Diastasis Recti : Now What?! (Part 2)

(Pssst....make sure to check out Part 1 first!)  

Now that we've established that many of the popular messages we hear about diastasis recti abdominis aren't entirely accurate, let's come up with a better way to address DRA!

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First, let's make sure you're assessing your DRA correctly.

  • First, lie down on the ground with your knees bent, feet flat on the floor. (Placing your hands directly on your skin (instead of your shirt) give you better feedback as to what your tissue is doing.)

  • Place three fingers horizontally across your belly button (to start) and press firmly as you lift your head off the ground, towards your chest. You're feeling for the ridges of your rectus abdominis ("6-pack" muscles) and the tissue between them. As you press into that space, gauge the distance (in finger-widths) and the tension (does it feel firm, like the tip of your nose? or soft like your cheek?) Write down these findings.

  • Repeat the measurements halfway between the belly button and the sternum and halfway between the belly button and the pubic bone and note your findings there, as well.

  • Now, repeat the test but use your "piston breath" (a la Julie Wiebe, PT). Inhale, and then begin your exhale, gently lifting your pelvic floor muscles (imagine drawing a bean up into your vagina/anus) before and as you lift your head. Do you notice a difference? Repeat these measurements above and bellow the belly button.

Most women will find that their linea alba is able to generate more tension when they exhale and lift versus when they just lift their head. This is great! This gives you an indication of how your inner core system is better able to support you with an intentional exhale (which supports to integrated functioning of the inner core unit) and may lead to what had previously been considered a DRA to be what we refer to as a "functional" DRA. While a gap still exists, the abdominal wall is able to generate enough tension and manage pressure well.

Many women will also note that if they change the position of their pelvis, or bring their head up more, their gap and tension will change. This is a good reminder that the rest of our body impacts our core. This also reminds us that there is no real standardization in measurement and so it’s important not to get hung up on the numbers.

If you've assessed yourself and find your linea alba to be in need of some TLC, consider these strategies to help rebuild your strength and stability:

What to try: Seeing a Pelvic Floor Physical Therapist (PFPT).

How it can help: It would be remiss of us to neglect to mention the value of a trusted PFPT. Our scope as fitness professionals is limited and we encourage everyone we work with to see a PFPT after birth, or whenever indicated. The pelvic floor sets the foundation for the rest of the core's functioning and while we can offer tips on how to get a general idea of how its functioning, the most accurate way is by getting an assessment with a PFPT. They can also better assess how the rest of your core is functioning due to their advanced training and speciality in rehab. We strive to maintain close relationships with PTs practicing in our area so that we can better service our clients. A PFPT also has access to tools that some women may find helpful - SRC recovery shorts (for early postpartum), kinesio tape, etc.

What to try: Pay attention to your daily postural habits. How do you stand/sit all day? Are you thrusting the rib cage? Tucking your pelvis under? Always carrying a child on one hip?

How it can help: There is no such thing as "perfect posture", as our bodies are capable of assuming a variety of positions and should be encouraged to express this variety but often, we will find that we tend to always wind up in the same position over and over again and it's not always one that promotes our muscles being able to work most efficiently or effectively. Particularly during the initial stages of DRA, a ribs-over-hips alignment is preferred, particularly when the body is under load. You won't (and don't need to) maintain this position 24/7, but an awareness of what your body is doing can help!

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What to try: Pay attention to your breathing.

How it can help: Our inner core musculature is deeply (no pun intended ;) ) involved in our breathing. When we inhale, our diaphragm descends to allow for the lungs to fill with air. Our internal organs (and potentially our growing baby) head downward and our pelvic floor musculature descends to receive the change in pressure. Additionally, the ribcage and abdomen expands to make room for the inhaled air. On exhale, the reverse happens: the pelvic floor recoils, the abdomen and ribcage gently "deflate" and the diaphragm ascends. This balance allows for intra-abdominal pressure to be managed, and for our bodies to stabilize from the center: two things that are important for DRA improvement.

Many of us hold our breath to complete low-level tasks (like picking up a piece of mail off the ground, or getting ourselves out of a chair). For most of us, this level of difficulty isn't anywhere close to our maximal lifting capacity (where a breath hold is going to be appropriate and necessary). In life, and in fitness, and especially when managing DRA (a condition of poor pressure management), using our breath is helpful for optimal results.

Julie Wiebe's "Piston" approach is our preferred way to communicate and implement a strategy of breathing that works to retrain automaticity and full function. Before exertion, we use a "blow before you go" (a term coined by Wiebe) cue that triggers the inner core unit to engage when we need the greatest support. The "exertion" is usually described as the "hardest" moment in a movement, for instance, coming up from the bottom of the squat (you would "blow before you go" (BBYG) just before you stood up). You may find, especially in the early stages of DRA healing, that an exhale (and BBYG) throughout the entire range of motion (in the squat: throughout the descent and ascent) feels more supportive. That's a great choice for you, then! You will want to play around with what feels best for your body, during your movement.

As we are "blowing before we go", we're also giving intention to what's happening in our deep core musculature. Another cue coined by Wiebe, "pick up (your) bean" refers to the action of the pelvic floor as it recoils on exhale. We give awareness to "picking up the bean" and "gently zipping up a pair of pants" as cues to bring awareness to the action of the pelvic floor musculature and the transversus abdominis. The eventual goal is a functional return to automaticity, but many women with DRA will initially have to give more intention to their breathing and what their inner core unit is doing during movement (in- and outside the gym).

Here it is, broken down simply. We'll use the example of getting out a chair:

Sitting in the chair (and checking in to align yourself with your ribs over hips), you'll inhale before anything happens, imagining an umbrella opening in your ribcage, allowing for 360 degrees of expansion.

You'll then begin your exhale, gently lifting your bean, and then start your ascent.

Continue your exhale to carry you to the top and inhale as you descend to start the process over again.

Initially, you may find that an exhale throughout the entire range of motion feels more supportive (meaning, you would also exhale as you descend). You can pause in between each movement to inhale and then have your exhale support you as you're moving through the position that feels unstable to you.

You can use this strategy for strength training, picking up your kids, shutting sticky windows, etc.

What to try: Modifying your movements outside of "exercise"

How it can help: Our body works as a system, not in isolation. Even our movements that may not immediately seem to be related to DRA (getting up from a chair, driving to work, etc.) can have an impact on our healing. We're not going for perfect here - we're going for awareness and progress. Many of us wear our babies for hours while thrusting the hips forward and ribs back, potentially creating a situation that may prevent a DRA from healing as efficiently as possible, for instance. We also might be forcefully bearing down (on our pelvic floors) and out on our abdomens when we aggressively sit up each time from the floor, or while getting off the couch. Again, it is not necessary to obsess about every little movement you're doing, but some intention, especially in the early postpartum period, will allow your body to rebuild its strength more successfully. It is also important to assess whether you're gripping your abdomen/glutes/back all day. Many of us hold excessive tension throughout our bodies, instead of allowing for a dynamic state of tension and relaxation throughout the day. We recommend setting an alarm for every hour (or 2) and using that as a designated time to check in with your body: are you holding tension in places where you don't need it? Strive to build awareness on releasing the excessive tension in your body.

