The Dr Louise Newson Podcast - 081 - Pilates & the Menopause - Dinah Siman & Dr Louise Newson

Episode Date: January 11, 2021

In this episode, Dr Louise Newson is joined by Dinah Siman who is a Yoga and Pilates teacher and the founder of Menopause Pilates. Dinah chats to Dr Newson about the history of Pilates and how the method arrived in the UK with Alan Herdman, and how it is now established as a tried and tested system for functional body work.  Dr Newson shares her experience of Pilates during her last pregnancy and talks with Dinah about the huge benefits of muscle strengthening, bone loading, flexibility and proprioception it brings during menopause and beyond, and the focus on breathing and pelvic floor health.  Dinah also talks to Dr Newson about the one-day Menopause Pilates course that she has have created for Pilates teachers and fitness professionals. The course contains evidence based information and exercise and educational resources and will be launching early in 2021. Dinah has been teaching Pilates to women in the menopausal transition for over 23 years, this combined with her own experience of menopause and passion for sharing menopause education has resulted in this unique one-day course.    Dinah's Three Take Home Tips: Try to view the menopause as an opportunity to learn Pilates, it will also benefit your long term health and fitness.  If possible, start learning Pilates with a 1:1 session or shared private lesson for a bespoke approach, before joining a class. And finally - give it time.  It can seem like learning a new language and that doesn't happen overnight, so have patience! Follow Dinah on Instagram: @menopausepilates Email: [e-mail]  

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsome, a GP and menopause specialist, and I'm also the founder of the Menopause charity. In addition, I run the Newsome Health Menopause and Well-Being Clinic here in Stratford-upon-Avon. So today with me for my podcast, I have Diana Seaman, who is a Pilates teacher, who I've been connecting with remotely for quite a long time. time actually and now we're seeing each other on the screen but I've still never met you face to face. But welcome. Thanks ever so much for agreeing. Thank you. Thank you for inviting me. So we've done a few or I've done a few podcasts about yoga which is something that I practice

but actually we haven't done one about Pilates and it's very much in my radar and in fact I when I was pregnant for the third time I did Pilates all the way through my pregnancy and it was great actually. I really enjoyed it. I just haven't got time to sort of do everything. But it's one of those things that I think many people don't know anything about. And I don't really think you might correct me, but I don't think it's a sort of thing you can put on a DVD and then through a screen if you've never done it before. Because it's quite subtle some of the movement. So I'd really like to just start off really asking you what is Pilates and what's the origins and what's just explain to us novices. Yeah, no, I mean, Pilates has been around a long time. Joseph Pilates developed it,

but it was kind of a well-kept secret, if you like. So he was around in the early part of the last century. He was German, and he developed his own fitness program for himself because he was a sickly child. And he studied a lot of different things. He looked at what the ancient Greeks did. He looked at bodybuilding. He looked at all sorts of different things. And he developed his own program to help himself. Then when things changed, he was actually interned as a prisoner of war in the Isle of Man, funnily enough. This is around the First World War time.

And he worked with the prisoners in the Isle of Man. And when the flu epidemic was going on, the people he worked with, the men he worked with didn't get the flu. and he was making getting them moving and even though some of them had lost limbs he was developing ways of getting them to move using springs and different things from the beds this sort of thing so he knew he was very much onto something about looking after yourself holistically and being looking at diet looking at lifestyle looking at exercise he was well ahead of his time he wrote a book which is called return to controlology because it was originally called controlology which is a funny expression and there are are some really good books that you can read about how he developed his system. And eventually, after many things, he ended up in America because between the wars, he was training the German police force, but he didn't like the way things were going. So he left Germany. And he met his wife, maybe not married, not sure, Clara on the way over on the boat. And she was a nurse. So he

set up his own practice in New York. And it happened to be next to the New York City Ballet. So he started to do a lot of training of the dancers who were injured, which is why a lot of people think that Pilates is what dancers do or it's a dancers thing. It sort of got associated with that. And then fast-tracking forwards, in the late 60s, a man called Alan Hurdman went over from London to the States, and he trained in Pilates Method and he brought it back to the UK, and he was the first one to bring it back.

