New Diastasis Protocol

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.

Photo by Arren Mills on Unsplash

Pilates for Orthopaedic Conditions

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.

harlie-raethel-ouyjDk-KdfY-unsplash

Common Orthopaedic Conditions –

  • Back pain (non specific, specific, root nerve pain, disc herniation and piriformis syndrome)
  • Shoulder conditions (rotator cuff tear, impingement and frozen shoulder)
  • Golfers and tennis elbow
  • Hip and knee arthroplasty
  • Arthritis (osteoarthritis and rheumatoid arthritis)
  • Osteoporosis and osteopenia
  • Hypermobility

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.

Photo by Harlie Raethel on Unsplash

 

Pandemic Plateau….?

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.

sven-mieke-jO6vBWX9h9Y-unsplash

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.

 

Hotel Workouts

sergio-pedemonte-bmy4kUG4n3M-unsplashIf 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).

 

  1. 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.
  2. 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.
  3. 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.
  4. Childs pose: Sit back on your heels stretch your arms forward onto the floor.
  5. 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.
  6. Sit ups: support the head if necessary, deep exhale as you come up.
  7. Plank: On your elbows – keep breathing, back of the neck long don’t drop your chin.
  8. 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!

Photo by Sergio Pedemonte on Unsplash

Pelvic Floor 101!

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.

PelvicFloor_Burrell_V2

  • 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
  • Poor alignment
  • 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!

Upper Back Mobiliser

Modern living tends to cast our bodies into a forward flexion bias stiffening & restricting movement of the upper back, neck & shoulders. It seems to be one of the main complaints & one of the things most class participants would like to relieve. 

The thoracic spine (upper, mid back) provides much of the rotation & extension of the spine but thanks to lifestyle factors such as looking (down & forward) at phones or computers, driving, leaning down over children or  poor posture it tends to get very restricted. Anyone that plays sport is likely to find their performance limited by stiffness in this part of the spine  & it’s common to get compensation injuries in other parts of the body as a result.

Typically a stiff thoracic can cause pain between the shoulder blades but also transfer excess loads onto the lumbar spine, neck & shoulders, which in turn can lead to pain in these areas as well as headaches. A stiff thoracic spine will also result in the Old Hunchback of Notre Dame look (!) & lead to a Dowager’s (or Bison’s) Hump – a thickening of the soft tissues at the base of the neck. So, some good reasons there to keep up with some basic maintenance to keep it supple!

In the classes we work through a few different exercises both in side lying & on all 4’s to help mobilise the thoracic spine & then follow up with some strengthening work to help keep the spine aligned. Here’s one of those exercises that’s really effective as the ground ‘fixes’ the hips which will give you a better chance at rotating correctly through your thoracic instead of cheating with another joint deformation.

Thread the needle pilates_16

pilates_16a

Make sure you have your knees hip width apart & hands, shoulder width apart. Don’t collapse your supporting shoulder / shoulder blade as you bring the other arm under & as you reach up try to really extend through the arm (….mine is bent, probably from too much baby holding!). Try 10 on each side, exhaling as you extend the arm up.

Post Natal Exercise – Where do I start??

After a bit of an end of pregnancy slow down (!) on the blog front I thought it would be an opportune time to write some post natal exercise posts to both remind myself & give some direction to anyone beginning the journey of reconnecting with their non-pregnant selves!

With any exercise programme, post natal or otherwise the ability to breathe correctly during exercise is essential to having a fully functioning core. Reconnecting with your breath will provide the foundation to both your core’s recovery rate & help you to progress with bigger more integrated core movement patterns (A.K.A sorting out the mummy tummy!).
Breathe_titled-300x300Whatever birthing experience you had or however fit you were/are post partum reconnecting with your breath is where you need to begin. The nature of pregnancy – with the baby in the tummy thing (!) – can create a disconnect with the way we breathe due to the expanding uterus squashing the diaphragm resulting in there being less room for your lungs to expand – so it is vital to relearn this essential function.

Try this – find a quiet space to practice lying down with a neutral spine & pelvis.

Inhale (the expansion): Breathe wide into your ribs, try to do this 3 dimensionally so use the floor against your back as a reference, don’t just flare the ribs outward. Your abdominal wall will expand. Try to relax your shoulders, neck & jaw.

Exhale (the compression): As you breathe out feel your ribcage contract & lower, your abdominal wall & lumbar/thoracic muscles (see the pic) will tension. Think about connecting with your pelvic floor by drawing it up (think picking up a tissue with your vagina) from your vagina to your anus.

Once you feel you have the full core connection try this sitting & then standing making sure to integrate the pelvic floor contraction on each exhale & fully relax/release it on each inhale.

For some women, it will come as a relief knowing that all is required on the exercise front is a bit of breathing to get started but for others wanting to just get the running shoes back on & pick up where they left off, it may pose more of a frustration or perceived limitation to getting their bodies back. Understanding why we need to start with the breath is key to accepting your journey to hot mumness (technical term!) – safe in the knowledge that you’re going to reclaim (& maybe even improve on) the body you want both aesthetically & functionally without having to pee your way through a kettlebell workout because you haven’t addressed proper pelvic floor & core restoration!

So – at a glance list of ‘Why’s’:

  • Costal breath patterns (as directed above) will help take pressure away from healing abdominal & pelvic floor tissue.
  • Develops your MUCH NEEDED pelvic floor reconnection.
  • Increases your oxygenated blood to help healing abdominal & pelvic tissues.
  • Strengthens & supports your post partum abdominals, back & pelvis.
  • Helps aid valuable relaxation which in turn will help balance the hormone levels that control weight.