What to try: Modifying your "core" movements during exercise.

How it can help: Structured movement that meets you at your current ability level and progressively becomes more challenging provides the stimulus necessary to promote change. Initially, we'll spend some time focusing on building a connection with the deeper core musculature. We recommend doing this in a variety of position, as life occurs in a variety of positions. Many DRA programs have only featured "core" exercise in a supine (lying down, face up) position but we don't live the entirety of our lives on the ground. Here are some exercises that we're fond of that replace typical "core" exercises(not all of these will be appropriate for every person. You can monitor your core's performance by feeling what is happening, as best you can, or by taking a video to watch yourself. You are making sure to not "dome" or "bulge" at the linea alba, you're not holding your breath, and you're feeling gentle activation from the pelvic floor and TrA.) This is by no means an exhaustive list, but these are exercises we felt comfortable suggesting, knowing that some women reading this may not have access to in-person help. (Please, of course, seek assessment from a Dr./PT before beginning any exercise program.)

Lying down:

(P.s. don’t press your low back into the floor, as is often suggested. Allow for a neutral curve in the lower back.)

Supine Marching

Heel Slides

Dead Bug Variations

Supine Cable Pulls

Supine Dumbbell Resists

Pallof Press

 

Quadruped:

(Watching out to make sure your abdomen isn't merely hanging down here)

Quadruped rocking

Bird Dog Variations

 

1/2 Kneeling:

Chops

1-Arm Fly

Pallof Press

 

Kneeling:

Weight Raise

Pallof Press

1-Arm Fly

Cable Press Down

 

Seated:

Marching

(+any of the above kneeling exercises)

 

Standing:

Chops

Cable Press Down

1-Arm Fly

Pallof Press

Weight Raise

Weighted Carry

Unilateral Weighted Carry

Check out this video for an overview of the above:

 

What we’d also like to mention is that, during a training program, we’re implementing exercises that first encourage the retraining of the core system before we’re concerned about intensity or “fitness” in a conventional sense. It is important to address your core’s function in various positions, not just lying down, or seated. We continue to assess and reassess as we progress. There is no list of magic exercises, unfortunately (trust us, we wish that list existed!)

What to try: Prioritize whole-body strength

How it can help: Our entire body is at least somewhat affected by a DRA and so we address not only the core, but the body as a whole. Our preferred method for addressing whole-body fitness with mamas is to incorporate movements that prepare them for both daily life, and higher-level fitness pursuits.

Remember, it's not just *what* you do, it's *how* you do it. We recommend implementing Julie Wiebe, PT's Piston approach here. Ribs over hips, hips untucked, blow before you go.  

Here are some (likely) familiar movements/exercises. Each movement has a version that is likely more supportive to the core and one that isn’t. Prioritize rib over hip alignment, that “blow before you go” exhale, and being aware of your core’s function in not only your daily life, or “core” exercises, but in the resistance training you’re doing for your entire body.

 

You don’t need to get too creative here. Focus on first being able to manage your own body weight, then begin to add load. Stick to basic movements and focus on progressively making them more challenging. It is important to continue assessing your DRA and symptoms as you perform exercise. Movements/exercises will vary in their appropriateness for each person and the only way you will definitely know is by trying them and assessing for function/pain/undesirable symptoms (doming, bulging, discomfort, feelings of being unsupported). We make no claims that any of these exercises are appropriate for someone with DRA; instead, we remind you to monitor closely and evaluate your personal needs.

What to try: Consider the programming of various movements

How it can help: In the early stages of DRA healing, we often prioritize upper body horizontal pushing to upper body horizontal/vertical pulling in part because some women will lack the mobility to perform overhead pressing/rows/pull-up type movements without flaring the ribcage. This doesn't mean that there isn't a place for those movements; it just may mean that we are more critical, especially early on, with the distribution of movements in your program. We are also particularly interested in rotational movements and assessing whether the person performing them is able to do so without flaring the ribs or losing power from the hips/trunk. Sometimes, we find that rotating towards (instead of away from) the midline yields a greater ability for the client to feel what’s happening, but this is not a rule.

What to try: Address habits outside of the gym/movement.

How it can help: Your body's first priority, when you're not sleeping, not eating well for nourishment, and chronically stressed, is not going to be to devote energy to healing DRA as well as it possibly could be, if it were better supported. This can be really difficult postpartum; we definitely get it! The reality is, this time period is often so chaotic that taking care of yourself may have obstacles that are too difficult to fully overcome. Instead of hoping for perfect sleep, and the most healing nutrition, focus on what you can realistically do. Can you have your partner take care of baby while you catch up on sleep? Can you outsource meals so that you always have something that nourishes you? Can you enlist in the help of a mental health professional (many work online now!), if you're feeling overwhelmed? Self-care is not selfish and the healing of your DRA can be assisted when more of your wellness needs are being met.

What to try: Getting help from an exercise professional.

How it can help: Having another set of eyes can better help you navigate what may be keeping your DRA from achieving resolution. We're happy to help, of course! If you're not local, please feel free to reach out and we can try to connect you with an exercise/rehab professional in your area.

What to try: Give yourself grace, patience, and support.

How it can help: We know that it can feel frustrating when it feels like your body is not recovering from pregnancy and birth. We also want to gently remind you that recovery from any exhausting event is taxing on the body and takes time. Having emotional support while managing DRA can be crucial. Working on body image, letting go of preconceived beliefs about how your body “should” be functioning, and giving yourself the permission to accept where you are is helpful. Obsessing about DRA measurements and spending every moment thinking about your DRA is neither healthy nor helpful. We support you and want to support you supporting yourself; please reach out to us, if you’re feeling particularly down about your DRA. We will help you get the resources you need.

What to try: Surgical intervention.

How it can help: Not everyone can resolve their DRA with conservative measurements. This doesn’t mean that you failed, or that exercise doesn’t “work”, it just means that surgical intervention is the most applicable tool for your unique situation. The recommended criteria that, when met, suggests surgical intervention is warranted is: a woman is at least a year postpartum, and a proper program geared at restoring function has not led to the desired results, the abdominal contents are easily felt, the woman is unable to control pelvic motion during uni- or bilateral squatting, the ability to stabilize increases when the abs are approximated, in addition to a few other physical and neurological assessment findings. Simply put: if it’s been over a year and you haven’t seen resolution and your function is suffering, surgery may be a good choice.


We hope you've found this two-part series to be helpful. Many new mothers feel overwhelmed with the wealth of information out there for diastasis recti abdominis. We know this was a long read, but we believe that the greatest gift we can give to new moms is the sharing of knowledge. Our knowledge is always expanding. We are constantly evolving our skillset in an effort to greater serve our clients, and as new information arises, we’ll be sure to keep you posted on updates to our approach! If you have any questions, need clarification on anything discussed, or would like to set up an assessment session at any of our 4 Bay Area locations, please let us know! We would be happy to help you as best we can.

