Category: Disastasis Rectus

5 Exercises to Move Better During Pregnancy

Featured ~ jesspreale ~ Leave a comment

Yesterday afternoon, I met my team of pelvic PTs at at the office for some photo and video time. Our model? Dr. Kellie, who is about to have her last week with us in the clinic before leaving on maternity leave for her second daughter. You see, working at a pelvic PT practice, we have to take advantage of one of our own being pregnant! How could we miss an opportunity to record videos and take pictures to expand our library! 🙂

Movement during pregnancy is incredibly useful. First, it can help with many of the aches and pains that commonly develop. It helps to keep your muscles active, and ultimately, can help prepare you for the process of labor and birth. We wrote a while back on healthy exercise during pregnancy, so start there if you want to know where you should get started for movement.

Today, I wanted to focus on movement to help you feel better. These exercises promote gentle movement around your spine and pelvis and activation of the muscles around your deep core.

Cat-Cow

Goal: Improve mobility around your spine and pelvis. Coordinate movement with breathing.

  1. Inhale slowly, and as you do, gently let your tailbone out, and lift your head

Try not to allow your back to dip super far down but stay within a comfortable range.

2. Exhale and gently tuck your head, lifting your belly up and rounding your spine, allowing your tailbone to tuck.

3. Repeat this flowing gently with your breath as you inhale and exhale

Aim to do this 10-15 times in a row, alternating with the modified child’s pose that is described below.

Modified Child’s Pose

Goal: Lengthen lower back, gluteal muscles, pelvic floor, and inner thighs. Encourages relaxation and opening around the pelvis.

This exercise works really nice to alternate between sets of the Cat-Cow.

  1. First, place pillows in front of you, leaving a gap for your belly. You can use 1-3 pillows, depending on your belly size.
  2. Sit back on your heels, and open your knees to a comfortable width.
  3. Lean over the pillow, allowing your body to relax and reaching your arms forward. Let your head rest to one side or the other.
  4. Relax in this position for 1-2 minutes.

Ball Pelvic Mobility

Goal: Improve the movement around your pelvis and spine

  1. Sit comfortably on an exercise ball with your feet supported on the floor
  2. Inhale, letting your pelvis out, allowing a small arch in your back
  3. Exhale, tucking your pelvis under gently pulling your belly in.
  4. Repeat this to warm-up x 10
  5. Then, add a rotation, inhaling and rotating clockwise with your pelvis until you reach the arched back position. Then exhale, continuing to rotate clockwise until you reach the tucked position.
  6. Repeat this x 5-10 repetitions, then switch to counter-clockwise.

Bird-Dog Progression

Goal: Activate your deep abdominals and pelvic floor muscles paired with your breath.

  1. Begin in a hands and knees position with your spine in a neutral position (not flexed or arched)
  2. Inhale to prepare, exhale and gently engage your pelvic floor muscles while gently drawing in your belly. Aim for a slight contraction (not hard!).
  3. While you do this, extend one arm in front of you.
  4. Exhale, lowering your arm and relaxing your muscles.
  5. Repeat, alternating lifting with your opposite arm. Be sure to keep your spine in a comfortable position while you are doing this exercise. Repeat this movement for 10-15 repetitions.
  6. To progress this exercise, you can also perform with an alternating leg movement, aiming to keep your spine in a neutral position.

Wall Squats

Goal: Coordinate movement with breath, activate pelvic floor with gluteal muscles

  1. Place a ball behind your back and lean against a wall. Keep your feet placed out in front of you, flat on the floor.
  2. Inhale while you bend your knees and lower.
  3. Exhale, engage your pelvic floor muscles slightly, and lift up to standing.
  4. Repeat this exercise for 10-15 repetitions, performing 2-3 sets.

Note: While doing this, keep your feet far enough in front of you that your knees don’t cross your feet.

I hope you’ve enjoyed these exercises! What exercises do you like to do to move well during pregnancy? Any favorites we need to add?

Look for more coming from us on all of this in the future!

Mother’s Day Specials!! My gift to YOU!

~ jesspreale ~ Leave a comment

Good morning friends,

With Mother’s Day around the corner, we’ve been wanting to give back and help out the mothers in our community (around the country…around the world!) who are struggling in this interesting new normal. Figuring out managing caring for children, homeschooling, work/family obligations, all while trying to keep their families safe, sane, engaged. Let’s be honest, being a mom is the hardest, but most rewarding job ever!

To celebrate our mamas everywhere, we have a few discounted specials to roll out to you!

