Exercising With Endometriosis: What To Do And What To Avoid

March is Endometriosis Awareness month so I thought I’d take the opportunity to highlight what exactly this condition is and how those living with it can exercise safely and comfortably.

What is endometriosis and how many women does it affect?
Endometriosis is a chronic health condition where endometrial cells, which normally line the walls of the uterus, grow in other parts of the body. These cells can stick to organs in the pelvis, form plaques and patches within the abdomen region, and also follow the same cyclical changes as the menstrual cycle leading to bleeding at the same time as a women’s period. It’s also incredibly common – 1 in 10 women of reproductive age are affected by endometriosis, which equates to roughly 176 million women worldwide living with the condition.

What are the symptoms?
Signs, symptoms and severity vary widely from person to person, however some of the most common complaints include:

• Pain: before/during your period, sex, around the time of ovulation, during urination, or with a bowel movement.
• Heavy bleeding: some may also notice heavy clots during their period, have longer than normal periods, irregular bleeding, or experience spotting before their period is due.
• Bladder and bowel problems: constipation, diarrhea, feeling the need to frequently urinate, and bloating are also common.

Is it curable?
Presently there’s no known cure for endometriosis, but treatments and lifestyle management can be incredibly helpful in managing symptoms and helping those with the condition live full meaningful lives.

How exercise helps
Sometimes the last thing you feel like doing when you’re in a whole lot of pain is exercising, but it can help in a multitude of ways. Here’s why:

Exercise reduces inflammation within the body
Endometriosis is an inflammatory condition so anything we can do to help decrease whole body inflammation is helpful. Research shows that as little as 20 – 30 minutes a day of moderate intensity activity, such as brisk walking or swimming, can have anti-inflammatory effects.

Exercise helps with desensitisation of pain
Chronic pain caused by endometriosis can cause the nervous system to become overactive and on high alert. When pain signals to the brain are constant and amplified the body becomes increasingly sensitive. Consequently, what was once NOT painful, becomes painful. One way to reverse this is through desensitisation, which involves gradually exposing your body to movements that cause mild discomfort in a relaxed, safe and controlled environment. By doing this we are retraining the brain that movement is not a threat to the body, which can help improve quality of life and help with activities of daily living.

Exercise and stretching can help relax tight muscles

Often the pain caused by endometriosis can cause the muscles around the hips, pelvis and abdomen to contract and become tight. Before we begin any strength work it’s important to make sure those muscles are lengthened and relaxed.
This often means a visit to a women’s health physio who can use manual therapy techniques such as massage to release tight areas.
Following on, whenever I work with clients with endometriosis, I always advise a very thorough warm up including:

• 5 minutes of deep breathing, relaxation and visualisation of their pelvis being relaxed, pain free and capable of exercise
• 10 minutes of light cardio exercise such as treadmill walking; aerobic exercise increases blood flow around the body and can start to relax tight muscles
• Stretching of any tight areas such as the glutes, hip flexors or side stretch

Exercise can improve strength and posture
Once your body is warm and your muscles are lengthened and relaxed, THEN we can start to build strength. My main focus for endo sufferers is improving strength and posture.

When I work with clients who have endometriosis, I often notice their posture is forward and rounded. The reason for this is often two-fold: the structures around their pelvis and abdomen are incredibly tight AND they are also in a lot of pain and generally guard the area by rounding over.

To reverse this, I prescribe lots of posterior chain exercises such as rows, box squats, glute bridges, bird dogs, and clams using a TheraBand. Pilates exercises on the reformer can also be incredibly helpful and is a good way to get a solid workout without aggravating your endo symptoms.

What Exercise Helps Endo

• Low impact aerobic exercise: think brisk walking or swimming; upright cycling if tolerated otherwise the recumbent bicycle can be a good alternative; Aim for 30 – 60 minutes most days of the week.
• Strength & core exercise: focus on slowly rebuilding lower back strength and core control with progressive Pilates movements and basic pelvis floor exercises. In addition to this focus on a whole-body strength workout performed 2 days per week which focuses on posterior chain exercises. Best to have a program tailored to your needs so get in touch if you’d like some help with this!
• Stretching: after you’ve warmed up and again after you’ve finished your workout, make sure to stretch tight areas.
• Relaxation exercise: Pilates, Yoga and Tai Chi are all great mind-body forms of exercise that can get you moving without overtaxing your nervous system. Finding the right one for you is a process of trial and error so be sure to work with an exercise physiologist or physiotherapist who can give you tailored advice.
• Social activities: being with others and moving your body in ways you enjoy can be the best exercise there is! I encourage clients to explore other avenues of movement such as dance classes, bush walking, lawn bowls, gardening, or water aerobics.

What Exercise to Avoid With Endo

There are no hard and fast rules when it comes to this because the severity of the condition and its symptoms vary widely from person to person. However, when I first start working with a client, I generally advise that they avoid:

• High intensity workouts such as circuit training or intervals. This may further aggravate their already sensitised nervous system.
• High impact exercise such as running or boxing. Again, this may fire up the nervous system too much and lead to tight painful muscles.
• Abdominal exercises such as crunches, or sit-ups. Most of the time these muscles are in spasm and overly tight from constant pain. We must first work on relaxing them before strengthening them back up in a slow controlled way. I usually focus on core exercises where the spine remains in neutral such as modified planks and side planks where appropriate

Exercise is just one piece of the puzzle when it comes to improving your quality of life living with endometriosis! That’s why I always take a holistic approach to treatment and talk about getting enough sleep, eating well balanced meals, managing your stress and pain levels, and using mindfulness techniques to keep you feeling at your best!