Diastasis Recti: Gap in Abs, Gap in Knowledge (Part 1)

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Pregnancy and postpartum recovery are periods of great transformation in a woman's life (which, if you’re pregnant/recently had a baby, is probably the biggest understatement of the year!). The human body displays its incredible propensity for adaptation, healing, and resilience during those 9+ months of a pregnancy and as it recovers. Although the body has the capability to carry a baby to term and repair itself afterwards, the process doesn't always go as smoothly as we wish it would! Pregnancy and birth are associated with conditions that affect a woman's health, function, and appearance, and diastasis recti abdominis (DRA) is one such condition.

Diastasis Recti?!?! What's that?

Before we clear up the common misconceptions about diastasis recti, and how to ‘treat’ it, here's a brief overview of the condition:

Diastasis Recti Abdominis refers to the widening of the gap between the two portions of the rectus abdominis muscles (your "6-pack" muscles). This "gap" is actually a fibrous band of connective tissue called the linea alba which runs from the xiphoid process (a cartilaginous process with a fun name at the base of the sternum) to the pubic symphysis (the joint in the middle on the front side of the pelvis, where the two pubic bones meet) and functions to unite the muscles of the abdominal wall. During pregnancy, it stretches to accommodate the growing baby (similar to malleable Saran wrap), moving the rectus abdominis muscles farther away from each other (something which some women will notice when they glance down at their bellies). While this may seem disconcerting, know that this ability of our body is a crucial one, as the expansion allows the space for baby to grow without one's abs "ripping" apart (a common misconception is that DRA involves muscles brutally tearing apart. This is not true!).

When the gap broadens beyond 2.5cm (roughly two fingers), it is classified as diastasis recti abdominis (we will discuss below why only evaluating the distance does not give you all the info needed, but for now, know that that is the criteria used to distinguish DRA). The most common symptom is a bulging or doming of the linea alba outward during certain movements (sit ups, for instance), a feeling of not being supported in the abdomen, and the appearance of protruding belly.

Now that we've covered the basics, let's clear up the common misconceptions about DRA:

1.) "Diastasis Recti is primarily a concern of appearance."DRA is a medical/functional concern and while it has an aesthetic component, it isn't just about looks.

We prefer to refer to DRA by its clinical name as opposed to "mummy tummy" or "mom pooch" for this reason, as reducing it to a name (and one that isn't very kind, at that) that focuses on the outward appearance gives the erroneous message that a DRA doesn't affect more than the look of one's belly. In a cultural climate where women often have difficulty having their medical concerns addressed seriously, or financially covered with their insurance, we feel that it's especially important to reinforce the reality that DRA impacts more than just how a woman looks. DRA impacts her total body's function and, as a result, it is important to address.

Additionally, DRA may or may not be why your postpartum midsection is different than it was previously. Meaning, you can have a “pooch” and not have DRA and you can have DRA and not have a “pooch”. Addressing your DRA will likely change the appearance of your abdomen to some extent, but may not give you the flattened stomach you anticipate (which, by the way, is totally ok! Bellies come in all different shapes and sizes). The entire abdominal wall stretches to accommodate a full-term pregnancy and this stretching can lead to a broader or “poochier” belly, even in the absence of DRA. One last note on belly size: we have been led to believe that abs should be taut, bellies flat, and waists narrow in order to be attractive and functional. This is a false and potentially very damaging thing to believe. “Normal” bellies are as diverse as we are and there is simply no right or wrong way for a postpartum belly to look.

2.) "Diastasis Recti is rare." or  "DRA is so common that everyone has it, so who cares?!"

Research (1) found that 100% of women have a DRA by 35 weeks gestation (remember how cool it is that the body can adapt to pregnancy?!) and that 35-39% had a DRA that persisted at 6 months postpartum. Similar research(2) also found 100% of women to have DRA by 30 weeks gestation, while another research study(3) notes 66% of women had DRA by their third trimester (and that 36% continued to have DRA at 7 weeks postpartum). The variance in statistics may reflect a difference in the method of measurement, or the criteria used to "diagnose" DRA, and also speaks to a lack of research on the topic. What is clear, however, is that the vast majority of women have DRA by their third trimester and many will find that their DRA persists postpartum, without intervention.

The greatest time of healing occurs between 1 day postpartum and roughly 8 weeks postpartum. After the 8 week mark (4), progress tends to slow without intervention.

3.) "Diastasis is entirely preventable!" / “There’s nothing you can do to influence it!”

Consider this: research supports the fact that a vast majority (if not all) of women have DRA by the end of their pregnancies, and the stretching of the linea alba is a response that allows the baby room to grow. Is it reasonable to suggest that we can prevent DRA from occurring at all? No! And not only that, but we wouldn't want to prevent the natural expansion of our abdominal walls! What we can do, is choose activities that hopefully do not exacerbate the DRA, ideally managing the severity of the condition postpartum. There is currently no quality research to support the idea that DRA is preventable. The news isn’t all doom and gloom, though! Despite the studies being of poor quality, there is a bright glimmer of evidence-based hope in this systematic review from 2014 (4) which states that,

“The available evidence showed that exercise during the antenatal period reduced the presence of DRAM by 35% (RR 0.65, 95% CI 0.46 to 0.92), and suggested that DRAM width may be reduced by exercising during the ante- and postnatal periods.”

Again, the studies cited were generally poor in quality (due to a variety of factors), but this does support the idea that DRA severity can potentially be mitigated with exercise. What this tells us, more than anything, is to be wary of programs that guarantee results or that promote the idea that their method is supported by scientific evidence of good quality.

The authors of the systematic review state their hypothesis for why there may be a noticeable effect:

A possible explanation for how exercise during the antenatal period may reduce the risk of developing DRAM is that exercise helps to maintain tone, strength and control of the abdominal muscles, consequently reducing stress on the linea alba. Additionally, women who exercise during pregnancy generally also exercise prior to pregnancy and, therefore, may be fitter and have better conditioned abdominal muscles compared with women who do not exercise during pregnancy.”

The studies that looked at postnatal exercise and DRA were of poor quality and the one random controlled study (considered the gold-standard method) looked at the effect of pelvic floor/abdominal exercise merely hours (6, 18)  after birth and the authors concluded that it failed to be clinically relevant. (Duh, right?!)

Although we do not have substantial evidence of what, why, and how exercise impacts DRA, we have observed positive benefits of exercise in women with DRA (and without!).

What we aim to do at The Lotus Method is mitigate the effects of a growing pregnancy on a woman's abdominal wall (and the rest of her body), as much as possible, theoretically lessening the severity of DRA.

4.) "All it Takes to Fix a DRA is One Exercise/10 Minutes a Day!"