50% off first Virtual Pelvic Floor Consultation

Mother's Day Sale-2

First, we are offering 50% off a virtual pelvic health consultation  with one of our incredible pelvic floor specialists. Honestly, we’ve never discounted our services before, but I just felt like this was the right thing to do. So, for $97 you (or the mama you gift this to!) can receive a 55-minute virtual consultation. If you live in Georgia, this will be a pelvic floor physical therapy evaluation. If you don’t, our license won’t let us provide you with physical therapy, but we can still offer you a virtual coaching consultation.  So, if you’re struggling with any pelvic health problem– constipation? pain with sex? bladder leaks?– or if you need help recovering after children, getting back to exercise, or preventing problems in the future– this deal is perfect for you! Don’t miss out on this opportunity!!

20% Off Online Classes

Copy of Copy of Copy of Copy of Copy of Copy of Copy of Black Friday (1)

Along with this, we are offering 20% off our on-demand classes via the Southern Pelvic Health x The Vagina Whisperer partnership! Each of these classes is 90-minutes and covers SO much information, with great bonuses included! Classes are normally $39 each, so this is a nice discount to get some solid information!! (Gift idea: Consider a birth package for that pregnant mama in your life! Combine our birth prep class with a posptartum recovery class so that new mom has all she needs to rock her birth and after!) Be sure to use promo code MOM20 at checkout! 

These specials are only available through Monday May 11, so don’t delay!

Happy Mother’s Day!

~Jessica

Diastasis Rectus Abdominis (Part 2): How can you help it?

~ jesspreale ~ 2 Comments

2 weeks ago, we chatted about what exactly is a diastasis rectus abdominus (DRA) and how to check to see if you have one. Today, we’re going to talk about how pelvic floor physical therapists evaluate a person with DRA, and what can be done to improve this. If you are struggling with support at your belly, I also hope you will join us for our upcoming LIVE class focused on this exact topic! Sara Reardon and I invited Sarah Duvall, an incredible expert, to join us for a 90-minute class on Diastasis Recti Rehabilitation. We took a lot of time to plan out this content, and I have to tell you all– this class is going to rock! The LIVE event is coming up Sunday May 3rd at 3pm EST, and it will be available after as a recording. We have a lot of great bonuses also– including handouts on exercises to get started and a lot more! Registration for the LIVE class is limited, so don’t wait to sign-up!

As we discussed previously, DRA involves an increased gap between the two bellies of the rectus abdominis muscle and a loss of support at the abdomen. Often times, people experiencing this will feel like they don’t have as much control or stability at their belly, and they may feel a bulging at their belly (some will even feel like they look pregnant when they aren’t!) We also discussed how to check to see if you do have a DRA. Now, let’s talk about how we approach making this better.

Your first visit 

When we first evaluate someone with a DRA, we always make sure we get a complete history of the problems and challenges they are experiencing. This includes discussing any pregnancies/births (if applicable), their pelvic health (yep– bladder, bowel and sexual function), musculoskeletal challenges, medical problems, and their fitness preferences and routines. Then, we discuss their diastasis and what is bothersome to them. Is it primarily the appearance or the knowledge that it is there? Are they also struggling with back pain or pelvic organ prolapse or other problems? Does their diastasis limit their ability to exercise or lift their children? Our goal here is to really have a complete picture on the challenges they are facing.

The exam

Next, we move into an examination. This can include many different parts. As a diastasis is a pressure system problem, we want to look at everything that could impact the system. This could include:

  • Movement patterns
  • Spinal mobility
  • Preferred postures/positions
  • Ribcage movement
  • Breathing patterns
  • Pelvic floor function (yep, sometimes people with DRA benefit significantly from a specific pelvic floor exam if they’re on board with it!)
  • Scar tissue mobility
  • Myofascial mobility at the abdomen and the back
  • Abdominal, hip, and pelvic motor control/strength

Each of these components can actually influence how much pressure is at the linea alba (between the two bellies of the rectus abdominis) and the control at the abdomen. If someone has decreased movement around their spine and ribcage, this can impact the fascia around the abdomen and contribute to widening at their midline. If they have less optimal breathing patterns, this could be funneling pressure where we don’t want it to go, instead of spreading the pressure out across the trunk and sharing the load.

Once we do a comprehensive evaluation, we develop a treatment plan to address the problems we found. This typically includes:

  • Improving global movement patterns
  • Improving breathing patterns (both in static postures and during movements/activities)
  • Restoring mobility and improving sensitivity at muscles and soft tissues (including scars)
  • Optimizing the pressure system
  • Retraining the abdominal wall

I want to talk a little bit more about how we can optimize the pressure system and retrain the abdominal wall.

