Exercise after Childbirth-Proceed with Caution! Part 3

May 31, 2013 in Abdominals, Childbirth, Diastasis Recti, Exercise, Post Partum, Pregnancy

Exercise After Childbirth-Part 3

So we’ve discussed the issues of low back pain and pelvic organ prolapse in two previous posts.  There is one other issue you need to be aware of that doing the wrong kinds of exercises can keep from healing and that is diastasis recti.

Diastasis Recti

A diastasis recti is a separation of the rectus abdominus muscle, otherwise known as the six-pack muscle. The rectus abdmonius muscle runs from the sternum down to the pubic bone and has two muscle fibers separated by a connective tissue called the linea alba. During pregnancy, as the uterus expands the two muscle bellies separate and the linea alba gets stretched thin. It is very important to allow this connective tissue to heal so the muscle bellies can come back together. Any activity that causes the abdomen to move forward forcefully causes this connective tissue to stretch out thus preventing it from healing.

Also any twisting motion causes the rectus muscle bellies to separate making the diastasis larger. You need to avoid all twisting motions and any forward forceful movements so you can let your rectus muscle to come back together and heal. Sit ups or crunches, especially with twisting are the worst thing you could be doing right after having a baby as the transverse muscle is so weak it can’t keep the lower abdomen from jutting out.  Many moms are doing sit up wondering why they aren’t getting their bellies smaller.  Sit-ups are working the wrong muscle and doing more damage than good in the post partum period.  It’s the transverse muscle that needs to be strengthened.

I’ve written a another post on how to prevent diastasis recti in pregnancy and I also teach a class and offer a video on healing Diastasis Recti you can check out here.

What is the best way to strengthen the abdominal muscles?

Pulling your belly button all the way back toward your spine and holding it there, WITHOUT HOLDING YOUR BREATH, and then trying to do little pulses to take it back even farther.   When the muscle is weak you will notice movement with your pulses at end range of your abdominal contraction.   You want to get the muscle stronger to when you go to pulse there is actually no movement that occurs.   That will help shorten your lengthened abdominal muscles.  Start off just doing 10 pulses and work you way up to doing as many as you can at one time with 100 being your goal.  Doing this several times throughout the day will help you lose the pooch that so many women have after pregnancy.

 

Exercise after Childbirth-Proceed with Caution! Part 1

May 29, 2013 in Abdominals, Childbirth, Diastasis Recti, Exercise, Post Partum, Pregnancy

Exercise After Childbirth- Part 1

Most new moms are ready to shed those extra pounds and jump right back into their pre-pregnancy workouts right after giving birth. With all the changes that have happened to your body over the last 9 months doing what you did before getting pregnant might not be the smartest and safest thing for your body. Certain exercises can cause long-term problems for your body. Knowing what exercises are safe to do and which are harmful is very important after having your baby.

3 Issues you want to Avoid when Resuming Exercise After Delivery

There are 3 major issues you might encounter if you are not careful with exercising immediately after giving birth. You are at risk for low back strain, prolapsing of your pelvic organs (falling out of your vagina) and diastasis recti- a separation of your rectus abdominus muscle, known as the six-pack muscle.

Each issue is so important that we’ll talk about them in a separate post so you have clear understanding on how to avoid developing these problems that are no fun to experience.

Low Back Strain/Pain

Our core muscles in our body are made up of 3 muscles, the transverse abdominus, the pelvic floor and the multifidus muscles in the back. Two of these muscles have been completely stretched to the max from childbirth and pregnancy and are very weak, the tranverse abdominus muscle and your pelvic floor muscles. The transverse abdominus muscle runs from your spine in the back around to the front and attaches into the rectus abdominus or the six-pack muscle. It acts like a corset supporting your spine. Remember how stretched out this muscle was with your pregnant belly? If you don’t do any strengthening of this muscle and just let it be it will shrink back but may not be as short as it was prior to pregnancy, thus giving you a little pooch in your belly.

So your pregnancy loosened the corset around your back and pelvis and you don’t have the support you had prior to pregnancy.

Jumping right back into doing the same exercises as you did before pregnancy can cause a strain on your back as your abdominal  and pelvic floor muscles don’t have the strength to stabilize the spine like it did before.

So your first order of exercise should be to re-strengthen your transverse abdominus muscle and your pelvic floor muscles.  Performing a kegel, or pelvic floor contraction is important in the post partum period.  Normal strength of the pelvic floor muscles is the ability of the muscles to maintain a good contraction for 10 seconds.  Click here to learn more about restrengthening your pelvic floor after childbirth.