As professionals who care deeply about the moms we're working with, and because we understand that the demands of parenthood are extensive, we wish an answer as simple as "do this one thing for 10 minutes a day" would suffice, the reality is that it's more involved than this. First, although the discussion of DRA involves a specific region of the body (the “core”), DRA does not only impact the core. Sure, you may be doing an exercise that is helpful in resolving DRA for a few minutes a day, but what are you doing the other 23+ hours a day? It is important that we move beyond the idea that movement done during "exercise time" is different than movement we do outside the gym. All movement matters and our day includes endless opportunities to establish better function. If we approach healing DRA as something we do for a small amount of time and then go back to our "normal" ways, we will likely not obtain the results we're hoping to achieve.

5.) "You Just Need to Activate the TrA!" or "Pull Your Belly Button to Spine for DRA Resolution!"

The transversus abdominis (TrA) is our deepest abdominal muscle, commonly referred to as our "corset". Common cues have focused on drawing the belly button in towards the spine and holding there for improved core function. While the TrA is instrumental in proper core function, it does not work in isolation. In fact, no muscle works in isolation! As a result, we prefer to approach core function with a "team" approach. Renowned physical therapist, Julie Wiebe, PT,  provides an easy-to-understand description of this when she refers to the muscles of the inner core unit (the diaphragm, the pelvic floor muscles, multifidus, and yes, the transversus abdominis) as gears working together. If one gear isn't working well, the system is likely not either, but no singular muscle is responsible for the performance of the entire team. Some programs aimed at DRA rehab have only focused on the job of the transversus abdominis without viewing the body as a whole. Full function of the core is reliant on more than the TrA. Beyond the innermost core musculature, the more superficial muscles (the rectus abdominis, the external and inter obliques) are also important in fully regaining (or building) abdominal strength and function.

Constantly pulling the belly button to spine, a common cue given by fitness professionals, is unlikely to provide the desired effect of appropriately activating the TrA (which isn't enough to resolve DRA, anyway) in connection to the rest of the inner core unit and may increase pressure on the pelvic floor. To use another example from Julie Wiebe, PT: picture an inflated balloon (your internal abdominal, responsible for managing pressure) and then imagine squeezing the balloon in the center. What happens to the balloon? It bulges down and up, around the brace you've created by squeezing it. That pressure has to go somewhere and in many women who either consciously or subconsciously grip or squeeze their abs in all day, it may end up traveling downward on the pelvic floor. When the pelvic floor is unable to maintain that downward pressure, leaks may happen, prolapse may happen, discomfort and dysfunction may happen. When we only consider one part of a larger system, we run the risk of creating more issues on a path to solving another.

Fitness, pilates, and rehab professionals have long asserted that drawing the umbilicus towards the spine was the way to better abdominal function and support.  They describe the TrA as functioning like a corset and “drawing the abs together”. Recent research(5) found the that the drawing in maneuver actually slightly increased the IRD when compared to the crunch, as exercise that has long been discussed as the worst possible thing one could do for a DRA. Keep in mind that our primary concern is function, not solely the IRD and this is why we pay greater attention to the bigger picture instead of myopically focusing on the gap. TrA activation (as tested by the “drawing in” movement) broadens the IRD, at least in the short-term, and a crunch narrows the gap, at least in the short-term. Some would take this to mean that we should go back to just doing crunches and forget about the TrA entirely. This would be a misguided move, as the study doesn’t discuss the depth of the gap, the function of the rest of the “core”, and what happens in the long-term. Further research on crunches(6) concluded that the IRD is in fact narrowed by the crunch, but that the linea alba is also distorted. When the crunch was preceded by a pre-activation of the TrA, the IRD didn’t narrow as much, but the linea alba distorted less, suggesting that it may have a greater ability to transfer force between the two sides of the abdomen.  This research is included not to confuse you (although it is confusing!) but simply to challenge the notion that the TrA is the hero of “narrowing the gap” and that narrowing the IRD ought to be the sole pursuit of DRA recovery programs.

In “optimal”/”normal” core function, the diaphragm, transversus abdominis, pelvic floor muscles, and multifidus work together to create a reflexive, adaptive, mobile system that manages pressure, and provides mobility and stability. On inhale, the diaphragm and pelvic floor descend, the rib cage and abdomen expand, and on exhale, the opposite occurs. Reestablishing this pattern postpartum will almost certainly be more successful than just drawing in your belly button. Yes, on exhale, the belly button will gently move inward, but just pulling it in is not the path to a strong core.

Many professionals draw conclusions of support to their TrA-isolation programs from studies conducted by Paul Hodges, PhD, a world-renowned researcher. They appear to have simplified his findings, as an article of his from 2008 (7) states that

“While changes in transversus abdominis (and other muscles such as multifidus) can be a useful marker of dysfunction in the system (and recent data show that patients with delayed transversus abdominis do better with a motor control training approach than people without a delay),to limit treatment to this muscle is unlikely to be beneficial. The days of contracting transversus abdominis as the primary exercise and then sending the patient away are over.”

Certainly, the TrA is an important muscle. Is it the most important muscle in healing DRA? Not necessarily.


6.) "The Gap is The Only Thing That Matters." or "Results Can be Assessed by Circumference Measurements."

Recent research supports our broadened understanding that it is not just the distance between the rectus abdominis portions that we need to be concerned about, but the tension of the linea alba. A DRA may not become smaller than 2 fingers in some women, but if their linea alba is able to generate sufficient tension, we would consider their DRA to be "functional", or healed. Many women will mistakenly believe they have DRA when they self-assess because they were not informed of the importance in gauging the tissue quality of the linea alba. Similarly, some women are assessing their DRA by doing circumference measurements. The circumference of one's abdomen will vary depending on hormones, what she ate that day, how relaxed she is, whether her bowels are full etc.

Another thing to consider is that the measurement of DRA in finger-widths is far from scientific. My fingers may be much larger than yours, for instance, making validity difficult. Similarly, some sources consider DRA anything above “1.5 fingers”, some say 2.5. Again, 2.5 large fingers? Tiny fingers? Who knows?! What you need to know is that an inability to generate tension through the linea alba is suggestive of DRA and a large gap is likely problematic. Don’t get hung up on the minor details, though.

7.) "One Exercise/Exercise Modality Will Fix Everyone." / "Everyone Can Heal Their DRA with *THIS* Program!"

Everyone is different! Everyone's pregnancy is different, everyone's body is different, everyone's preferred method of exercise is different! While the end goal is the same (restore tension/function to the linea alba and promote an optimally functioning core), there are many ways to get there. While the initial stages of healing may look very similar for people, different exercises done in different positions may prove to be more successful for some. The important thing is finding what works for you. This is one of the biggest reasons we, at The Lotus Method, focus on individual training. We use every movement as an assessment and don't believe that cookie-cutter programs are the best route to success. An exercise program is only successful if the person performing it sticks to it, and we're unlikely to stick to things that don't resonate with us. We strive to integrate movements that you like, and movements that will prepare you for the type of exercise you personally enjoy. We can adapt most movements to work with you by changing the strategy you use to perform it.

