1. Presentation title (Date) Presentation Title Presentation title (Date) Pelvic floor, abdominal & back training

2. Presentation title (Date) Lesson Objectives Explain the term core stability & the muscles responsible List the functions of the Pelvic floor Explain and demonstrate how to locate and train the pelvic floor Identify best methods of training the abdominal and lower back muscles

3. Presentation title (Date) Pelvic Floor Sling or hammock-shaped muscle (floor of the pelvis) Originates on pubic bone & inserts onto coccyx Figure of 8 producing sphincters around: urethra, vagina, anus Muscle is in 3 layers: Superficial layer is the figure of 8 perineal muscle Intermediate fibrous layer which is a triangular ligament allowing 2 openings - urethra & vagina Deepest layer of the levator ani muscles Due to effects of relaxin and weight of baby these muscles are stretched during pregnancy & delivery Baby weighs on the pelvic diaphragm Excess impact can lead to stress incontinence Contains both fast and slow twitch muscle fibres

4. Presentation title (Date) Function of the Pelvic Floor Support organs of the pelvis (bladder, uterus and bowel) Resist rises in intra-abdominal pressure caused by coughing, sneezing, lifting or straining Plays a significant role in the continence mechanism Co activate with TA to assist pelvic spinal stability Has an inhibitory effect on bladder activity

5. Presentation title (Date) Pelvic Floor

6. Presentation title (Date) Weak Pelvic Floor Implications If stress incontinence a problem then high impact activities contra-indicated Reduced ligament support for the pelvic organs can increase risk of prolapse Encourage bracing & lifting of pelvic floor throughout CV session Consider comfort of the perineum eg. Upright Vs recumbent cycle

7. Presentation title (Date) Stress incontinence Loss of urine involuntarily Caused by coughing, sneezing, straining, lifting or jumping

8. Presentation title (Date) Episiotomy A surgical incision into the perineum between the anus & vagina to widen the exit route! Performed: before a forceps or vacuum delivery during the ‘push’ phase of delivery

9. Presentation title (Date) Pelvic floor recovery & repair Episiotomy healing generally within 10 days Takes 6 weeks for stitches to dissolve Exercise will: increase blood flow to area improve the disposal of waste products from area likely to reduce pain felt may assist the cut / tear to close Start as soon as comfortable

10. Presentation title (Date) Pelvic floor exercises Contract and release (fast or slow) The Elevator Pulses at the top of the movement Use gravity where possible Focus on relaxation during eccentric phase Breath regularly throughout No limit of amount you want to do Suggest 2-3 sets of 20 reps daily

11. Presentation title (Date) Presentation Title Presentation title (Date) Core stability training

12. Presentation title (Date) Abdominal muscles 4 layers - working inside to out Transverse abdominus Internal oblique (inverted V) External oblique (upright V) Rectus abdominus

13. Presentation title (Date) The abdominal wall

14. Presentation title (Date) Group activity In pairs list all the functions of the abdominals What are the benefits and concerns for pregnant clients regarding abdominal and back training 5 minutes task

15. Presentation title (Date) Function of the abdominals Supports abdominal contents & pelvic contents Maintains upright posture Supports lumbar spine Allows forward & lateral flexion & rotation of spine Braces body when under stress (cough) Aids propulsive movements (‘push’ phase of delivery Controls the movements of the limbs during exercise

16. Presentation title (Date) Benefits and concerns Benefits: Supports lumbar spine Supports internal organ Supports uterus Controls movement of trunk Aids ‘push’ phase of delivery Potential problems/conerns: Body position Breathing Braxton-Hicks contractions Doming Muscles contract over rounded shape

17. Presentation title (Date) Linea Alba Central connective tissue joining of the aponeurisis of the transverse & obliques separation of rectus abdominus at the linea alba is diastasis recti

18. Presentation title (Date) Practical group activity List all the abdominal and back exercises that you currently use with your clients Consider Rectus Abdominus, Transverse Abdominus, Internal/External Obliques, Erector Spinea & Pelvic Floor. Suggest adaptations for the various stages of pregnancies to ensure safe exercise selection- prepare to feedback to the group Task time 45 minutes

19. Presentation title (Date) Abdominal exercises Hollowing on all floors Side bends 3/4 moving side plank Hip rolls on stability ball – engaging TVA Brace and hold standing

20. Presentation title (Date) Lower back exercises Mobility: –cat stretch (all fours) –fetal position (side) –fetal roll (back) Strength –single arm raise (all fours) –superman/sand lizards (all fours) –resisted back extension (seated)

21. Presentation title (Date) Summary Abdominal training should continue throughout pregnancy although adaptations will be necessary to ensure safe exercise prescription. Most exercises will focus on TVA and pelvic floor activation, rather than rectus abdominus. Lower back training is essential throughout pregnancy. Although adaption's may be needed. Consider the usage of pillows, cushions, & resistance tubing to aid comfort, safety and effectiveness for participants.