Core strength and Diastasis Recti during Pregnancy

I have had women contact me who are pregnant and realize they have the abdominal separation that often happens in this season, Diastasis Recti. This condition has become a “buzz word” for women having kids as it becomes more talked about in maternal care. So I thought I would address this topic for anyone in this position and hopefully give you some helpful information and tips and dispel any fear here.

What is Diastasis Recit (A recap on DR):

Diastasis recti | BabyCenter
What happens to the outer muscles during DR

First of all, what is Diastasis Recti? I have mentioned this condition in other posts and I have an online training program written specifically for it (Mom Core Challenge). Diastasis Recti is when the outer abdominal wall separates as the muscle tissues spread in pregnancy while the belly is growing. The linea alba is a the connective tissue that holds the two ab sides together (these abs are considered our “six pack abs” or Rectus Abdominis). The linea alba thins and loses tensions as the belly expands. Sometimes it thins so much that feels like there is a big gap between the abs. Behind these outer ab walls is another abdominal muscle layer called the Transverse Abdominals. These muscle fibers run like corset around the front of the body and are very important for spine protection, posture, hip stability, etc. These muscles spread and lose a little tension but do not separate like the outer muscle group. (We will address the Transverse Abdominals/ TAs in another post for some exercises).

Here are common questions I get about DR in pregnancy:

  1. Is DR “bad” when you are pregnant? The short answer is “no, the separation itself is fairly common and an expected compensation of the body as the baby grows.” However, with a DR you are more vulnerable to injury so there are some movements that can be avoided and some cautions you can take to better protect your body in this vulnerable season.
  2. How do I know if I have DR when I am pregnant? You may notice if you have DR in pregnancy if you notice a “coning shape” of the stomach when you sit up or move into certain positions. Some women even can feel the separation with their fingers when they push into the abs. Many women expecting have no idea if they have an ab separation or not.
  3. Can DR be helped when pregnant? Correct core and breathing exercises that are safe for pregnancy can prevent DR from getting much worse during pregnancy, protect you from other injuries, assist the core in a better healing after baby is born, and sometimes (rarely) even heal the DR to some extent.

I Realize I have DR…now what? 

If you have realized you have Diastasis Recti during pregnancy it is important to first know what to avoid and how to support this vulnerable area so you don’t make it worse without knowing.

**Note: it is normal for the DR to get wider as baby and belly grows, however, some movements and habits can cause pressure on the DR causing it to spread in a way that can be avoided.

1.Avoid crunches and sit-ups: This can mean exercising, but also daily movements. If you are reclined on your back (sitting or supine) and you crunch or sit full up without support, you are likely putting pressure out on your ab separation. Instead of this movement, try rolling to one side, using an elbow to prop yourself up, and then lifting the body up sideways.

2. Practice good posture as much as you can: Posture habits definitely can make you susceptible to ab separation. If you are over-flaring your ribs (pushing the rib cage out) or have an over exaggerated curve in your low back, you are probably making your body more vulnerable to injury. Pregnancy brings some unavoidable postural changes. A few you can intentionally work on even while pregnant. Try not to let the low back arch too much (tilt pelvis back a little). Also, place a hand on the front of the ribs and try to bring the upper body forward a little (without hunching) to bring the ribs together and down if they are very flared.

4 Common Posture Myths – Posture Makeover
Flared ribs position

3. Don’t hold your breath! Holding your breath while lifting, pushing, pulling can put pressure out on the abdominal wall and down on the pelvic floor. Both can suffer injury. Instead, try to inhale as you prep for a movement and then exhale gently (forcefully if it is a very hard movement) as you push, pull, lift. As you exhale, draw the pelvic floor up (contracting it) and the abs “in” engaging the core.

4. Don’t twist excessively: Twisting can definitely hurt the already stretched abdominal muscles. Twisting will be difficult at a certain point in pregnancy anyways. Don’t twist diagonally (like the Triangle Pose in yoga) if you know you have DR and be cautious when twisting more than is comfortable while very pregnant. Obviously you have to twist to some degree (like when driving a car and looking in your blind spot) but try to move the whole body together to avoid pressure on the abs.

How to Do Triangle Pose (Utthita Trikonasana)
Triangle Pose in yoga

5. Don’t do back extensions or “core holds”: Back extensions (such as the Cobra Pose in yoga) will push out on the abs. “Core holds” (such as a “Boat Pose” in yoga) where the core is holding the body up and the back is vulnerable can also put pressure out on the separation. To release the low back try a forward lat stretch, modified child’s pose (with wide knees), or hands and knees rocking. Cat/cow rotations can be practiced as long as you are very conservative with the amount of “swooping” in cow pose.

