I have had an enlightening few weeks studying Munira Hundani’s new course ‘Diastasis Rectus Abdominus and the Postpartum Core’ which for me, presented a fascinating new framework for both assessment and exercise prescription of the post partum core.
Diastasis Rectus Abdominus (DRA) is a widening of the linea alba (the midline of the abdominal wall) experienced by women during and after pregnancy. Whilst it is normal to experience some degree of separation it should generally resolve naturally postnatally however in approximately 1/3 of women the excessive and prolonged widening prevails adding to a sense of disconnection and dysfunctionality .
Commonly the protocol for fitness instructors, like myself, for dealing with DRA is to present a long list of things to avoid to prevent further widening of ‘the gap’. These might include lifting heavy weights (e.g children), sit-ups, plank, boat pose (Navasana) jack knives, russian twists etc for fear of causing too much Intra Abdominal Pressure (IAP) and worse still increasing the gap. The assessment of the DRA would usually be conducted primarily in supine using a head lift protocol and exercise prescription would typically be progressed dependant on the inter recti distance (or width of the gap)
Hudani’s work paints a much more positive picture for the treatment of DRA as well as a much bigger focus on the individualised journey that success should take accessed via the initial assessment. Crucially she demonstrates how clinical research shows that there is little to no correlation between the DRA itself and formally associated issues such as lower back pain or indeed the ‘type’ of exercise a woman should do. Rather than point the blame at ‘the gap’ she explains that the inter recti distance is just a another part of the abdominal wall that has widened as a whole, coupled with altered breathing and core connection strategies resulting in a mis-management of IAP. She goes on to emphasise the importance of IAP and how harnessing it using the diaphragm and the Transversus Abdominus (TVA) is the key to success.
So what does this mean for women with DRA? Well, by assessing the DRA in positions which prompt more IAP (i.e standing or sitting as opposed to supine – which, she explains, is particularly unproductive for those with increased circumferential laxity) it helps to illicit a better provocation of TVA’s true ability to activate and therefore a ‘way in’ to strategise a stepwise approach for that individual. The idea of using and creating IAP to strengthen the core automatically reduces the fear factor around creating too much IAP. Once the re-training of the diaphragm and TVA has successfully been achieved the list of formally avoided exercises are the very ones which need to be integrated in to optimise core and indeed whole body strength. This means your favourite yoga class, HIIT workouts or Pilates classes are once more back on the table.
If you have been affected by diastasis and are looking for ways to help progress do get in touch via the contacts page for more information.
I’ve just spent the last couple of months updating my Pilates for orthopaedic conditions knowledge with FutureFit and wanted to focus a bit on exactly why Pilates is so helpful in the treatment of common orthopaedic conditions. Whilst I don’t solely use Pilates in my movement sessions but instead use a range of functional movement protocol the traditional Pilates principles certainly embody and underpin the main focus of exercise prescription for rehab thereby providing a safe and effective recovery.
Common Orthopaedic Conditions –
Back pain (non specific, specific, root nerve pain, disc herniation and piriformis syndrome)
Arthritis (osteoarthritis and rheumatoid arthritis)
Osteoporosis and osteopenia
The Pilates mat repertoire gives a great range of exercises which allow for enough regression or progression to take participants with very limited movement capabilities and progress them in a sustainable way. The incorporation of the Pilates principles which are taught alongside each exercise help to integrate the breath with core co-contraction, increase body awareness (and therefore autonomy) and focus on the quality of movement.
A tailored programme can offer you many things – principally better alignment and mobility of the spine but also increased muscle strength and endurance, reduced stiffness and improved flexibility, reduced pain, better balance along with improved well-being.
If you are affected by any of these conditions it’s important to seek out an effective exercise programme which meets your needs and minimises your symptoms. Due to covid-19 I am not currently able to offer sessions but feel free to contact me for further advice.