For more info on Pilates & women specific exercise click & follow the blog for updates!

Test Your Balance, Part 2

As a continuation of the post I did on testing your balance part 1 I wanted to add a simple continuum of exercises from easy to hard that you can practice & use to challenge your stability.

 

So as aforementioned in part 1 the goal of these balances is to test your proprioceptive balance system – that does’t mean using strategies such as bending your knees or holding your arms out high wire style…or fixing your eyes on something, it’s about testing your own internal balance system with your body in the correct (or as close to correct) standing alignment.

pilates_16cYour body uses your proprioception system to create an image of what is internal or inside the skin – in much the same way as a dolphin uses sonar or an animal uses it’s whiskers. Proprioception literally means ‘ones own perception’ & that information about change of skeletal position travels by our neurones to the brain to act on. The more muscle fibres you have firing & the more supple (not tight) the tissue, the better the proprioception.

When you practice these consider your alignment: stand with your feet hip width apart & the outside edges of your feet straight. Back your pelvis up over your heels keeping your ribs aligned over your pelvis. Then draw your head back over your spinal column. When you come on to single leg balance make sure you push down into the floor with the standing leg as opposed to hiking the low back/hip up on the non-weight bearing leg.

1. 2 foot balance eyes open
2. 2 foot balance eyes closed
3. 1 foot balance eyes open
4. 1 foot balance eyes closed
5. 1 foot balance eyes open with head turns
6. 1 foot balance eyes closed with head turns

……And Breeeeeeathe!!

Different Pilates teachers put different amounts of focus on the breath  & whilst it can add to the seemingly endless checklist of things you are trying to get right in an exercise. For me, it is key to the success of any core restoration & here’s why.

Once you understand the body’s breathing apparatus & functionality it becomes quite clear that we get an intrinsic core contraction (tensioning) with each exhale & an intrinsic expansion (or opening) with each inhale so only by harnessing this inherent bodily function will we truly get the core working optimally. Working against this pattern will help facilitate back pain, exacerbate a diastasis recti & generally leave you vulnerable to injury.

Your-Breath-Your-Core-1024x565

But as well as providing an intrinsic support system for the body, breathing correctly also helps reduce stress – controlled breathing can cause beneficial physiological changes that include:

  • lowered blood pressure & heart rate
  • reduced levels of stress hormones in the blood
  • reduced lactic acid build-up in muscle tissue
  • balanced levels of oxygen & carbon dioxide in the blood
  • improved immune system functioning
  • increased physical energy
  • increased feelings of calm & wellbeing.

Conversely when a person is under stress, their breathing pattern changes. Typically, an anxious person takes small, shallow breaths, using their shoulders rather than their diaphragm to move air in & out of their lungs. This style of breathing disrupts the balance of gases in the body. Shallow over-breathing, or hyperventilation, can prolong feelings of anxiety by making the physical symptoms of stress worse as well as facilitate adaptively shortened muscles along the neck & shoulders.

Try practising the breathing exercise described above whilst lying on your back in a quiet area – then begin to introduce some gentle core exercises as you do so & see how well incorporating the breath helps engage the whole core system.

5 Core Exercises To Practice

Regular conditioning of your core with proper muscle activation is key to maintaining good alignment & preventing back, neck & shoulder pain. This post will be a reminder for some of the exercises I teach in the classes as well as add a bit of variety for home practice.

post2First make sure you create space & time to focus on your technique – you will need to use your brain to find the right muscles (!) – predominately the co-contraction between transversus abdominis (TVA), pelvic floor & multifidus AS YOU EXHALE!

Try this technique to engage with your TVA:

Lie on your back with your spine in a neutral posture (slight curve in lower back). Take a breath in & as you exhale think about lifting your lower tummy up (not sucking in) & *gently* drawing your tummy button toward your spine – you should not feel any movement of your hips, pelvis or spine & you can feel the TVA activate by placing your fingers on the inside of your hip bones. It should feel like a deep tension not so much that it pushes your fingers away.

Try holding this contraction for 3-5 seconds & then release – breathe throughout this exercise! Repeat & hold for 3 sets of 10 repetitions 3-4 x a day.

Once you’ve mastered this you can apply it to all movements/exercises that involve any level of effort. Just remember to go with the breath pattern always exhaling on exertion to benefit from the intrinsic TVA contraction, tensioning your abdominals & lower back muscles.

So here are 5 exercises to practice whilst integrating TVA & pelvic floor activation through different planes of movement:

1. Single leg extensions: Lying with your spine in neutral (slight curve in lower back) ‘bolt’ your tailbone down as you lift knees up to 90 degree. Moving with the breath exhale as you drop one toe to the floor. Repeat, alternating legs for 10-20 x as along as you have good control with no bulging/doming abs.

2. Ball roll outs: From kneeling with shoulder ‘set’ roll forward until you feel the hips open at the front. Make sure you engage your core (as above) to keep the spine in neutral. Repeat 10-20 reps as along as you have good control with no bulging/doming abs.

3. Squats: Inhale as you go down & exhale to go up, move with the breath. Try to keep your spine neutral by untucking your pelvis an& make sure your knees don’t extend over your toes. Repeat…all day long!!

4. Knee lifts: From all 4’s with shoulder set exhale as you engage core & hover the knees. Repeat 10-20 x

5. Side Lift: Assume the position in last pic, inhale & prep core then exhale to lift the top hip up. Try to keep the supporting elbow under your shoulder (mine’s sliiiiiiiightly forward!) Repeat 10-20 x both sides.

Remember you don’t need to do specific ‘ab’ exercises – rather learn to & actually use your core muscles throughout your daily activities. Crunches will merely retard the body’s correct muscle balance.