Remember also that the conclusive evidence on how and what exactly can heal a DRA ,in terms of exercise, is non-existent. The foolproof way to treat DRA has yet to be discovered (or at least validated). We all have plenty of anecdotal evidence: all of the trainers at The Lotus Method have worked with women who have significantly improved their DRA. Unfortunately, this evidence doesn’t yet have good quality studies to support it. Similarly, we all have friends (or perhaps ourselves) who have had “good results” with various programs. This is still not enough to support a method or modality over another for a larger sampling of people. Additionally, correlation does not equal causation.

We wish it were so, but not every DRA can be managed with conservative measures. Some DRAs will require surgical intervention for full function and anyone who tells you that they guarantee that they can solve your DRA should be approached with caution. The reality is, we don't always know how a person's connective tissue will respond to exercise or lifestyle changes and we can't give anyone a 100% guarantee that what we do will work. We do our absolute best, within our scope, to help every woman we meet. That may mean referring to physical therapists or other practitioners who are qualified to help. Even in the event that surgery is indicated, a smart strength training program will still provide several benefits. Surgery won't solve the strategy and won't rebuild total body strength, but exercise can and so it's crucial to continue utilizing movement, even if it ends up that your DRA is in need of surgical intervention for full resolution.

DRA healing is an evidence-guided trial and error process. There is no surefire solution that works 100% of the time. Anyone who says otherwise is selling you something...and something that isn’t necessarily going to work. ;)

8.) "It's Impossible to Tell if an Exercise is/isn't Working for Me."

It may be challenging to know with absolute certainty if you're on your own, but there are a few simple clues to look for: first, what does your abdomen look like when you perform the movement? Is there a ridge protruding from the middle when you do a certain thing? That's a good sign that you aren't able to manage that exercise - yet! Second, what does it feel like? Do you feel like you need to hold your breath in order to complete the movement? Do you feel like your guts are spilling out? Those are good signs that your core system is not managing to meet the demands of the exercise you're performing. Best to scale back, or modify the way you're performing the movement. Although it may be different than the workouts you used to do where you were jamming to music and not tuning in to your body, it's best to spend some time really listening and looking for the clues your body is giving you, especially when rehabbing DRA.

9.) "Only Core Exercise Selection Matters."

For optimal functioning of your core, we need to really think big picture when it comes to movement. How your upper and lower body moves will impact how your core works and vice versa. For instance, if you lack mobility in your shoulders, you will likely need to thrust your ribs each time you reach for something overhead, leading to an extended abdominal wall that may lose its capacity to fire as automatically as required. When this becomes our dominant pattern, we're introducing possibly hundreds of times a day when the abdominal wall remains in a lengthened state and doesn't have the opportunity to work to its full capacity. That childhood song about the "knee bone's connected to the thigh bone...the thigh bone's connected to the -" may not have been anatomically accurate in terms of the technical terms, but it wasn't so far off! We're all connected. What one structure does will impact what a neighboring structure does. This is why DRA is a whole-body issue, not just a core issue. We will certainly include exercises that engage a greater percentage of core musculature (just as we will with every muscle/movement as this is part of how we achieve the progressive overload needed to cause a response from the body), but we don't only focus on "core" exercise when working with a woman with DRA. Muscles of the deep core are always working, whether we're aware of them or not. Because our bodies work as a system, simply doing "ab"/"core-specific" exercises aren't enough for a fully functioning middle.

10.) "NEVER DO CRUNCHES OR AB EXERCISES AGAIN."

The goal with DRA rehab is, if possible, to return to full function. Full function is defined by you (what do you want to be able to do?) but it generally means that you can do a variety of movements without symptoms. Spinal flexion (the action of a crunch/sit up) is a basic human movement and shouldn't be seen as the sole "bad guy". The movement is neither good nor bad; it's the application that matters. Do you bulge when you sit up or crunch? Yes? Then that's probably a good indication that you're not quite there yet. If you're able to manage your intra-abdominal pressure (no bulging, no pain, heaviness, etc) and your core works well in that movement, crunches may not be the villain they're been made out to be and, according to more recent research could potentially be useful! (6) Having said that, does that mean 100 crunches will work wonders for you? No, of course not. We still think there are likely better exercises for you to perform, but in some people, that movement pattern is going to be fine and could possibly be beneficial. We evaluate on a case-by-base basis, just like everything else!

11.) "There are DRA-safe exercises and exercises that no one with DRA should ever do!"

The internet is full of exercises that are considered "DRA-safe" and while the intention is generally good, it's not always the case that these black and white lists include accurate information for the individual performing the exercises listed. We have clients who will experience symptoms when they first do "safe" exercises like heel slides or supine marching and won't experience issues when they do more "challenging" movements. This is why it's crucial to not only look at what exercise you're doing, but how you're doing it, as well. Also, some "DRA-safe" exercises (like supine marching, for instance) will not provide some people with a great enough stimulus to challenge the core to improve and some of these exercises may be too challenging for others. Research also supports this(8) approach: testing of intra-abdominal pressure (IAP) in different women performing the same movements found a wide range, suggesting that some of the subjects were able to complete an exercise (a sit-up, for example) with a very small increase in IAP, while others showed a large increase. The way we do things matters and needs to be part of the equation when deciding what movements to focus on in an exercise program.

It's just not possible, without evaluating someone, to say for sure what movements they should do. (But don't worry, we'll provide some guidelines in Part 2!)

12.) "Just Wear an Abdominal Binder!"

Some gentle compression may be helpful in the early postpartum period. Additionally, some women find taping to be helpful. These tools are useful when the encourage the function of the abdominal wall and when additional loading (movement) is incorporated. They are definitely not a substitute for functional movement and without loading, the abdomen is not given the stimulus it needs to become stronger. Some binders function more as a corset, aggressively cinching the waist. This does not encourage the expansion of the ribcage/abdomen on inhale and can possibly increase downward pressure on the pelvic floor.

13.) "Diastasis Recti Rehabilitation is Too Complicated!"

Yes, the has been a long blog (Whew! Almost to the end!) but the concepts of DRA recovery are actually pretty simple. We've alluded to several of the strategies we use to address DRA, but for a fuller picture, you'll want to check out Part 2 of this blog where we discuss this more in depth! We first wanted to establish the what and why behind dispelling some of the common DRA myths.

References

1. Mota, P., Pascoal, A., Carita, A., Bo, K. (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with limbo-pelvic pain. Musculoskeletal Science & Practice, 20(1), 200-205. DOI: http://dx.doi.org/10.1016/j.math.2014.09.002

2. Gilleard, W. & Brown, J. (1996). Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period. Physical Therapy, 76(7), 750-762.

3. Boissonnault, J., Blaschak, M. (1988). Incidence of diastasis recti abdominis during the childbearing year. Physical Therapy, 68(7), 1082-1086.

