Imogen Williams Physiotherapy and Pilates

02/04/2026

That heavy, dragging feeling down there can feel worrying.

You might notice it after a long day on your feet
Halfway through a walk or run
Or when your body is tired

And it is often followed by thoughts like
Is something going to fall out
Am I making this worse
Should I stop what I am doing

This is one of the most common things I hear in clinic.

And it is understandable that it creates fear.

But this feeling does not mean your body is broken.

In most cases, it is a sign that your pelvic floor is under more pressure than it can currently manage.

Not damaged
Not failing

Just overloaded

This can happen when your body is tired, when muscles are not coordinating well yet, or when pressure is not being managed effectively through breathing and movement.

It is not a sign that you need to stop everything.

It is a sign that your body needs support and guidance.

With the right approach, you can reduce that heavy feeling and build strength in a way that feels safe and manageable. If you are worried or notice changes, seeing a pelvic health physio can give you reassurance and guidance.

Save this if you have felt this and were not sure what it meant

30/03/2026

“You’ve been told not to lift… but what if that’s not the full story?”

I saw a patient this week who had been told to avoid lifting completely.

She was doing her best to be careful.
Avoiding certain movements. Holding back in exercise.
Trying not to make things worse.

But at the same time, she wanted to feel strong again.
To keep active. To be able to get through everyday life without second guessing every movement.

Because the reality is…..we need strength.

To lift our children.
To carry shopping.
To move through life feeling capable and supported.

So we didn’t stop exercise.

We worked on:
• how her body manages pressure
• how she breathes during movement
• how to build strength gradually and safely

And she’s now exercising without making her symptoms worse.

This is the part that often gets missed.

It’s not about avoiding movement.
It’s about learning how to move in a way your body can handle.

If you’ve been told to stop everything, you’re not alone.
But there’s usually a way to keep moving safely with the right guidance.

You don’t need to choose between protecting your body and getting stronger.

Save this if you’ve ever felt unsure about what’s safe for your body ❤️

26/03/2026

A really common thing I hear is
“I just can’t feel my lower abs working.”

I recently worked with someone who felt like her lower tummy wasn’t engaging properly. She described it as feeling unsupported, like it still looked a bit pregnant, and her core didn’t feel like it was working during exercise.

She had been doing lots of core work, but her DRAM wasn’t improving, which was really frustrating.

What was actually happening was that she was gripping through her upper abdominals rather than getting connection through her deeper core.

So instead of progressing exercises, we took things right back to basics. We worked on relaxing the upper abs, improving her breathing, and gently connecting into the pelvic floor and deep abdominals.

We tried this in different positions including lying, sitting and four point kneeling to help her find that connection.

It took time, which is completely normal, but once it clicked everything started to feel much more coordinated.

This is something I see a lot. It is not always about doing more or harder exercises, it is about building the right foundation first.

Save this if core exercises never quite feel right for you.

18/03/2026

Post-op support for women with endometriosis is often limited, but recovery is about more than simply waiting for time to pass.

Depending on the individual, rehab may include support with pelvic floor function, bladder and bowel symptoms, graded return to activity, and building confidence with exercise again.

Pain can change how the pelvic floor behaves, how movement feels, and how safe exercise seems. That’s why recovery often needs a more individual approach.

I also think it’s important to acknowledge that many women with endometriosis already know a huge amount about their own body. They’ve often spent years learning what triggers symptoms and what helps settle them. Good rehab should build on that knowledge, not ignore it.

Save this if you’re preparing for surgery or supporting someone who is.

16/03/2026

Because it’s Endometriosis Action Month, I wanted to highlight something I’m seeing a lot in clinic.

Women with endometriosis often become incredibly good at managing their symptoms because they’ve had to. They know their triggers, what settles things, how their bladder and bowel are affected, and when exercise feels supportive or too much.

But despite all of that knowledge and resilience, there is often still a big gap in support, especially around pelvic health rehab before and after surgery.

Pelvic health physio can help with:
• pelvic floor function, which is often altered by pain
• bladder and bowel health
• returning to movement and exercise
• rebuilding confidence after surgery

This is one of the reasons I’m really enjoying supporting these women.

11/03/2026

When people think about pelvic floor health they often think about exercises only.

But everyday habits also influence how well the pelvic floor functions.

Things like breathing patterns, bowel habits and how your body manages load can all make a difference.