Pregnancy Exercises - Yoga Shoulder Stretch with Swiss Ball - YouTube
Forward lat stretch

6. Do engage the core in movements: Engaging your core (drawing the lower abs in…talked more about in the next post Prenatal Core Exercises) is a great way to protect your separation, back, and hips while pregnant. When lifting, squatting, pushing, etc, draw the abs and pelvic floor in to create a support system for the core and pelvis.

7. Do practice prenatal core exercises: These exercises should be gentle and safe for pregnancy but effective in strengthening the inner core muscles of the abs (the TAs) to not only protect the body but to support your baby in a good position. My next post will include these!

8. Use a belly binder support if helpful: There are a million different belly supports, sleeves, and binders on the market for pregnancy. Using one could add some extra support to the core and back as the baby grows and protect your DR as you get bigger. Look for one that adds support but doesn’t restrict breathing or feels too tight (not a corset). Something adjustable could be beneficial as you get bigger but isn’t usually as discreet as cloth sleeves. One of my favorite options is to use KT tape to tape the belly and protect the DR/add support to the back. Your chiropractor, physical therapist, or trainer may be able to show you how to do this. It is not noticeable under clothes but adds support and protection to the belly.

Pregnancy Tape - Helps with Pelvic, Belly and Back Support – Cozy Bump
KT taping belly in pregnancy

If you think you have Diastasis Recti during your pregnancy, don’t be anxious, it is an acceptable response of the stomach muscles to make room for baby. However, it is important to let your OB/midwife/healthcare provider know and practice safe movements and exercises to protect the area.

Check out my next post on Prenatal Core Exercises to strengthen the inner core and protect your DR even more!

Running after Baby

Michelle Tucker, pre/postnatal trainer

How to ease into running after having a baby? Just do kegels, right?!

So many moms are or become runners. Why? Running is free (mostly), it can be done anywhere, it is an effective cardio workout for minimal time needed, you can take your child with you in a stroller (if needed), the outside time is therapy, and lastly, “anyone can do it”.

Did you know that most postpartum women who end up injured, injury happens in the first few months AFTER pregnancy?!…Running and other intense exercise can often be part of the reason.

Running sounds doable, right? What happens at 6 weeks when the doctors says you “can resume all normal activities”? We are left with very little clarity on what that means and misinformed about the needed progression back in to “normal activities” so we don’t injure ourselves. Prolapsed pelvic organs, joint injuries, and damaged spinal discs can all result (and have) for moms who enter back into high impact activities before their bodies are ready. I don’t want to scare moms but I do want to help you progress back into your activities the right way so you don’t regret now or years later!

So how do you ease into running after having a baby? Below I have narrowed down my tips to my essential “dos” for running postpartum. Please feel free to reach out if you have more questions after reading this:)

  1. Do give your body enough time to heal after birth: 6 weeks is not usually enough time for any mom’s body to be ready to run again. If you have had a Cesarean birth you need to let the incision heal but also make sure your abdominal muscles are responding. If you have had a vaginal birth you need to give the pelvic floor enough time to heal from the trauma of deliver. Ideally waiting 4-6 months postpartum helps ensure the pelvic floor muscles have regained more integrity to handle the load of running. But don’t fret if that seems too long. There is a lot to do until then to get the body back to running condition!
  2. Do make an appointment with a pelvic floor therapist in your area: These professionals are very knowledgeable and such a wonderful tool to help you recover well from birth. Your appointment doesn’t have to be due to an injury or symptom. Just let your OB and the therapist know you want to be seen to ensure everything is healing well and that you can use your pelvic floor muscles correctly. When training clients, I watch to make sure the right muscle is activating. PF therapists do the same thing to help the pelvic floor. The pelvic floor such an important muscle group that doesn’t just keep you from peeing yourself. They add stability to the spine and hips, support the core, and hold up our organs!!
  3. Do start a core program appropriate for postpartum: This should include activating and strengthening the pelvic floor, the inner abs (transverse abdominus), the paraspinal muscles, and glutes. A really good core program will teach how to breath while doing your core exercises, which helps a lot in “reactivating” muscles that can turn off or become weakened/lengthened during pregnancy. Strengthening your core will protect your spine and joints while running. For more help with this check out my program “Mom Core Challenge” which has helped many moms regain core strength after having children.
  4. Do follow an appropriate strength training program for postpartum: A program that strengthens muscles needed for running and proper form will go a long way in preventing injury but also making you a better and stronger runner. Ideally this program would include one-legged and balance work to mimic the stresses of running.
  5. Do start with interval run/walking and increase slowly: There are great apps available (Couch to 5k is one) that are helpful for interval running. The idea is that you jog for a certain amount of time and have intervals of walking in between. Start with a 1:3 ratio (1 min of jogging followed by 3 min of walking) for about 15-20 min. Then as you feel stronger you can lengthen your jogging time and shorten the walking intervals. This is a simple concept but so important to allow the body (especially the pelvic floor) periods of rest so it isn’t over fatigued.
  6. Do allow the body rest day(s) between running sessions: When you start out running, allow yourself a non-running day after you jog. That will give you a chance to let your body rest and tune in to evaluate any concerning pains that indicate a risk of injury. This schedule (when starting out) will help you know if you need to back off at any point.
  7. Do stretch and release tight muscles after running: Okay, I get it, who has time to stretch?! I get the eye roll as a trainer often when I ask my clients if they stretch. But seriously, much damage done to the body is preventable and even treatable by proper stretching! The power of releasing muscles and ligaments in the body is underestimated often. So before you walk back into your house and enter the loud, crazy that is your life, give your calves, glutes, quads, back and hamstrings a nice stretch session. Only 5 to 10 minutes is needed. Foam rolling is really effective too!
  8. Do invest in a good running shoes and a supportive sports bra: Good running shoes don’t just save your feet, they support the spine and joints during the impact of running. Having a properly fitted pair for you that addresses how you move is really helpful. Having a good bra is especially important if you are nursing.