And he had a studio from the late 60s, early 70s onwards in London. He's still going strong. And it's from him that everybody else. else has gradually learnt. But again, even when I trained 23, four years ago, you had to do an apprenticeship, so you spent two years roughly in a studio learning it on the job. And there was no training as they do now with matwork pilates or equipment Pilates. It was the whole thing. And it was very much about learning how to take the exercises, because there are a number of exercises from the method and adapt them to the person. So it was always about making sure the exercise works for

that person and changing it if it's not appropriate. So yeah, which is so important, isn't it? Because we're all individual and as we get older, we all have different sort of, even doing one side of my body is very different to another. And it changes all the time, doesn't it? And sometimes you can go for a walk and feel fine other days. You can go for walking and realize you've got a bit hip pain or you've got a little back pain or something else. So it's very important that, certainly I think about some of the aerobic classes I used to go to as a medical student in the 90s and 80s. and they were very, you know, step mobility. But it was the same class each time,

maybe slightly different track, but it was very repetitive. That's not great, is it? No, you want variety because you want your body to learn different things and respond to different things because we have to. So, yeah, so Pilates has got, I mean, it's had a number of sort of ventures

into the wider world, which didn't sort of take off. And then I guess it would have been in the mid to late 90s, things changed. And I think it's probably on the back of the aerobic, well, that that sort of way that it happened because lots of people got injured. Tell you that. And that coupled with people becoming much more aware of looking after themselves and of looking at things in different ways and trying to be more mindful about what they were doing. I think it's sort of the time was right and, you know, it hasn't looked back since.

It's now, you know, when I started teaching, I had to explain what Pilates is. Nobody knew. But now it's everywhere. Yes, it's interesting, is it? So my Pilates teacher I had when I was pregnant, actually learnt, was taught Pilates after he had something called Guillambare syndrome. It was a post-file. And as you know, it affects the nerves that feed the muscles.

And he became paralyzed and couldn't walk. And he used to be a contemporary dancer. And so he had to learn how to walk. And he found it very frustrating not having the right sort of physio and the right exercise. So he sort of learned Pilates for himself and then realized how. much it could help. But actually he, like you, I can see behind your machinery. And I hadn't used reformers before or used any of the equipment. And it's very different, isn't it, to just having a match. It is. It is very different. The matwork is a component within the studio. And then

within the studio environment, you've got the reformer, you've got the trapeze table, you've got the chair, you've got the barrel in particular. Those are the main pieces. And the equipment gives feedback in a different way. So you can use it for resistance or assistance. And so in theory, the classical Pilates repertoire on the mat is the hardest thing to do. So that being said, it depends how you teach it what you do. But the studio environment, it's always taught in small groups and it's about people really understanding what they're doing with their bodies and really supporting themselves from this method. So you can use it either as a conditioning method or you can use it as a way of exercise depending on how, you know, what you want from it. So something for everyone,

which is really, really important. And you've developed this menopause Pilates program, hence, Emily. I have, yes. Well, basically, you know, I've been teaching menopausal women for 23 years, Pilates, and I've taught them yoga, and I've taught them gyrotonic, and various different things. Then, obviously, coming to my own perimenopause and menopause, it's not until you go through it that you really understand it, you know. And even though I'd been teaching so many women and sort of thinking,

okay, well, this doesn't make sense or this doesn't make sense. Once you experience it, you go, okay, right, I get it now. So I had developed quite a lot of things working with them, but then with my own experience, I've developed that further. And although I absolutely love yoga and I love Jarotonic, I found with all the injuries in my own body from many years of doing loads of exercise, that it was Pilates which was keeping me together and that I couldn't do what I normally did. So it's very much for me, menopause pilates is about education. It's about helping women understand what's happening, why they're seeing more shoulder problems, why they might have Achilles tendonitis, why things aren't working like they did while they get injured.

So it's looking at that methodology in particular. And then it's also very much about the educational side about what's happening in menopause, because this isn't talked about enough. So in my studio, we are constantly talking about menopause. And, you know, I have age range from late 30s, early to late 30s into the 80s. And so we talk about it, all of us, which is great because, you know, and then they talk about what their mother said, what their aunt said, and sharing information, it's really, really been interesting to see even in a short period of time, the number of women who have gone from, oh, no, no, no, you know, can't possibly take HRT. Menopause is completely natural to telling me that they're now using Vagifem.