If you’re feeling a growing sense of stagnation with your exercise routine as well as lockdown this may help…the exercise side of things anyway. It generally takes 6 – 8 weeks of training in a specific modality to see the results of your labour so if you’ve been focussing on your fitness in your allocated exercise time from the start of lockdown it’s the right time to give your programme a shake up.
Regularly mixing up your exercise plan is crucial to achieving results. Periodisation is a method to plan phases of your training to optimise different aspects of your ‘fitness’ thereby maximising your gains whilst also reducing the risk of injury or overtraining….and getting bored!
4-6 week periodisation phases to typically cycle through include a stability phase focusing on consolidating your core connection, peripheral joint stability and proprioceptive awareness. Followed by a strength phase, prioritising load over stability to increase muscle strength and finally, if appropriate, a power phase.
Here’s some examples of how you might progress exercises from a stability phase (12-20 reps 1-3 sets) into a strength phase (8-12 reps 2-4 sets):
Single leg alternate dumbbell shoulder press –> Standing barbell push press
Scaption on a single leg –> Standing kettlebell overhead press
TRX fly on one leg –> Bodyweight press ups (or decline to increase load)
Single leg squat –> Kettlebell goblet squat
Single leg Romanian deadlift –> Romanian deadlift
TRX hanging bodyweight lunge –> Dumbbell lunges
For more info on tailored exercise training programs drop me a line via the contact page.
Or, even more boringly titled ‘Appropriate Exercise’…..
I had wanted to get going sooner and magically ‘win the internet’ with incredible Pilates and Corrective Exercise routines to wow the masses but it quickly become apparent that not only was social media at saturation point with offerings but homeschooling had won in the battle between professional development and parenting…..any ground made was largely due to Joe Wicks google searches misdirecting to movewithjo.com….
With so much on offer and many turning to running to get the most from their allocated Exercise Time it got me thinking about the choices that were being promoted. I read Facebook comments about overloaded abdominals from You Tube workouts, I listened to my friend tell me about her neck pain attempting The 100 whilst doing a virtual Pilates class her work had set up and I witnessed a lot of extremely unsustainable running styles in the park.
As a corrective exercise specialist I wanted to highlight the importance of self preservation in these exacting times and offer up an Appropriate Exercise Checklist!
Appropriate Exercise Checklist.
Is your body pain free after undertaking new exercise? (symmetrical delayed onset muscle soreness aside) Check your technique, if you’re not sure give it a miss.
Is your body pain free on a normal day to day basis – Are you incorporating maintenance exercises to help vulnerable areas? e.g pelvic floor, neck or back tension.
Try to think about ways to counter the positions you hold yourself in during the day – like sitting, screen-time to prevent muscle tension and imbalance.
(Similarly to 3) Try to think about supplementing your body with extra movements and positions that you are not getting through your daily life? Reaching, rotating, hanging, squatting, pushing and pulling through a variety of ranges of movement…?
Is the exercise you are doing the right impact for you if you’ve had pelvic floor or joint issues? If you feel you have to run, consider shorter hill sessions to help reduce the impact but still get cardiovascular reward.
Take rest days, vary your exercises and do sufficient stretching.
I read a PubMed article recently about grip strength as an indicator of health related quality of life in old age and it got me thinking about what we are lacking or sidestepping in our daily lives that means we don’t achieve meaningful grip strength via our normal everyday movements and habits.
The article looked at quality of life in men and women ages 60-94 years old and used the measurement of grip strength to determine overall muscle strength and function. High grip strength is strongly associated with preserved mobility, higher activities of daily living and decreased disability and although it was outlining grip strength as an indicator of ‘general’ health (as opposed to isolationist strength purely at the wrist) there are many habits and environmental factors that rob us of this type of daily movement that would otherwise improve this outcome.
Here’s a list of 5 examples that I came up with to demonstrate ways in which we deny ourselves of those daily ‘movement vitamins’:
Coffee grinder – admittedly this is quite hard work but you will be rewarded with not just coffee but a better quality of life….and some would even argue better coffee!
Washing machine – imagine all the wringing and squeezing that went on before washing machines, perhaps once or twice a week skip the spin cycle and try and wring out the excess water.