A quick note of caution: If you finish your run and have a heavy, dragging sensation in pelvic floor that doesn’t go away after resting then you need to back off on the running and reassess how much your body can handle.

Remember, while you are nursing, your ligaments and muscle tissue is looser due to hormones. Be gentle and mindful of your body in this season. Also, drink plenty of water to ensure you can keep up your milk supply while exercising.

Running is a wonderful exercise and can be beneficial on many levels for people. Respecting your body and allowing the proper time it needs to transition into this high impact will go a long way for you life-long! I love supporting women getting back into activities that they love and helping them balance the stress of motherhood (not to mention keep them moving and healthy). Keep running, mamas!

How to Exercise with Pelvic Girdle Pain in Pregnancy

Pelvic girdle pain in pregnancy happens to many women (it’s been estimated 1 in 5 pregnant women experience it (1)). A combination of Relaxin hormone that makes everything looser and a widening in the hips to allow baby to grow makes the pelvis a vulnerable part of the body in pregnancy. When the hip joints move out of alignment it can cause pain to the joint and the related tendons/muscles. The pain can range from uncomfortable ache to sharp, stabbing pains in your pubic bone.

I have worked with several clients who feel they are at a loss of how to exercise with this pain. Walking can make it worse and even certain lifting exercises hurt. But don’t give up! You can stay active. In fact as long as you aren’t making your pain worse I encourage you to! Studies show that exercise can help people effectively manage pain better and stay mentally/emotionally more healthy (2)! I am going to give you some tips here on what you can try for your own exercise regime that won’t cause more pain and may even help diminish the pain you have.

What are a few common types of Pelvic Girdle Pain? (these are the ones I commonly see with clients although there are more)

  1. Symphysis Pubis Dysfunction: the joint in the very front of the pelvis is inflamed from moving slightly or being pulled while joints are more lax in pregnancy.
  2. Pubis Symphysis Diastasis: the joint in the very front of the pelvis separates to some degree. Causes extra mobility in the hips and different painful sensations in the pelvis.
  3. One-sided Sacroiliac Syndrome /Double Sided Sacroiliac Syndrome: The joints in the back of the pelvic bone are inflamed and somewhat mobile. Moving too much can cause pain in the joint and all throughout the hips, back, legs.
  4. Hypermobility: when the joints in the body are more mobile than usual. This can be genetic, due to different hormonal changes (or extra Relaxin hormone in the body), and can be contributed to by a lack of strength in the stabilizing muscles around a joint.

What Exercises are Recommended for Pelvic Girdle Pain?

Biking for cardio

**As always, check with your doctor before starting any exercise regime. This information is not meant to diagnose or treat any condition. It is tips and ideas on how to help you stay healthy and active in pregnancy. Each pregnancy is different and needs to addressed individually. If you are experiencing pelvic pain in pregnancy it is important to let your healthcare provider know.**

  1. Biking in a seated or recumbent bike (not a spin bike): Stay seated, keep the seat high/far back enough to allow full extension of the leg, don’t rock the hips while biking (which may mean monitoring how much resistance you use).
  2. Walking on stable surfaces for limited amounts of time.
  3. Light strength training in stances where both feet are on the ground or while seated. Even better if the hips are square and feet are next to each other.
  4. Circuit machine strength training where the pelvis and back are supported.
  5. Foam rolling the legs in positions where the legs are together. If stretching is causing more pain to the pelvis try rolling gently.