And I'm like, whoa, great, you know, because the work you're doing, the conversation widening and opening up. But I kind of feel that in the Pilates environment as well, it's a great opportunity to talk about it and to understand what's happening and to understand how you can help yourself. Absolutely, yeah. And I think it's really important, isn't it? Because so few of us have time to go and see a doctor or we sort of feel a bit nervous talking to our doctor because you think, well, it's a natural process. Like you say, why would we go and pester a doctor, who's going to be very busy, especially now. It can be quite difficult to see your doctor face to face.

But actually, to have other environments that are less formal, if you like, actually you can get more information. Yeah. So to have polarity. And often, you know, when you go to a regular class, you're seeing people in your class probably more than you're seeing your friends. Yeah. But it's really important that people are given the right information because, as you know,

for many years and decades, women have been given wrong information. So there's all this misconception. So to have a safe environment where people with knowledge are helping each other, that's really powerful, isn't it? It is. And, you know, a lot of the women I teach came off HRT in 2002 because they were told to. And, you know, they now say they wish they hadn't. So I've got a lot of women who are in that age group.

And then I've got those coming up who, you know, the number of times I've had women, me to come in for their first one to one. And then they just burst into tears and they say, I don't know what's wrong with me. And then I just said, well, have you thought you might be paraproysal? And they haven't heard of it. So it's having that time, as you say, to talk about it, to feel it's a safe environment. And, you know, within menopause, Pilates, within Pilates, we talk about pelvic floor. We talk about breathing. We talk about integrated movement in the body. We talk about understanding how you use your hip, how you use your shoulders. It's a lot about body awareness, developing body awareness and understanding your body because menopause is a great

opportunity to actually make changes, to understand what's happening, to learn something new. And I guess, well, because of how I teach and where I've been in this area for such a long time, I tend to get people refer to me who have got problems. That tends to be how it is. They've got back problems, joint problems. They've had surgery or they're in pain. I have a good connection most Pilates teachers will with osteopaths, physios and chiropractors in the area. So, you know, they might say, oh, sending this person to you, got this issue or whatever. But a lot of women, as they get older into the menopause, are losing their muscle strength. And they don't know why.

And they don't understand why suddenly they can't do what they did or things are hurting because they've got inflammation. So, you know, educating and understanding what is happening. happening is critical. And a lot more women are hypermobile than realised they are. And that really starts or can start to cause issues once you hit perimenopause. Yeah. And it's so important because lots of people don't realise how important estrogen, but also testosterone and hormones are and being anti-inflammatory and our muscles and joints. But also building our muscle strength. So a lot of women are now realizing the importance of osteoporacist because one in two, women over the age of 50 will develop

osteoporosis if they don't take HRT, but actually you need your muscles to support your skeleton. Exactly. And it's not so much about wanting to keep skiing until you're 80 or keep, you know, doing triathlons, but actually it's about holding your zimma frame. It's a bit, be able to get out of the bath. And that's what's really important. I know it sounds really silly. No, no, it's functional. I see so many women, or I have done over the years who have said, I don't need to do exercise. I'm not into that muscle, you know, that tuning whatever. it's a waste of time, but then they're the ones that can't get out of the chair. They've got no thigh muscles.

They've got no arm. And this sort of sarcopenia, this loss of muscle mass is so common. And it's not really thought or taught about very much to people. You know, even this morning when I was teaching, some of the ladies were saying, well, you know, I've been walking. I've been walking. I said, yeah, walking is brilliant. But it is not going to build muscle the way you need to build muscle.

And that's quite a difficult thing to understand that you have to do more than your daily living in order to improve your daily living as you get older. So it's quite a tricky one. And of course the other thing which is something I come across a lot is weight gain, obviously, for women as they hit panopause. And Pilates is great because it's very often accessible to women who have gained weight. And it's again about feeling you can move and you feel safe and you don't feel that. you're in an environment where people are looking at you. And so you can start to make changes. You can use Pilates as part of a weight loss program as well. But then again, you know, we see a lot of Achilles tendonitis, plantapaceitis, which come with the weight gain. And then,