While this is a great idea and may be a little easier for a mom who had a c-section than a vaginal birth, trauma to the pelvic floor tissues can prevent any strengthening from happening.  Helping to heal the vaginal tissues that got so strained during the birth process can help improve your muscles ability to contract.   Click here to read more on how to do that.

Working on restrengthening your abdominal muscles is also a must after childbirth.  The abdominal muscles act as a corset to support our spine.  Without this support our spine is at increased risk for injury.   The abdominal muscles get extremely lengthened during pregnancy and sometimes can separate creating a diastasis recti.  If you have any separation, this alone can cause low back pain as the muscles are ineffective in supporting the spine.   You need to heal this first and part of healing a diastasis is restrengthening your abdominal muscles correctly.   Doing crunches will only make things worse!

In my class and video, How to Lose the Pooch for Good, I present a 4 step healing process to bring your abdominal muscles back together and also how to restrengthen your abdominal muscles safely to get rid of your “pooch” for good!

Also your pelvis has just gone through an amazing transformation getting your baby out and may have some challenges getting back to it’s normal position.  This can create low back pain as well.  Opening up to allow your baby out creates an instability that takes time to solidify again.  This usually takes around 3-4 months.  I recommend you wait until then to resume any high impact aerobic activities.  Focus in on just doing your abdominal restrengthening and your kegels and walking for the first 3 months.  Then once your core is stronger then you can introduce more high impact type of activities.

But with everything you do, you must listen to your body.  If it doesn’t feel right, don’t do it!  You only have one body, so you need to learn to take care of it, honor it and do what feels right.

Abdominal Hernia’s-Diastasis Recti in Post Partum Women

April 22, 2013 in Abdominals, Diastasis Recti, Post Partum, Pregnancy

Diastasis Recti- Abdominal Muscle Separation

Do you know what one of the most commonly untreated issues women face after delivering a baby?  It hardly ever gets diagnosed and if it does the medical community doesn’t think there is any solution other than surgery.

Diastasis Recti

I’m talking about Diastasis Recti.  This is the separation of the rectus abdominus muscle, which is the “six-pack” muscle in our abdomen.  The rectus abdominus muscle has two sets of muscle fibers that run up and down from the sternum, or chest plate, down to the pubic bone. They are connected by a connective tissue called the linea alba. These muscle bellies can become separated and the connective tissue between them stretched thin with pregnancy.   The muscle bellies get forced out to the side to make room for the expanding uterus.  Also, activities with a forward forceful movements as in coughing, sneezing, laughing, or doing sit ups incorrectly can create a diastasis or make an already existing one worse.

Abdominal Muscles

The abdominal muscles are one of the most important muscles in our body. They are responsible for all of the support and movements in our trunk and consist of three layers. The most superficial layer, the Rectus abdominus, otherwise known as the “Six-pack” muscle, helps us to bend forward or sit up from laying down. The middle layer includes the Internal and External Obliques which helps us to twist and the deepest and most important layer, the Transverse abdominus, helps to compress the abdomen in and is part of our core muscles to stabilze the spine and pelvis.

How do you know if you have Diastasis Recti?

The separation of the Recti muscles is called a Diastasis Recti. You will know if you have one if you are laying down on your back and you place your fingers pointing down toward your spine in your belly button. When you lift your head any fingers that fill the space between the two muscle fibers of the rectus abdminus let’s you know you have a separation.  One to two fingers separation is considered normal.  However you also need to check the depth of your connective tissue.  That linea alba needs to be very superficial.  If you sink down past your fingertip the connective tissue still needs to heal.

Also another key sign you have a

Doming of linea alba in Rectus abdominus with diastasis recti

Doming of linea alba in Rectus abdominus with diastasis recti

separation is when you lift your head do you have any doming in the midline of your abdomen?

There are certain things we do like getting in and out of bed, doing abdominal crunches, and playing golf and tennis that can make this separation worse and keep it from healing.

At Intuitive Hands PT we offer training and education to teach you a 4 step program to help you heal a Diastasis Recti and also to help you lose the “pooch” from pregnancy. By learning how to use your body and strengthen your transverse abdominus muscle correctly you can loose your “pooch” and bring the rectus abdominus muscle bellies back together again.

