How It Will Be Even Better In The Future

Following Nicholas’ rehabilitation after his disc prolapse, we have been working hard to determine the best way to incorporate some of the additional core stability training, in particular, Multifidus training, as part of everyone’s Pilates program over the next few months. So why is this important?

What Does Multifidus Do?

The Multifidus are a small group of back muscles which make up some of the deepest layers of the back muscles. In particular, they make up the ‘Local Stabilizing system’ of the lumbar spine, which means their major role is to keep one vertebrae (eg the top vertebrae) ‘stable’ over the other vertebrae (eg the bottom vertebrae), so that the power muscles, such as the erector spinae muscles can move the spine safely. In other words, the multifidus control the amount of glide one vertebrae has over the other. If this is ‘uncontrolled’, it puts pressure on the support structures such as the discs and facet joints, causing injury.

Multifidus 1


How Does Multifidus Differ From The Abdominal (Transversus Abdominus) Muscles In Core Stability?

These muscles work together, but are not the same thing. The Transversus abdominus muscle wraps around the body and attaches onto the spine indirectly through a thick layer of connective tissue called the thoraco-lumbar fascia. The multifidus muscle attaches directly on the lumbar spine and has a more direct action in maintaining core stability. Multifidus also attaches onto the thoraco-lumbar fascia, so the muscles are linked and enhance each other’s actions

How Do We Train Multifidus?

We can now view multifidus directly on ultrasound. Viewing the activation of this muscle will now become a standard part of your re-assessment and we will work on teaching everyone how to contract this muscle during their Pilates sessions over the next couple of months

Multifidus 2

To Re-train These Muscles

• Kneel onto your hands and knees
• Make a small arch in the lower back
• ‘Squeeze’ the muscle of the lower back ‘in towards each other’. You should feel the muscle in the lower back puff up. Hold for 3 second

Don’t worry, we will be practicing these exercises during your Pilates sessions


Written by Nicholas Charalambous
Physiotherapist at MD Health