Optimizing the pressure system

When improving DRA, it’s very important to keep the pressure system in mind. Pressure at the abdomen and pelvis depends on coordination of several muscles that work together in synergy. This includes the glottis, intercostal muscles, respiratory diaphragm, transverse abdominis, lumbar multifidis and the pelvic floor muscles. Mary Massery (who has contributed SO much to our understanding of these pieces) created an analogy of a soda pop can.

can-307312_1280

In this analogy, the glottal folds are at the top, the pelvic floor muscles at the bottom, and the respiratory diaphragm in the middle. The intercostals, lumbar multifidus, and transverse abdominis are around the can. So, basically, these structures together work together to keep pressure spread out, leading to a strong and functional core. In the soda pop can example, the thin aluminum is pressurized on all sides, leading to a strong can that is difficult to break (Of course, this changes if the can is open or has a hole in it!)

So, in the case of a diastasis rectus, the pressure system is often not working optimally. Basically, pressure in many cases is funneled toward the belly, instead of being spread to all the structures, and this can contribute to gapping, bulging and a loss of support.

So, from a treatment standpoint, our goal becomes to optimize this system. We get to play detective and find out which of these structures are working well, and which need some assistance to do their job optimally. Then, we retrain this system, focusing on the natural synergy that should be present. When this is done well, we help the body learn to spread the load, decrease the funneling of pressure to the belly (or elsewhere) and thus, we improve what the person is experiencing at their abdomen.

Retraining the abdominal wall

After we improve the pressure system, we need to retrain all of the muscles in the abdominal wall. This further helps to improve the pressure system, but it also can assist in stimulating the fascia in the abdomen. Often times, retraining the abdomen starts by building the pressure system base like we discussed up above. This base– the pelvic floor- diaphragm- transverse abdominis- lumbar multifidus- base– is the key to what else we need to do to improve function at the abdomen. The transverse abdominis is particularly important. This muscle helps to tension the linea alba, which improves force transfer through this structure.

Next, we use breathing and awareness of muscles to retrain these muscles in a variety of movements, postures, and exercises. This can start as a simple progression– learning to activate these muscles while breathing and lifting an arm, then lifting a leg– and progressing from there.

We also teach self-awareness of the abdomen. So, this helps you identify how you manage pressure in your abdomen, and this is very important in making sure you are challenging your system, while still being able to control pressure (and not allow the pressure to funnel in your belly and produce coning and doming). As we progress in exercises, we ultimately want to retrain this system within the rest of the muscles in the abdomen, and this is fun, because we can be very creative and often help people progress toward things they did not think would be possible for them. So, can someone struggling with a diastasis eventually do planks? sit-ups? Abdominal crunches? What about pilates? Yoga? Barre classes? Most of the time, we can work together to help you reach the goals you want to reach. I really believe there are not “bad” exercises, but the key thing is determining the readiness of the person to do the exercise well, and ensuring that they can modulate pressure while doing the movement.

So, if you’re struggling with your belly…

Know, that there is hope. There is so much we can do to help restore stability at the abdomen and improve the way you move and transfer force through your belly. Come and join our upcoming class (or get the on-demand recording if you’re reading this later!) If you’re struggling, there can really be so much value to being evaluated by a pelvic health provider in person. So reach out! And if you need help finding a pelvic PT, check out this prior blog post to help you!

As always, reach out if you have questions!

~ Jessica

Diastasis Rectus Abdominis (Part 1): What is it? Do you have it?

~ jesspreale ~ Leave a comment

If you’ve been pregnant before, you know the feeling of going out and having everyone comment on your beautiful belly. Of course, we all get the occasional, “wow, are you sure you’re not having twins?” “When are you due? You’re not going to make it there!” (And can we collectively just tell those people to leave us alone!!) BUT, the majority of the comments are, “you look amazing!” “Wow, she is really growing!” “How are you feeling? Congratulations on your baby!” Honestly, my own body self confidence was at a high during pregnancy.  But then, our sweet little love muffins are born. And society expects us to very quickly bounce back to our pre-baby state (and I have so many thoughts on that…because we just went through this transformative, incredible experience, that took nearly 10 months to build! And often times mamas are left alone to figure things out after birth).

As an aside, this was one of the BIG reasons that my friend and colleague, Sara Reardon, and I decided to partner together to create live & on-demand classes! We recognized that soooo many people are struggling with pelvic health problems. While individualized pelvic PT is so beneficial, it’s not always possible for people at the time they need it. For one…ummm…coronavirus/social distancing. But also, some people prefer trying to learn and work independently, may feel too nervous to discuss their problems with a provider, or may have a schedule/time constraints/financial constraints/geographical constraints that just don’t allow individualized care at the time they are wanting it. SO, these are our classes. We have 2 LIVE postpartum classes coming up– TOMORROW 4/14 is our “Postpartum Recovery After a Vaginal Birth” Class, and the following Wednesday 4/22 is our “Postpartum Recovery After a Cesarean Birth” Class (SO excited about this one as a mama of 2 Cesarean babies!). These classes are built for the consumer—BUT, if you are a health care provider, I can guarantee that you’ll learn a bunch also! We sold out before the start of our “Pelvic Floor Prep for Birth” class, so if you’re on the fence, register soon and reserve your spot!