of course, more inflammation because the estrogen is depleting. So it's really trying to link everything together a lot of the time for women so that they understand that this is happening because of that. And if you want to be strong into old age, then the functional exercise, maintaining, keeping your weight under control, you know, having a lifestyle which works for that is going to be beneficial. Yeah, and I think it's so important, isn't it? Because obviously I am very pro-HRT because for the majority of women, the benefits, that way the risks. But whether a woman takes HRT or doesn't take HRT, she's still got to look after a future health. There's no point me taking HRT and doing no exercise. eating chocolate every day. But it's very important when people feel well, they often,

the first thing that goes is exercise, isn't it? I think it's very easy to have an excuse that you're too busy or you're too tired. And it happens to all of us. We all sort of find it hard. But actually, if you have it as part of your routine and even some very simple things, obviously it's a real luxury to be able to go to a studio with equipment, but you can still do Pilates at home, can't you? Absolutely, definitely. And, you know, Matwork Carter's is accessible. to everybody and, you know, there are a lot more teachers around. So, yes, you can do it in different ways for sure and it is accessible. And I think the great thing about going to a class, which of course has been very difficult of late, is it gives you that regularity. And a lot of women

who come to class don't particularly like exercise, but they're happy to be taught or they're happy in the group because of the social aspect as well. Lots of them do. But, you know, there are definitely those who say to me, I hate gyms, I hate this, that and the other, but they'll come and do Pilates. So it's that continuity. And it's surprising how much even one class a week will make a difference. Yes, that's exactly right. I mean, I think we can all do more, couldn't we? But even doing once or twice a week really makes, because it's continual. And certainly everyone I see in my clinic, I always ask about their diet and their exercise. And I can often tell the women that exercise. And you can also sometimes I find tell the different type of exercise a woman does, despite the way she is.

And I don't know what you think, but certainly as we get older, I think some of their sort of high energy hit type classes can be quite detrimental for that cortisol or that stress. Yeah. If you've got dodgy knees, the pelvic floor is not great. It's not going to be ideal, isn't it? No, no, that's where yoga and Pilates are great because they support the system. They teach you to work with your breasts. And, you know, we have got to nurture ourselves. We have got to look after ourselves.

and women are so bad at looking after themselves because they're always looking after other people. And if they just would give to their own body, the care they give to other people, that would be a great starting point. And I think also you're right, because many women are used to running or doing high impact exercise for stress relief,

which is actually possibly not the best thing to do anyway. But once you get to perimenopause, very often, you know, anywhere or tear or areas of inflammation just kick off. So they can't do what they did. So understanding that, but not sort of thinking, okay, well, that's it, I can't do anything. But actually modifying, finding another way around it is a good thing. And understanding that, you know, if you are hypermobile, then your tissue is going to need more support, more strength, because you don't get the feedback.

And unfortunately, the ligaments, which are really overworked in that range, get more lax, again, because of the lack of estrogen, get more pain. So building up the strength. And again, I mean, I'm very much in favor of HRT, but I know it's a personal choice. But I, you know, I will always say to a woman who's had surgery, who's got back problems or any issue, have you considered it? Because it's going to help the pain. It's going to help inflammation. It's going to help you build strength. And actually, it should be considered because it is really, in many ways, it's a no-brainer if you can take it. Even if you don't want to take it forever. But if you've got pain and you cannot get out of that cycle and no physio is helping and exercise isn't getting there, it might be that's the missing element. Yeah, and sometimes it's very difficult to know if someone is perimenopausal or even if their menopausal is their pain related to their lack of hormones. And often we give HLT and there's different types, different doses, but we give it and then review people.

And so many women say to me, goodness me, those pains have just melted away. And you know, then it's related to their hormones. If it doesn't help, then obviously it's not. Exactly, there's something else going on. And there's other benefits of taking HRT, but it's certainly worth at any age. We recently have someone in our clinic who started for the first time HRT age 91.

Wow. That's quite an achievement, isn't it? But, you know, the beauty of it is it can be tailor-made. So it's just a small dose sometimes. And even a small dose can actually help protect the bones. And osteoporosis is so important, isn't it? But it's not a condition that we've spoken about much. because it's always cancer that gets the front page or heart disease.

Osteoporosis doesn't have the same. People just think it's just something that we have and it's not going to cause any problems. But osteoporosis of the spine is a real issue. And our whole core strength is so important, isn't it? I think people don't realize until they don't have it. Exactly. Back pain, isn't it?