That’s why pelvic health rehab often involves looking at the whole system, not just the pelvic floor muscles themselves.

Small changes can make a big difference over time.

09/03/2026

Today I was back in the lecture theatre at Cardiff University teaching the physiotherapy students about pelvic health physiotherapy.

Sitting there brought back a memory because I remember being in that exact lecture theatre about 20 (eek!) years ago listening to the same topic.

At the time it completely freaked me out and I remember thinking this is definitely not the area of physio for me.

And yet… here I am.

It was really fun to talk to the students about what pelvic health physiotherapy actually involves and why it’s such an interesting area to work in.

One of the things I always try to highlight is that pelvic health issues show up across so many areas of physiotherapy — MSK, sport, respiratory, neuro, elderly care, persistent pain and more.

So even if you don’t specialise in it, having some knowledge makes a big difference for patients.

The students were really engaged and asked some great questions, which was lovely to see.

And I always encourage them not to write pelvic health off too quickly… because you never know where your career might take you.

I could even see our old seats at the back left hand-side 😅🫣

08/03/2026

Something I’ve been working on recently within our NHS pelvic health physiotherapy service…

We now have a self-referral option, so patients with musculoskeletal problems in pregnancy can refer themselves directly rather than needing a GP referral first.

Hopefully this will make accessing physiotherapy a little easier and quicker for those who need it.

✨ Pelvic Health Physiotherapy – New Self‑Referral Pathway ✨
You can now self‑refer for selected pregnancy‑related musculoskeletal conditions:
- Pelvic girdle pain, low back
- Thoracic or hip pain (pregnancy → 6 months post‑birth)
- DRAM - Diastasis of the Re**us Abdominis Muscles (up to 12 months post‑birth)
- Carpal tunnel syndrome or De Quervain’s (pregnancy → 6 months post‑birth)

Who should NOT self‑refer and seek advice from your midwife or GP:
MSK pain not related to pregnancy
Symptoms outside the timeframes above
Peripheral joint pain (except pregnancy‑related hand/wrist conditions)
Any pelvic floor symptoms

Visit the link to refer yourself: https://forms.office.com/pages/responsepage.aspx?id=uChWuyjjgkCoVkM8ntyPrhghrPfymOJLhVqlXdp2OltUN01TMEhGTlZNNkdVTkZFQ05JWkIzRDAzUyQlQCN0PWcu&route=shorturl

03/03/2026

These are higher-level abdominal strengthening exercises I use in pelvic floor rehab.

Not early-stage.
Not day-one postnatal.

These are for when:
✔️ You can coordinate breath and pelvic floor
✔️ You have good basic control
✔️ You’re ready to build load tolerance

At this stage, we’re working on:
– Rib to pelvis control
– Eccentric abdominal strength
– Pelvic floor + deep core timing
– Control under increasing demand

Rehab isn’t just activation.
It’s progression.

Save this for when you’re ready to level up.

27/02/2026

Try these 4 lateral hip exercises using a small Pilates ball 👇

Strong glutes….especially glute med, play a huge role in pelvic stability, load transfer and single leg control.

And that matters for your pelvic floor.

When we strengthen the lateral hip, we’re not just “working the bum”, we’re improving how the pelvis manages pressure during running, lifting and impact.

These are the kinds of exercises I often include as part of pelvic floor rehab and performance work.

Save this to try later 💫

23/02/2026

Pelvic floor rehab isn’t just about squeezing.

Yes….pelvic floor exercises matter.

But if we don’t assess:

• Hip strength
• Single leg control
• Load transfer
• Movement patterns
• Running mechanics
• Squat mechanics

We’re often missing part of the story.

Your pelvic floor works as part of a system.

My background in MSK physio means I assess the whole picture- not just one muscle group.

And that’s often where the breakthroughs happen.

19/02/2026

You might think you’re weeing more in pregnancy just because baby is squashing your bladder…

But hormones are involved long before your bump gets big 🤍

Progesterone (one of the main pregnancy hormones) relaxes smooth muscle throughout your body. That includes:

• The bladder
• The urethra
• The pelvic floor

When those muscles are more relaxed, it’s harder to “hold on” — and you may feel the urge to go more often.

On top of that, your kidneys actually produce more urine in early pregnancy.

So if you’ve noticed changes from the first trimester… you’re not imagining it.

Save this for later 🤍
Or send it to someone who’s expecting.