Anyone with a diastasis can be helped no matter how long your muscles have been separated.   If you are currently pregnant, reading this previous post on how to avoid developing onein the first place can help save you ton of effort in the post partum period.

Caring for your Belly During Pregnancy-Preventing Diastasis Recti- Part 3

March 29, 2013 in Abdominals, Childbirth, Diastasis Recti, Pregnancy

Part 3- Preventing Diastasis Recti in Pregnancy

This is the final post in a three part series on how to minimize and protect your abdominal muscles from developing diastasis recti.

In the other two posts we talked about how rib thrusting and forward, forceful movements of your belly can contribute to development of diastasis recti.  See these posts here to review, part 1 and part 2.

There is one other motion that we do at least two times a day, more if you are getting up to empty your squished bladder in the middle of the night, that causes the greatest strain on our abdominal muscles.  That is the way we get up and down from laying down.  What most of us tend to do is just lay straight back down and jack knife straight on up to sit up from laying down.  This motion puts the greatest amount of strain on your abdominal muscles.  If you continually get up and down this way, your abdominal muscles will separate.

There is a better way to lay down and get up without straining your abdominal muscles.

LAYING DOWN CORRECTLY

Let’s start with laying down.  Sitting on the side of the bed you want to pull your belly button back to your spine and then lay down on your side while your legs come up onto the bed.  Next, and the most important step, is placing your head down on the pillow while on your side.  Then contract your belly again as you roll over onto your back.

To get back up, the most important step is the keep your head down on the pillow while you roll over.  If you lift your head you are essentially doing a crunch and your belly will pooch out or dome if there is any separation.

During this entire motion it is important to contract your abdominal muscles by pulling your belly backward toward your spine.  Remember your head is the most important step and should be the last thing down in lying down and the last part up in getting up.

This takes practice to remember how to do it correctly and to make it a habit.  You will want to continue to lie down and get up in this fashion well after you baby is born.  This can help heal any separation you may have in your abdominal muscles after your baby is born.

There are other steps you need to learn to heal a diastasis recti, if you have one.  You can learn how to do so by watching my How to Lose the Pooch For Good and Heal Diastasis Recti.  Check it out!

Caring for your Belly During Pregnancy-Preventing Diastasis Recti- Part 2

March 27, 2013 in Abdominals, Diastasis Recti, Pregnancy

Part 2-Preventing Diastasis Recti in Pregnancy

Diastasis Recti is a separation of the rectus abdominus muscles that is a common occurrence during pregnancy.   What we do with our bodies during pregnancy can make this separation worse and the recovery process longer.   There are three aspects you need to be aware of to help prevent diastasis recti.   In a previous post we talked about the first aspect of how rib thrusting contributes to the development of diastasis recti.  See this post to review rib thrusting.

The second aspect you need to be aware of to avoid diastasis is to protect your abdominal muscles with all your activities.   Any time the belly protrudes forward forcefully, like when you laugh, cough or sneeze, the abdominal muscles get strained apart.  The more strain the more separation.  If you are in your late second or third trimester and you notice any doming in the midline of your belly, this is the abdominal muscles separating.  You want to avoid this.

The third trimester is the period of time that greatest strain is placed on the abdominal muscles.   The less your belly domes up in the middle the less separation there will be.

How do you stop the doming and separating?

You can stop the separation of the abdominal muscles by pulling the belly button back to the spine before you do any activities that may strain the belly.  So before you cough, laugh or sneeze bringing your belly button into your spine.   Also before you go to lift anything heavy, contract your abdominal muscles back toward your spine.

DON’T DO SIT UPS OR CRUNCHES

Doing a crunch shortens the recti muscles and actually makes any separation worse.  When the muscles shorten they bulge out in the middle.   Crunches also increases pressure in the pelvic bowl area.  This can weaken the pelvic floor muscles and contribute to pelvic organ prolapse.   You don’t want that!

Sit ups should be avoided and are not an exercise I ever recommend to my patients.  There are other more effective ways of doing abdominal strengthening than sit ups.

Best form of Exercises during Pregnancy

If you want to strengthen your abdominal muscles just pulling your belly button back to your spine is the safest and most effective way to do so while pregnant.  Walking is another way to strengthen the abdominal muscles, as they have to work to support the spine.  In my opinion, walking is the best form of exercise you can do while you are pregnant.

So protecting your belly by contracting your belly button back to your spine with everything you do is the second step in avoiding a diastasis recti while pregnant.