4. Benjamin, D., van de Water, A., Peiris, C. (2014). Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review.Phsyiotherapy, 100(1), 1-8. doi: 10.1016/j.physio.2013.08.005

5. Mota, P., Pascoal, A., Carita, A., Bo, K. (2015). The immediate effects on inter-rectus distance of abdominal crunch and drawing-in exercises during pregnancy and the postpartum period. Journal of Orthopaedic & Sports Physical Therapy, 45(10), 781-788. DOI:10.2519/jospt.2015.5459

6. Lee, D., Hodges, P. (2016). Behavior of the linea alba during a curl-up task in diastasis recti abdominis: An observational study. Journal of Orthopaedic & Sports Physical Therapy, 46(7), 580-589. DOI:10.2519/jospt.2016.6536


7. Hodges P. (2008). Transversus abdominis: a different view of the elephant. British Journal of Sports Medicine 42:941-944.

8. Shaw, J., Hamad, N., Coleman, T.,  Egger, M.,  Hsu Y, Hitchcock, R., Nygaard, I. (2014). Intra-abdominal pressures during activity in women using an intra-vaginal pressure transducer. J Sports Science, 32(12), 1176-1185. doi: 10.1080/02640414.2014.889845

How Can I Benefit from Working with a Personal Trainer Specializing in Pregnancy and the Postpartum Period? 

While having a personal trainer used to be considered a luxury reserved for celebrities and athletes, more people from the general population are learning the value of using a professional to make the best of exercise in their lives. The pre- and postnatal periods are times in a woman’s life that are marked by significant change and what had been working before pregnancy or kids may not be the best approach anymore. Hiring a personal trainer during this time can help to keep you stronger and more active as you navigate the journey through motherhood. The benefits of exercise to mom and baby are well-documented and, fortunately, becoming common knowledge. It is no longer seen as a wise decision to cease exercise, provided there are no major health issues and mom is feeling good. Even though exercise is considered an excellent habit for mom to adopt or continue, the demands of pregnancy and postpartum recovery place on a woman’s body are significant, making smart and strategic choices regarding exercise essential during this time. 

Contrary to what many people believe, an understanding of pregnancy and recovery is not considered required knowledge for personal trainers. In most certifications, the process of pregnancy is rarely mentioned, if at all. Most certifications will include a paragraph or two on pre- and postnatal training, meaning that most personal trainers are not qualified to work with women during this time. To address this need, certifications on pre- and postnatal training have been created but many are outdated and/or lacking information. Even the most comprehensive certification will likely not be enough to fully address the needs of this population, and so a personal trainer must embark on continued education as the research evolves. 

Working with a person who specializes in pre- and postnatal exercise allows you to have the confidence that your exercise routine will be appropriate for your baby, and your changing body.

1. Working with a Pre/Postnatal Exercise Specialist Allows You To Adapt Your Workouts to Your Stage of Pregnancy/Postpartum

A woman’s body goes through an incredible amount of change that begins the moment she conceivesand continues well-beyond the “6-week checkup” postpartum. As a result, her exercise routine throughout the trimesters and into her recovery will need to reflect this change. Pre/Postnatal specialists can effectively guide you from conception (and before!) to postpartum (and beyond!) with varying workouts that address your body’s needs as those needs shift. 

2. A Pre/Postnatal Exercise Specialist Can Help You Make Safe and Smart Choices

Many women originally seek out the assistance of an exercise professional during their pregnancy because they are concerned about the impact of their exercise on their unborn baby’s well-being. While this concern is obviously at the forefront of any mama-to-be’s mind, babies are so well-protected in utero that that are very few exercises that pose a concern to the fetus. The greater concern is the impact of poor exercise choices and execution on the mother’s body, a concern that has largely been ignored by the majority of the fitness industry. Hormonal and biomechanical changes that occur in a mother’s body can increase the likelihood of pain and dysfunction (such as diastasis recti, pelvic organ prolapse, incontinence, etc) which can be exacerbated through exercise.  A qualified pre/postnatal trainer not only knows how to modify exercise selection to mitigate the possibility of dysfunction, but they also know how to change the strategy (the way one performs an exercise) to help your body perform at its best. 

Your Pre/Postnatal Exercise Specialist will also refer you to qualified medical professionals, should the need arise. Having a cohesive team of practitioners dedicated to keeping you in the best health during these chapters is just one more benefit of working with a trainer during this time!

3. Pre/Postnatal Exercise Specialists Can Help You Achieve Your Fitness Goals (even if you’re dealing with common pregnancy or post-birth dysfunctions!)

If you are already managing dysfunction or pain, a pre/postnatal trainer can help you figure out how to stay active in spite of your condition! Just because you have pelvic organ prolapse, or diastasis recti, or pubic symphysis pain does not mean that you can’t partake in engaging and challenging exercise! It’s not just what we do, it’s how we do it. Many women find that, when working with a qualified professional, they’re actually able to do more challenging and more rewarding exercise than they thought possible. 

4. Working With a Pre/Postnatal Specialist Keeps You Strong and Active for Labor/Delivery and Motherhood

Trainers who specialize in working with moms know how athletic being a mom (and the process of becoming one!) can be. They can design workout programs that not only address your fitness goals, but that address your daily activities, as well — from getting baby out of the crib, to picking up the carseat (and groceries and the dog and the diaper bag…!), to carrying the 3-year-old who refuses to walk, to running after your older kiddos — motherhood is hard work! In addition, pre/postnatal trainers will discuss ways that you can prepare your body for the demands of labor and delivery! Working with a pre/postnatal specialist will pay off in and out of the gym!


If you’re ready to find out what it’s like to work with a Pre/Postnatal Exercise Specialist, we’d love to help! We know you’ll feel stronger, more confident, and we’ll make sure you have a blast accomplishing your goals! Fill out our contact form to schedule your assessment session today!  

Running During Pregnancy

There is possibly no activity more freeing than lacing up your shoes and heading out for a run! We train many (prior, current, and future!) runners at The Lotus Method and strive to support each woman in building the capacity to enjoy the benefits of running. Running during pregnancy can be fine, but there are a few things that are often not considered when determining the pros and cons of running. 

The American Congress of Obstetrics and Gynecologists advise that pregnant women who habitually engage in vigorous-intensity aerobic activity (ie, the equivalent of running or jogging) or who are highly active “can continue physical activity during pregnancy and the postpartum period, provided that they remain healthy and discuss with their health care provider how and when activity should be adjusted over time” (Department of Health and Human Services, 2008). 

The ACOG does not speak directly about our biggest concern regarding running during pregnancy....

The biggest consideration we are thinking about when deciding whether running is the best choice for pregnancy is the health and function of the pelvic floor. During pregnancy, the extra weight from the baby (and everything that comes with him/her!) is placed on your pelvic floor, a basket-like structure of musculature and connective tissue that lines the base of the pelvis. The pelvic floor provides structure and support to our bodies, aids in continence, and plays an important role in birth, and sex, as well. Along with having to manage the extra load of our bodies due to pregnancy, the pelvic floor's ligaments become softer and more relaxed in response to the changing hormonal landscape of pregnancy. 