Wheelie suitcase – do you wheel your suitcase? Does it glide smoothly across the airport floor?! Think about all that grip work and corresponding arm and core effort if you were to carry it. Not quite as comfortable but perhaps more so than general physical decline!!
Car key automatic lock – this seems quite petty but just on principle the price of convenience is robbing us from basic wrist turning actions and even extra movement around the car to lock the doors in the name of convenience.
Automatic can opener – another wrist strength robbing device!
To conclude, even though the study just involved a small amount of participants and also incorporated the social aspect of ageing into the equation it makes a good example of how a few simple steps on a daily basis and a bit more awareness can contribute to a healthier outlook.
If you travel a lot for work it can be hard to prioritise your own movement let alone specific exercise. This post is an aid to those trapped in their hotel rooms (!) and in need of some body maintenance to cancel out all the sitting, screen watching, suit and work shoe wearing (that also ‘cast’ your body into unhelpful postures).
Chest stretch: Arm at 90 degrees (i.e. bent at the elbow) with your forearm against a wall or door frame the stretch the chest open, away from the wall. One arm at a time then switch.
Door frame: Reach up to a door frame and try to extend your arms whilst breathing deeply lengthening on the exhalations. Try to create space from your ears to your shoulders.
Back extensions: Lying prone, chin slightly tucked – on an exhale raise your chest of the floor a tiny bit whilst lengthening your arms/fingertips towards your feet. Also try to draw your shoulders back as if opening your chest.
Childs pose: Sit back on your heels stretch your arms forward onto the floor.
Hamstring stretch: lying supine stretch one leg up – use a belt or tie around the foot to get leverage (keep the other knee bent and try not to press/flatten your lower back) Switch legs.
Sit ups: support the head if necessary, deep exhale as you come up.
Plank: On your elbows – keep breathing, back of the neck long don’t drop your chin.
Childs pose: same as before but with the palms up.
Note: Written descriptions of exercises and movements can be lost in translation! So if these do not translate easily for you do get in touch via the contact form. Readers who have had been having sessions will recognise the cues!
It’s easy to do exercise for exercise’s sake particularly at this time of year when the internet is awash with new year’s resolutions & calls to reinvent yourself through exercise! What we really need to access through our, let’s call it, ‘planned movement’ is an intended physiological response – meaning not just ticking something off the ‘to do list’ but creating a more nourishing exercise programme that provides ourselves with the missing movements that our modern lifestyles do not afford us.
Here are three 10 minute exercise ideas (50 seconds per exercise with 10 seconds rest) to try, you could do them as is or cycle through just some of the exercises for a different focus.
10 minute Full Bodyweight Workout (for strength)
Squats (with band pull apart to add in some shoulder blade work) Wood chops (alternate sides) Side lunges (or jumping jacks…) Wall sit Rows Band pull ups (with band under foot to work shoulders/core) Push ups with push back (regular push up half or full with a shell stretch back between reps) Hovers on all 4’s (or plank) Hip lift with chair (supine with legs elevated, push hips up) Leg extensions (supine with alternate leg extension for abdominal load)
10 minute Correctives (for transitioning to better alignment)
Supine half dome thoracic stretch Supine half dome thoracic stretch, in slightly different place on the spine Rhomboid push up Shell stretch (try palms up & down) Side neck stretch with median nerve floss left Side neck stretch with median nerve floss right Calf stretch over half dome left Calf stretch over half dome right Long arm reach Rotator cuff band pull with slow return
10 minute Evening Stretch (for counteracting the effects of too much sitting)
Chest stretch against wall left Chest stretch against wall right Hip rock left Hip rock right Pigeon left Pigeon Right Adductors knee bent left Adductors knee bent right Supine over half dome Head nods
If you have attended classes or currently train with me most of these will be familiar – if not, videos to follow……. or drop me a line!
In sessions we are often trying to ‘undo’ or improve on aches & pains (limitations) we have, whether it be through bad alignment or injury. Both of these are usually caused by having poor alignment resulting in our inability to maintain a sustainable functioning muscle balance.