A lot of people have degenerative back condition, but they don't know until they've had a scan or they've had a problem. Yeah. But it's trying to preserve what we've got for as long as we can. Totally. And that, you know, again, Pilates works on strength, works on mobility, flexibility, works on bone loading, body awareness, awareness of the pelvic floor.

Because again, this is a whole area which women don't talk about, you know, incontinence and all of this needs to be brought out into the open. Because, again, there is so much that can help if you know. Absolutely. And I think you're right. I mean, menopause is a real taboo, but actually urinary symptoms, so incontinence, whether it's urge or stress. You know, lots of people find they can't cough or sneeze. Yeah.

They couldn't run without wearing a pad. But they won't get help because I just think it's part of getting older. Yes. And it shouldn't be. No. Or they say, well, I only have a little leak. It's not that bad. Well, actually, if you're having any leak, then it needs to be seen.

Exactly. But it is, if preventing, by keeping. your pelvic floor as strong as possible can make a real difference. And it's not until you haven't got those muscles. My pelvic floor is quite strong because I do yoga, but I had a hysterectomy a year ago and I obviously wanted to do my pelvic floor muscles. I couldn't even feel them. Didn't ever exist? Straight after the operation and it was quite a shock actually because I thought, goodness, these muscles have always been there. They're just there for me. I can do my pelvic floor muscles when I'm cleaning my teeth and I suddenly, it was like they didn't exist because

they've been damaged obviously by the surgery. And it made me realise, goodness, it's so important to try and keep what you've got. Absolutely. You lost it. It's really hard. Yeah. But muscles are very forgiving, aren't there? And they've got great memory.

But they, even if someone hasn't exercised for a long time and is too scared, if you like, to go to a gym, you can start very slowly with Pilates. Very much so, yes. That's a great thing about it. It's really adaptable. And depending on, obviously, the experience and style of the teacher, you can start. you can adjust things to suit people very much so. And that is for me, my menopause Pilates program, which is very exciting.

I'm going to roll that out next year for Palatis teachers to do a CPD, focus purely on menopause and on the type of exercises which are nurturing and the type of exercises which are strength building and all the different aspects to look at and conversations to have. Because, you know, when I was a 34-year-old Pilates teacher, I wouldn't have known how to talk about vaginal dryness. How would I? But actually, if you have the information and you have a structure

and you know how this can be taught and talked about, then it's very doable. So it's all about education to me. So this is a program for other teachers. Yes. So I'm going to, that's hopefully coming out at the beginning of next year, along with my new website. And it is so.

So that's 20, 21, isn't it? Sorry, 2021. And it will be a very practical CPD for teachers, which doesn't have to be Pilates teachers. It could be fitness teachers, personal trainers, to give them much more awareness of menopause and what is required for women in this age. And looking at also signposting

how you can help not only the women you're teaching, but as a teacher, where you can go for more resources as well, where you can train more in different things to support. the work you're doing. So again, it's about getting it out into the community more and making it practical for everybody because for me, teaching is practical. It's about making a difference and it needs to make a difference for everyone. So is this the first Menopause Pilates course? It will be. Yes. Yeah. Yeah. That's brilliant, isn't it? Well, another reason I thought, actually, you know, this is so needed. And whilst I've been working in this field for such a long time

and kind of been taking it for granted up to a certain point, you can't take it for granted. because, you know, there are ways to help women. And if I can help younger teachers figure that out more quickly, so much the better. Absolutely. And I certainly hope that my generation is the last generation of really suffering with so little knowledge. And it's so important that everyone helps everyone. And actually, I just want to publicly thank you because you did a Pilates class in Aid of the Charity recently. And I was there doing it.

And it was really fun, actually, to do Pilates. And it made me realize how easy it is for anyone to do, but you could take it as much as you wanted or as little as you wanted. But it was a fantastic class. But it was great to see so much interest and support. And actually, for some of you that might have seen on my story before, your children were really supportive. And that was just so lovely because for them to be proud of what you're doing is really key. I remember a couple of years ago, one of my daughters who was 14 at the time told me off because I'd mentioned vaginal dryness on my Instagram. And people at school were making fun of her.

