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

 

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.

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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.

 

Grip Strength in Older Adults

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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.

Grip Strength as an Indicator of Health-Related Quality of Life in Old Age. by Musalek and Kirchengast

Photo by Jeremy Yap on Unsplash

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

Are You Sitting Comfortably?

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.

14322757_1152367408139894_4920083886017136014_n3 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.

 

Take a look back at my post on 6 Ways to Stretch at Your Desk for some ideas on how to counter desk sitting.

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.

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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.

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

Test Your ‘True’ Balance, Part 1

From time to time in class we focus on standing balance – it’s a good way to test all the principles we practice throughout the classes & as an indication of general muscle balance health. So I wanted to use this post to look at what goes on when we try to balance, how to test it & how to improve your ‘true’ balance.
So our body’s stabilise by using the relationship between the proprioceptive system (that’s information coming from the muscles, joints & tendons) & the processing of that sensory input (i.e. what the brain tells the body to do with that information). Tight or shortened muscles send ‘fixed’ information from your proprioceptors and this data/sensory input gives incorrect information to the decision centre (the brain) which in turn acts on this mis-information. The outcome is an overcorrection, a wobble or lurching movement in an attempt to stabilise you. Any restrictions or sub optimal muscle length tension will alter the correct information given to the brain.

Testing your ‘true’ balance – See how well you’re balancing with these simple tests.

pilates_16dStand with your feet pelvis width apart & check your feet are straight (as in the outside edges, see pic) – how does this feel? Any wobbles? Now close your eyes & see if there’s any difference with them open or closed. Maybe you felt you moved about more with your eyes closed – this is the ‘true’ part of the balance test – your eyes are not part of the sensory input we speak about when we mean whole-body balance, they are not part of the proprioceptive system they are part of the vestibular system (eyes & inner ears) but the poorer your proprioceptive system is the more you rely on your eyes to make corrections. So in order to stop the eyes doing all the work (& incurring eye muscle fatigue, dizziness & age-related changes in vision) you need to fix your body’s internal sensory input or proprioceptive system.

The progression to the 2 foot balance with eyes shut is to come onto a single leg with eyes shut. Whilst we may have some muscle tension issues within the body it’s also our inability to process information through our feet & inform our bodies of correct posture, due to footwear that down trains our proprioceptive system. Think any type of heel, thick inflexible soles & too narrow toe boxes.

So hopefully this will give you a clearer idea of what you are aiming for when you consider/assess your balance – test yours & practice some ‘eyes shut’ standing to monitor your progress.

How To Lift Properly

I’ve adapted this from a list included in Isa Herrera’s book ‘Ending Pain in Pregnancy’ (a must read if you’re expecting!) even if you’re not pregnant you can be sure that following advice given to a demographic with arguably the most compromised core system out there has to result in the gold standard in lifting advice!!

  • Bring the load/Object Close: Bring your body as close to the load/object you are about to lift as possible. This will prevent you reaching too far forward to grab the object, placing increased stress on the low back. You want the object almost directly underneath your body before you lift it.
  • Wide base of support: You want a wide base of support when you lift objects to improve your balance & allow you to reach the object without straining the back or legs. Widen your stance & try to keep your toes out, as if you are about to straddle the object.
  • Squat down & bend your knees: To reach the object, you will need to squat down by bending your knees. The most important aspect of squatting down is maintaining a flat back with a slight lumbar curve or arch. This is what helps the jelly in the vertebra stay centred, placing less stress on the intervertebral discs.
  • Keep the load close: When you grasp the object, bring the load as close into your body & stand up with your back remaining straight up & down.
  • Take steps, do not rotate: Do not rotate, or twist your trunk to place the object on a different surface. Instead, take small steps with your legs to reposition your body. Set the object down using the same principles.

Remember, proper body mechanics take time but by mastering these steps you’ll prevent aggravating existing problems & reduce risk of future injury.