Anyways…back to our topic at hand: Diastasis Rectus Abdominis.

The abdominal wall is stretched during pregnancy to accommodate the sweet growing munchkin, and in some cases (most cases, according to some research!), this leads to a stretching at a structure called the linea alba- the connection between the two sides of the rectus abdominis or “6-pack” muscle group. When this becomes larger than about 2 fingers in width, it is known as diastasis rectus abdominis (DRA). This is what it looks like:

Ultrasonography_of_diastasis_recti
Mikael Häggström, M.D. – CC0, obtained via Wikimedia Commons

The two “+” marks indicate each side of the lines alba, and you can see that it is wider than it likely was previously. Note, this is an ultrasound image of a 38 year old mom who had diastasis after her pregnancy. DRA is different than a hernia. When a hernia occurs, there is a defect that allows an organ or tissue to protrude through the muscle/tissue that normally contains it. So, someone could have a DRA and not a hernia. Or, they could have a DRA and a hernia. Make sense?

Diastasis rectus abdominis is common during and after pregnancy, and varies in severity. For some moms, they may not really realize it’s even there. Others may feel a complete lack of support at their belly, notice a bulge, or even worry that they still look pregnant.  A recent study published in 2016 found that among 300 women who were pregnant and gave birth, 33.1% had a DRA at 21 weeks gestation. At 6 weeks postpartum, 60.0% had a DRA. This decreased to 45.4% at 6 months postpartum and 32.6% at 12 months postpartum. So, basically, many pregnant folk get this, and while for some it gradually improves over time, for others it can persist.

The link between DRA and musculoskeletal dysfunction is not confirmed. A recent systematic review published in 2019 found “weak evidence that DRAM presence may be associated with pelvic organ prolapse, and DRAM severity with impaired health-related quality of life, impaired abdominal muscle strength and low back pain severity.” This makes a lot of sense to me. Conditions like pelvic organ prolapse and low back pain are complicated, but in some cases do have components related to pressure management. The abdominal wall is very crucial in helping to modulate intraabdominal pressure, so it makes sense that when it is not functioning optimally, a person could struggle with managing pressure well.

The intra-abdominal pressure system involves coordination between the respiratory diaphragm, low back muscles, transverse abdominis, and pelvic floor muscles. These muscles need to work together to control pressures through to abdomen and pelvis and create dynamic postural stability. When the abdominal wall has a loss of support, this system can be impacted and contribute to pressure problems like prolapse and low back pain. However, those diagnoses are complicated. There are many other factors involved (like connective tissue support, amongst other things), so this is why a comprehensive examination is often very beneficial. This is also why not everyone who has DRA has pain.

I think it’s important to note here, that for some people, their DRA may not be contributing to things like back pain or prolapse, but it may still be a huge problem for them. People can feel guilty about caring about the cosmetic component involved in some instances of DRA…you know…the pooch. But, you know what– if this matters to you, then it matters! Feeling confident and strong is so important! So, don’t let anyone tell you what is or isn’t important for you to care about!

So, how do you find out if you have a diastasis?

The best thing to do if this is sounding like you is to see a pelvic PT to be evaluated comprehensively. There are many different things that can contribute to a loss of support at the abdomen, so looking at the complete picture is the best option. We’re going to talk about some of those pieces and how we as pelvic PTs evaluate DRA in Part 2 of this blog series. However, there are ways you can examine yourself and find out if you have a diastasis rectus. First, lie down on your back with your knees bent.

IMG_9612
In this image, my two fingers are at my belly button, and my other hand is over the top, reinforcing what I feel.

 

Start by placing two of your fingers at your belly button. Next, lift your head and your shoulders up (like doing an abdominal crunch) and sink your fingers in, gently moving them back and forth to feel the sides of your rectus abdominis. Notice if your fingers sink in, and if you feel a gap between your muscles. Repeat this a few inches above your belly button, and again a few inches below your belly button. Also notice how you feel as you do this– do you feel tension at your fingers? Do your muscles feel strong? When you lift up, are your fingers pushed out or do they sink in? What do you notice? (This is great information for you to understand how much force you can generate through your “gap” and will be important as we start discussing how we treat this!)

How can you help a diastasis?

Well, the good news is that there is so much we can do to help improve diastasis, make your belly stronger, and help you feel better.  In part two of this series, we’ll discuss the ways pelvic PTs can best evaluate someone who has a diastasis, and the methodology we use to treat this problem. The method of treating this has changed over time, so I’m going to give you my best understanding of the research as it’s available today! Stay tuned to learn more!

Stay healthy during this time my friends– and wash your hands!

~ Jessica