And I did say, well, do you know what? I'll close my Instagram account if I'm going to embarrass you because the last thing I want to do is embarrass you, I won't you to be proud of what I'm doing. And now, because I've got so many Instagram followers, they think it's amazing. Of course. Yeah. It's all right. But to me, you know, I work very hard, but my family are the most important thing in my life.

So actually to have your children supporting you, and I'm sure they're very excited about what you're doing next, aren't they? They're hugely supportive. They're great, actually. And I'm really, I'm so fortunate because both my sons will ask me, how are you? You know, and we talk about menopause, they want to know. And it's great because they are opening up the conversation with their friends and asking them, well, what's happening to your mothers or, you know, your arms or, and Tommy, who was the one who was doing the promoting for me, you know, he said to me, well, what about biological females who don't associate themselves as women? You know, what about them? I said, Yeah, because for the younger generations, you know, they're so much more open to so many different things

and making those links and connections. And, you know, he's great. He said, coming back on the train the other day, he said, I could hear this woman talking about her HRT. And I wanted to say, oh, what sort are you on? Are you on body identical? And what's your dose? He said, I mustn't, though. I can't do that.

He said, that would look really weird. But they are really aware. But it is great because I think the more they can have a conversation, normalize it. Exactly. It's normal. And we need to be able to talk about it. whether it's with our hairdresser or our Pilates teacher or with our doctor, it doesn't matter, it's just talking.

Totally. Yeah. And the other day a lady said to me that she'd never had such a relaxed conversation about the pelvic floor and urging continents. And I said, well, no, you know, we just have to talk about it. But it's all too hidden. So we have to get this out. Really do.

And it was great funding that class. I really enjoyed it. And we had a lady in Australia. We had a lady in France. We had people in Ireland. So it was great. It was really lovely. And that's one of the few good things, isn't it, about lockdown and coronavirus,

that it's linked communities together and the ability to share knowledge in a very quick, actually, way. Yeah. Globally is really key, isn't it? And there's a big movement. I think we all want to help each other and we want to do as much as we can to help. And be healthy, because at the end of the day, I know I'm a doctor, but I don't really want people to see me who we're ill. I want to try and help prevent disease.

So we can avoid the NHS and we can avoid going to doctors. and the more we can help by offering a really holistic approach by doing exercise and finding the right exercise for each person. Totally. Very much so. Yeah. No, it's really useful. So before I go, would you mind just sharing three tips?

And it would be really useful for three tips for people who are a bit nervous about Pilates. So three things to get them started. Okay. So I did think about this. Oh, good. I'm very pleased to do with her work. And I think for me, doing menopause as an opportunity to learn something new, Pilates, and might be something else, but obviously in terms of exercise,

to look at Pilates as a new possible way of finding an enjoyable form of exercise, which is going to support you ongoing. If you're going to do Pilates, if you possibly can have a one-to-one, that is the best thing you can do with a teacher. And find a teacher who is recommended. So a friend of a friend or you've read about them somewhere or you've checked them out, or from a physio or recommendation. If you can't find a recommendation, then there are a number of really good Pilates schools

which have got websites which will tell you where teachers are in your area. So if you just Google, you'll come up with Polestar Pilates, Body Control Pilates, Stock Pilates, Pilates Foundation. You'll find some well-known schools and they will have a register of teachers. if you can't afford to do a one-to-one, because I know it's not for everybody, see if you can share a session with a friend. Because if you just have that initial tuition, which is more detailed for you,

and you start to really understand what the teacher is saying to you, that's going to stand you in good stead. Then give it time, because it's like learning a new language. And we don't expect to speak French in three lessons. So even though it's our body, and we've been living in it for X number of years, you'll be asked to put together things, movements and breathing and various things, which might make you feel you can't do it. But you have to give it time. Have patience, be curious.

Give yourself at least six weeks, if not longer, to start to have a feel for what you're doing. Very good advice. Excellent. So no excuses for anyone listening. Not to try. So, well, thank you so much for your time today. Thank you. Brilliant. And keep up the good work is all I can say. So thanks ever so. much. Thank you. I love doing it. Thank you. For more information about the perimenopause and menopause, you can go to my website, menopausedoctor.com.uk or you can download our free app called Balance, available through

the App Store and Google Play.