What this adds up to is a pelvic floor that may not be able to meet the high impact demand of running. As a result, running may put us at an increased risk of pelvic floor dysfunction, including incontinence and prolapse, which may persist well after the immediate postpartum period. 

For this reason, we typically don't encourage running during pregnancy after the first trimester for most women. 

If running is something you're unwilling to give up beyond the first trimester (we totally get it!), we highly recommend seeking the expertise of a Pelvic Floor Physical Therapist (PFPT) who can give you a better idea of your unique situation. It may be that your pelvic floor is coping well to meet the demands of running and you might be able to stay in the game longer! 

What we really want to think about when we're deciding if running is an activity we want to continue to do throughout our pregnancy is the big picture and our long-term health. If there is a chance that running during pregnancy will predispose us to conditions that have longterm implications (and may even prevent us from running in the future), is it worth it? When there are so many other activities that will get our heart rates up and make us feel good, we're not so sure! 

So, what can you can do in lieu of running? Lots of things!

With all of these activities, follow a few simple guidelines:

-Keep your rate of perceived exertion (how hard you feel you're working) at a level where you can still speak a sentence, or 13-14 (somewhat hard) on a scale from 0-20. It's no longer considered necessary to monitor your heart rate (unless you have a preexisting condition). 

-Avoid activities that increase your risk of falling. 

-Watch out for symptoms of heaviness, pressure, dragging, and bulging in the pelvic floor. Leaking is another sign that the pelvic floor is overwhelmed by the activity being placed on it. Adapting the strategy in which you do the activity causing symptoms may be all you need to continue with the activity - you don't necessarily need to give it up!

-Consider:

  • Uphill walking 
  • Swimming
  • Spinning (keeping your tailbone untucked can help your inner core unit do its job best) 
  • Climbing stairs

And our personal favorite: 

  • Lift weights/resistance train faster! Keep your rest intervals shorter and work in a circuit format to reap the benefits of strength training and cardiovascular endurance. Check out the video below on how to turn up the intensity on simple strength training exercises without having to contend with the impact of running. 

Running will still be there for you if you prioritize the well-being of your body (especially your pelvic floor) and take your time during pregnancy and postpartum to focus on activities that take this transformative period into consideration. 

When the time comes to return to running postpartum, be sure to check out our tips on how to safely and effectively work back up to it. We also offer a Return to Running workshop! Keep your eyes on this space for more details. 

How to Get and Stay Strong to the Core During Pregnancy!

Core training during pregnancy is one of the topics that comes up most frequently when we are first beginning to discuss exercise with new members. Many women have questions about what they can or can't do to work their middles, how or when they should modify the exercises they've previously done, and what the goal is when training the core during pregnancy. A quick google search will show you everything from "avoid all core exercise!" to Instagram pages of women at 9 months pregnant during planks and crunches. How are you supposed to know what's appropriate for your body and your pregnancy?!

First...a note on what we're talking about when we say "core":

In most fitness spheres, the word "core" is used synonymously with "abs". Generally, when most people think of core training, they think of training the rectus abdominis (our "six pack" muscle), the obliques, maybe even the transversus abdominis, by doing exercises like crunches, planks, side planks, mountain climbers, or exercises believed to specifically "target" the "core". 

We'd like to change that discussion and specify what, exactly, we're referring to when we talk about "core" training. 

Picture an apple that you've eaten down to the seeds. What remains is the inner structure that helps to support the parts you aren't able to get through (the stem, the seeds, etc.). The more superficial apple bits you ate to get to the core were the rectus abdominis and the obliques and what's left is the "core". When we discuss your core, we're talking about these four muscles: the diaphragm, the transversus abdominis, the multifidus, and the pelvic floor muscles (there are actually several PF muscles, but for the purpose of this, we'll lump them together). If you picture a can of soda, the diaphragm is the top of the can, the transversus abdominis wraps around the middle, the multifidus is the back of the can, and the pelvic floor muscles make of the bottom. These four muscles work together to create dynamic stability and anticipate movement throughout the rest of the body. They are directly involved in respiration and the stability and mobility of our trunk. 

The other thing to know about the core is that, obviously, our babies end up taking space within them. This means that just the presence of pregnancy will shift the balance of the muscles in the core. No fear, though! We can still make efforts to ensure these muscles work as effectively and efficiently as possible throughout the duration of pregnancy. 

So, now that we understand what it is we're talking about when we say "core", let's talk about what you need to know about core training during pregnancy:

1.) Yes, We Absolutely Need to be Training Our Core During Pregnancy!

Now that we have a better understanding of what it is we're talking about when we say "core", it should be clear that it would actually be impossible not to train our cores! We need to train our cores to help our entire body function well and stay strong and adaptable to the demands of pregnancy and motherhood. 

2.) Use Your Breath and Alignment to Facilitate Optimal Core Function

A rib-over-hip alignment will place the elements of your core stacked on top of each other. Imagine a straw: the straw that is straight up and down is going to move a thick milkshake more than the bent straw. Imagine your trunk alignment in a similar way. Keeping your ribcage (where you diaphragm lives) over your pelvis (where your pelvic floor lives) allows these two to interact more effectively. In addition, the way you breathe will influence the function of the core. When you inhale, think about expanding through the ribcage, relaxing your pelvic floor, and softening your belly. When you exhale, the pelvic floor recoils, there's a gentle engagement from the transversus abdominis, and the ribcage will move back in. When you're lifting something heavy, you made need more awareness of the lifting of your pelvic floor (meaning, you would more actively try to "lift" up an object using the muscles of your vagina/anus). You'll want your exhale to begin your movement and continue throughout the entire concentric motion (usually described as the "challenging" part of an exercise. For instance, coming up from the bottom of a squat would be the concentric portion of the exercise. The eccentric portion is the lowering into the bottom of the squat, which is when (in most cases), you'd focus on inhaling. You would also want to prioritize keeping your rib cage over your pelvis during the entire range of motion of the squat. Using this strategy will help you keep your core doing its job as effectively as possible. 

3.) But what about my abs?!?!?!

Yes, your rectus abdominis and your obliques are important too! During pregnancy, they also stretch to accommodate your baby. Many exercises that attempt to focus specifically on these muscles (crunches, sit-ups, Russian twists, planks and plank variations) aren't the ideal choice for pregnancy. As a woman progresses through the weeks of pregnancy, crunches/sit ups (and all the variations!) will likely start to feel weird. One reason is that the action of a crunch is condensing the space available to your baby. Another reason could be that the motion increases the potential for excessive pressure on the pelvic floor. In addition, there's potential for putting excessive strain on the linea alba, the connective tissue that lines the center of our abdominal muscles, which may increase the potential for exacerbating a diastasis recti. We recommend holding off on crunches, sit-ups, twists with flexion (like a Russian twist) during pregnancy. Exercises where the trunk stays stable (like a plank/push up/hanging knee raise) may or may be appropriate, depending on your stage of pregnancy and how your core is functioning. How do you know what to modify? Look for doming of the abdomen, pain or pressure through the trunk/pelvis, or anything that feels "weird" or "off". 

