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.

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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

 

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.

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  • 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!

……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.

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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.

 

Pelvic Floor Exercise Progressions

You may need to strengthen your pelvic floor as part of some injury rehab, as part of your post partum recovery or for continence problems – one of the best ways to begin the road to recovery & full core restoration is by doing Kegels but how do we progress from there?

First let’s look at why the pelvic floor plays such an important role in our core restoration. Strengthening your pelvic floor will underpin any fitness goals you have, be they running, fat loss or just daily life. It’s worth noting that 48% of primiparous women & 85% of multiparous women experience some degree of incontinence also worth noting is that incontinence is the second most common reason after dementia for admission into assisted living. So pelvic floor exercise is crucial!

Initially & in fact after any injury the first place to start rehabbing a muscle is by being able to isolate the area in the first place. If your brain can’t access the neural pathway then moving on to a more complex movement will retard healing. So this is where a traditional Kegel (think, stopping flow of urine) is very helpful, a basic switching on & switching off of the muscle. Doing this will also help promote blood flow to the healing tissues & therefore aid the restoration process. If you find you can’t feel anything or you’re at all concerned get a proper exam by a women’s health physio who will be able to tell what’s going on.

This protocol will work well for that initial 6 week period post partum – you should feel the muscles getting stronger & easier to contract. Make sure you fully relax the pelvic floor between contractions as having a hypertonic or too tight muscle isn’t helpful either! Use your breath & visualisations to help you maximise the connection – so as you exhale, squeeze, as you inhale, relax. You can see from the diagram above how the pelvic floor muscles lie across the bottom of the pelvic cavities & this should give you an idea of what you are trying to access & also how important it is to have some muscle tension supporting the bladder, vagina & bowel.

Progress it by using pelvic floor activation as you lift & move, this is a key part of your on-going restoration. If you can protect the pelvic organs using the pelvic floor muscles as you add load (baby, laundry, you, buggies etc) you will prevent that added intra-abdominal pressure causing further stress on the pelvic floor leaving yourself vulnerable to pelvic organ prolapse or stress incontinence. This in turn will further strengthen the muscle’s function.

Note: Whilst I’m fully aware that men have pelvic floors too (!) this article is geared more toward women – hence the references to wombs & vaginas etc!