Ways to manage PGP in daily life movements:

  1. Stand with hips square. Don’t tilt one pelvis and rest on one leg.
  2. Rest the pelvis with lying and seated positions throughout the day.
  3. Keep light movement throughout your day. Don’t sit for extended periods without a position change.
  4. Sit with hips above knees. Choose supportive surfaces rather than fluffy couches, etc. Don’t cross your legs while seated.
  5. Sit down to dress.
  6. Place a pillow between the knees while sleeping to keep the hips square.
  7. Try not to perform activities where one leg is off the ground for extended periods.
  8. Use a stabilizing belt (SI belt) for support during movements and/or exercise.
Belts that stabilize the pelvis and help manage PGP

References:

1. Pelvic Girdle Pain and Pregnancy.  Royal College of Obstetricians and Gynaecologists. June 2015.https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-pelvic-girdle-pain-and-pregnancy.pdf

2. Reynolds, Gretchen. How exercise helps us tolerate pain. The New York Times. August 13, 2014.

Diastasis Recti-Does every mom get it?!

Diastasis Recti- buzz word in postpartum fitness right now. Ab separation, stomach muscles that literally separate during pregnancy. Sounds scary to new and expecting moms, is another “issue to address” for many busy, repeat moms. Either way, it affects most of the moms out there to some degree.

Research shows that about 60 % of women will have DR when pregnant and immediately after having a baby. It is actually a very natural response of the muscles to allow more room for a growing baby and our muscle fibers are created to stretch. Some bodies heal themselves in postpartum and the abs come back together most or all of the way within the first 6 weeks to 6 months after the baby is born. Many women, however, need to do a little extra work to not just heal the abs but regain core strength and tension to keep their bodies in good working order

Symptoms of DR can include a bulging in the tummy area that makes you look pregnant long after having a baby, a weak or “gappy” core feeling, weak pelvic floor muscles, and hip/low back pain. Assessing a DR is fairly simple. Here is how you can do it to yourself:

  1. Lie on your back with knees bent and feet flat on the ground
  2. Place one hand at the belly button with fingers running laterally across belly and the other behind the head to support the neck.
  3. Bring the head up off of the ground in a partial curl-up. Hold the top position and feel the stomach at the belly button to feel the sides of the outer abs/”six-pack” abs (you may have to press hard to feel under abdominal fat). Feel how many fingertips you can’t fit between the two wall so of the abs. Feel at belly button, above a couple inches, and below a coup inches (in front of the pelvis).
  4. Feel how many finger tips you can fit in AND what the muscle tissue feels like in the gap. Can you feel ab muscle layer below when you try to engage the lower abs (bring belly button “in”)? Or does it feel like a big valley below/deep hole?
Checking DR Part 1

If you have a hard time getting a good idea of what your abs are doing, seek out a professional to help. A core physical therapist, pelvic floor PT, or OBGYN should be able to check for you.

What you do with this information is critical. If you find that your gap is more than 2 fingertips wide, and if it feels like a deep valley below it (you don’t feel the inner core muscles engaging below) then the separation needs to be addressed.

If you suspect or know you have DR, mama you are NOT broken. Your body has NOT failed you. And you most likely do not need to consider surgery as your first option. Postpartum is often seen as a time to adapt behaviorally into being a mom. As a trainer, postpartum ALSO means a time of healing. THIS is the season to not focus on just losing baby weight (SUCH a misguided message by media). But instead to focus on healing and recovering from pregnancy and childbirth. This takes more than 6 weeks, commonly 1-2 years. If done well and properly the body will respond very well the rehab process. Postpartum means rehab and if it was treated as seriously as any other injury more women would move through it in a more healthy and successful way both physically and emotionally.

Many women do NOT need surgery to fix their DR. Several months of intensive/specific/progressive/consistent core exercises can heal much of the ab separation. Learning proper posture/form and use of the core during daily movements will help it continue to heal.

The wrong abdominal exercises can cause an ab separation to worsen and even lead to worse injuries (ie umbelical hernias and pelvic organ prolapse). Heavy lifting without proper core engagement can have the same affect.

My Mom Core Challenge was created for moms of all fitness levels to get a jump start on healing their DR (or just simply restrengthening the core) in postpartum. It has been successful for hundreds of moms who are 2 months postpartum to 40 years. Check it out here…

Mama, whether you know you have a separation or not, getting assessed and understanding how your core is doing is a helpful part of the healing process of postpartum. A core is the foundation to a strong body and a strong mama!