In the next post we will cover the third aspect, which is the most common motion we do at least twice a day that can contribute to diastasis recti.   Stay tuned!

If you want to know how to heal Diastasis please check out my video How to Lose the Pooch For Good and Heal Diastasis Recti 

 

Caring for your Belly During Pregnancy-Preventing Diastasis Recti

March 25, 2013 in Abdominals, Diastasis Recti, Pregnancy

Preventing Diastasis Recti in Pregnancy- PART ONE

Congratulations on being pregnant.   There is a lot of changes that will be happening to your body over the next 9 months, the biggest one happening to your belly.  You probably aren’t that concerned about your belly getting huge, because it will!  But you should!  Things you do to your belly during your pregnancy can impact your delivery and recovery.

As the belly gets larger one of your abdominal muscles, the rectus abdominus can get separated.  How you use your body can cause strain on this muscle and separate it more.  But it doesn’t have to.  The larger this muscle separates the less support your abdominal muscles have during labor and the longer it will take to heal afterwards.   It’s important for you to take care of your belly and avoid putting excess strain on the muscles of your abdomen so you can minimize the separation of your rectus abdominus muscle.

HOW TO AVOID STRAINING YOUR RECTUS MUSCLES

There are three important aspects to know about protecting your abdominal muscles during pregnancy.  Since they are each pretty involved this blog will be in three parts so you can better understand each section.  Before we get into those three aspects let’s talk a bit about the abdominal muscles and what we want to prevent.

The rectus abdominus muscle consists of two sets of muscle bellies that run parallel and are held together by a connective tissue called the linea alba.  This muscle runs from the end of the sternum to the pubic bone.  As the uterus expands the muscle bellies can separate and the linea alba stretches thin.  This creates what is called a diastasis recti.  The degree of separation depends on what activities and stresses you put on this muscle while you are pregnant.

13330_1413899876212_1494023040_31037601_6547864_sYou will know if you have this separation if you notice a bulging out or doming in the midline of your abdomen when you do activities.  Any bulging of this tissue can cause the muscles to separate more.

Avoiding any bulging is what we will be talking about in the second part of this blog post but for now lets talk about how to prevent it in the first place.

 

How do you Prevent Diastasis Recti?

The way you hold your ribcage during pregnancy is one of the biggest contributors to development of diastasis recti.

Rib Thrusting

Are you a rib thruster?  Your lower rib cage should be in the same plane as your hipbone.   The way to tell if you are is to check the bottom edge of your ribcage and see where it is in relation to the front of your hipbones.  You know those little bumps on either side of your hips, which professionals call your anterior, superior iliac spine, or ASIS for short.   If you draw a line from your nipples down to the edge of your ribcage place one finger there and then find that little bump on the sides of your ilium and see how these two points line up.  Are your ribs out in front of your hipbone?  If so, then you are a rib thruster!  If they line up in the same plane, as if walking forward to a wall, both boney points would hit at the same time, then you are not a rib thruster.  Good for you!  YOUR RIBCAGE

Thrusting your ribs puts added strain on the abdominal muscles and can separate the recti muscles, especially when you are pregnant!

 

Rib-thrusting-in-preg-edittedsmallest

Rib-thrusting-corrected-editsmallest-1To correct this rib thrusting, take that point of your ribcage and move it DOWN and back.  This movement happens at the spine and not with your abdominal muscles.  Standing with your back against a wall keep your shoulders and head touching the wall, see if you can get your lower ribcage to make contact with the wall.  If your shoulder muscles are too tight moving your ribcage backwards can cause your shoulders to pull forward.  That’s a whole other post, so stay tuned.

Work on keeping your ribcage down and back with everything you do, especially while walking.  It’s going to take a long time to break this habit.   But every chance you get, remember to bring them down and back and in line with your hipbones.

When your rib cage thrusts forward there is increased pressures in your abdominal cavity.  This increased pressure has to go somewhere.  It can go up into the diaphragm and cause reflex or go down and cause inguinal hernias or force the abdominal muscles to separate.  When you bring the rib cage down and back the pressures even out and decreases the forces in the abdominal cavity, helping everything out.

So your focus for now is to see where your ribcage is hanging out.  Work on bringing them down and back to be in line with your hipbones.

In the second part of this series we will be talking about how different activities you do can contribute to diastasis recti.

If you want to know how to heal Diastasis please check out my video How to Lose the Pooch For Good and Heal Diastasis Recti

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