4.) Think About the Big Picture

Instead of thinking about how the abs will get trained during pregnancy, realize that all the muscles of our bodies work together as a team. Instead of focusing on what specific muscles are doing and training each of them individually, think about the tasks you're asking your body to achieve and the movements your body makes. When we think about movement this way, we realize that all the muscles of the trunk are involved in a squat, in a deadlift, in a push up, etc. There may be times when we want to specifically think about the muscles we're using, but the majority of our training can revolve around bigger, compound movements, instead of isolated exercises. Your (inner and outer!) core is functioning during everything you do. We don't need a 30-minute "abs" class to "blast our cores". We need to move efficiently and functionally, before, during, and after pregnancy! This might feel like a big shift in thinking, but we promise it will make your training more effective and keep your training time down so that you can achieve the results you want in less time. 

So, what does core training look like at The Lotus Method? 

Here's a sample circuit:

Suitcase Deadlifts

Pallof Press

TRX Rows

Standing Woodchop

With these four example exercises and by using a breathing and alignment strategy that prioritizes our core function, we're able to get a total body, including our core!!, training session. Your personal training program will look different (based on your needs), but remember to think big picture, modify moves that no longer serve you, prioritize the function of your inner core unit, and have fun! Your pregnancy training will help set up the foundation for postpartum healing and an eventual return to full function and fitness. 

For more information, check out these blog posts:

http://www.juliewiebept.com/fitness/core-conversations-the-anticipatory-vs-reactive-core/

Exercising during pregnancy

How to exercise during pregnancy doesn't need to be a complicated mystery, even though it can seem confusing to know what to and what not to do. The internet is rife with suggestions and many fitness instructors and trainers have not received adequate information on what to be aware of during the pre- and postnatal chapter. Have no fear, The Lotus Method informational blog series is here! We'll be posting to help educate, empower, and demystify training through motherhood. 

Gone are the days where pregnant women were viewed as fragile. It has now become common knowledge that physical activity benefits both mama and baby (woohoo!) but there is still quite a bit of discussion on what exercise is most beneficial. As is true for many things, the answer here is "it depends!" 

What is your objective? 

A few great goals to strive for with exercise prenatally:

  • Maintain function and fitness throughout the duration of pregnancy
  • Prepare for labor/delivery
  • Prepare for the impending challenges of motherhood

At The Lotus Method, our focus is strength training. Here's why:

  • Resistance training enables mamas-to-be to maintain strength throughout their bodies by prioritizing movement patterns and muscles that allow for the body (including the ever-important inner core unit) to function optimally throughout the trimesters, making life inside and outside the gym easier and more enjoyable.
  • Prepare for the hard work of labor 
  • Motherhood is repetitive, physical, and demanding. Babies don't stay little for long and with them comes a lot of gear! Being able to manuever an infant in a carseat (without waking them from that precious nap you've been waiting for!!) is a lot more challenging than it may initially seem. In order to be up for the challenge, we strength train!

Strength training may initially seem intimidating but it's not all barbells and bros. We highly recommend seeking the expertise of an exercise professional you trust (like us!) to show you the ropes, but if you're unable to, here are a few tips to help you strength train as effectively as possible:

1.) Keep it simple. Focus on major muscle groups, and basic human movements. Simple sessions with squats, hinges (deadlifts), pulls (rows), rotations (woodchops), etc. can yield great results! Instead of getting caught up in the latest and greatest exercise in a magazine, stick to the basics. 

2.) Prioritize great form and utilize a strategy that takes your core into consideration. Your inner core unit is made up of your diaphragm, your multifidus, your transverse abdominis, and your pelvic floor. You can picture them as a canister. We want to keep our canister as stacked as we can and we want our breath to encourage these teammates of the core to work together! On inhale, our diaphragm descends, our rib cage expands, our belly softens, and our pelvic floor softens. On exhale, our pelvic floor lifts, our bellies generate gentle tension, and our diaphragm ascends. During your strength training exercises, you're going to work to keep your diaphragm stacked over your pelvic floor (which means your ribs will be stacked over your hips) and you're going to exhale with (and just before) the exertion (the "hard" part) of the exercise. For example, in the squat: inhale and soften your belly as you descend, begin your exhale just before you begin to come back up and continue that exhale until you get to the top. Throughout, keep your rib cage and pelvis aligned. It may take some practice! For more information, please check out this program, created by renowned women's health PT, Julie Wiebe: http://www.juliewiebept.com/product/the-pelvic-floor-piston-foundation-for-fitness-2/

3.) Emphasize exercises that will support you through pregnancy, back off exercise that cause you to strain. Every pregnancy is different and so there are no hard and fast rules about what exercises will or won't be appropriate throughout the duration of one's pregnancy. A good rule of them is that any exercise that forces you to hold your breath is likely too challenging. Consider reducing the amount of weight you're lifting or switch to a slightly easier version to see if you can return to your breath (as described above). Another thing to look out for is doming or ridging along the middle of your belly. This is indicative of a core that is unable to manage the amount of pressure being exerted and is a good reason to regress or eliminate the exercise. This is what we watch for during planks or push ups as our clients progress throughout their pregnancies and it's a reason we recommend eliminating crunches, sit-ups, double leg lowers and raises during pregnancy. 

4.) Easy on the impact. During pregnancy, there's a significant load placed on the pelvic floor. when we add impact (from jumping, running, etc.), we're asking a lot from our bodies to be able to stabilize and receive that force from above. As baby gets bigger, it's possible that, over time, the demand becomes greater than our bodies can handle and excessive impact from exercise could increase our risk of pelvic floor dysfunction. We generally recommend hanging up your running shoes after the first trimester, but if running is something you're truly hoping to continue longer into your pregnancy, we feel it's essential to work with a pelvic floor physical therapist who can give specific feedback and guidelines.

5.) Stop if you feel any of the following symptoms: pain, pressure (especially in the vagina), bleeding, lightheadedness, fluid leakage (urine or otherwise), anything else that strikes you as odd or abnormal. Follow up with your doctor to verify that everything is still A-OK before continuing. 

6.) Vary your workouts according to how you're feeling and where you are in your pregnancy. Your exercise routine in your first trimester may not look that much different than your pre-pregnancy workouts, but it may not be appropriate for your third trimester. Along with generally slowing down as you near the end of your pregnancy, you'll likely find that certain positions or movements aren't as accessible as they used to be. The push ups you blasted through at week 9 may now be causing some abdominal ridging at week 23; best to swap out the push ups for a standing cable chest press or incline/wall push up, for instance. 

Every woman is different, every pregnancy is different, every woman's pregnancy workouts should be different, too! 

For more individualized information, reach out to us to schedule an assessment session!