If much of your day is spent sitting or sedentary your body will be cast into that shape, there will be adaptations which define your body as ‘a sitter’ – even if you did a ‘workout’ (whatever that may be). What you do for the majority of your day will dictate how your muscles are conditioned. There will be specific movement pathways that your lifestyle does not expose you to due to ‘modern living’ & in particular the time saving devices we now have at our disposal e.g shopping online instead of walking to the shops & carrying it home, buggies, washing machines, cars etc.
In order to counteract this we need to look at steps we can take to change our environments to afford more movement time, different working postures or movement breaks spread out across the day.
3 steps to improving your ‘sitters body’.
Work on corrective exercises to help counter the effects of sitting.
Try to sit & do the movement we’re already doing with better alignment. See the picture on the left for ideal sitting alignment.
Look at ways we can change our environments & lifestyles to incorporate more activity where possible.
As sitting is now described as the new smoking I guess if you can fit some stretches into your workday it’ll just be the equivalent of vaping….maybe?! Anyway, whether you’re standing or sitting for long periods intermittent stretching and movement will help curb muscle tightness & pain as well as go some way into preventing the adaptive shortening of muscles.
Try to do them throughout the day instead of all in one go for get the most benefit – setting an alarm to move every hour will help to remind you.
1st row: Triceps, arm down back into lat stretch as you bend to the side (second picture).
2nd row: Hip flexor stretch on chair. Anchor the knee and drive the pelvis forward to open the front of the hip.
3rd row: Neck stretch, ear to shoulder into levator scapula stretch as you turn your head hold & try to place nose to shoulder too.
4th row: Hamstring stretch making sure you keep the hips parallel and tail bone sticking out.
5th row, left: Rhomboid push up in vertical or chest opener. From the position pictured bring your elbows in together.
5th row, right: Piriformis / glute stretch – lean on the knee to increase the stretch. Untuck your tailbone.
In Pilates classes we give a lot of emphasis to using the pelvic floor muscles throughout all the exercises but I wanted to use this post to look a bit more specifically at some of the precursors to pelvic floor problems & signs you may be at risk or already have issues.
There are specific signs to look out for which can indicate that you may have a pelvic floor problem – these are all suboptimal issues that you do not have to live with, a trip to the women’s health physio (or men’s) will help get you on the road to recovery just like any other muscle injury. I’ll stress again, these are not just conditions of age or things that ‘just happen’ – you can do something about it, just because something is common does not mean it’s normal.
Peeing when you exercise, laugh, cough or sneeze
Needing to get to the toilet in a hurry or not making it there in time
Loss of control over your bladder or bowel
Accidentally passing wind
A prolapse – in women, this may be felt as a bulge in the vagina or a feeling of heaviness, discomfort, pulling, dragging or dropping. In men, this may be felt as a bulge in the rectum or a feeling of needing to use their bowels but not actually needing to go
Pain in your pelvic area, or painful sex
Being pregnant & childbirth
The pelvic floor is just like any other muscle so if it’s too tight or too weak or a combination problems can occur but there are certain events in life & lifestyle factors that can contribute to creating imbalances or dysfunction. Some people have pelvic floor muscles that are too tight (hypertonic) & cannot relax. This can be made worse by doing squeezing exercises & overworking the muscles without learning how to relax – this is why I always try to give time in the class to focus on actually relaxing & releasing the abdominals & pelvic floor.
The main precursors for pelvic floor problems will involve any type of unmanaged pressure within the abdominal canister or where there is poor load transfer .
History of back pain
Ongoing constipation & straining on the loo
Being overweight with a BMI over 25
Incorrect heavy lifting e.g using the Valsava maneover
Chronic cough or sneeze
Previous pelvic injury
Wearing high heels
With the right technique & exercise selection, Pilates is a great choice to help strengthen the pelvic floor – at any age, whether you’ve just had a baby or your babies are having babies!