I have 3 finger diastasis width, what am I supposed to do?

Is there treatment for Diastasis Recti??

Simple Answer…YES

First off, the width of your diastasis recti is not the ONLY component that should be addressed. Don’t freak out if someone tells you that you have a 3 finger separation.  There is HOPE! It is normal to have some diastasis recti during the 3^rd trimester of pregnancy and for 6-12 weeks after pregnancy because your rectus abdominus muscle must separate in order for the belly to expand to make room for a growing baby.  The problem occurs when women do nothing to protect the healing process, they stress it more by doing particular movements too soon, they never retrain their core, pelvic floor, and posterior chain correctly, or there were imbalances present prior to pregnancy that could have contributed to the current issues. It is also important to recognize that during pregnancy we need to be smart with our training to not overload the rectus abdominus and pelvic floor and modify movements appropriately.

Trained health professionals, especially pelvic floor physical therapists, can be trained to assess width, depth, breathing, core control, the posterior chain, pelvic floor coordination AND load transfer testing.  We should check basics but BUILD on them.  A health care professional that knows how to treat diastasis recti SHOULD be looking at all of these components.

So what matters most?

All matter because they all are linked together. How you stand and sit aka posture all affect how your diastasis recti can heal or not heal. Your shoulder, ribs, hips and back positioning all affect your core and your pelvic floor. If you have a muscular imbalance in any of these places, it can create abnormal stress on the trying to heal diastasis recti. For example, a rib flare can create more tension on the abdominal muscles, low back and shoulder. Or a hip that is “tighter” than another can causing more pulling through the core muscles and back if the person is a runner and they do not have equal hip extension motion.  Even walking can place more stress on a DR if a patient has poor coordination and body awareness.

So what are some ways to protect the diastasis recti or help with healing?

–          Retrain OR learn how to engage your whole core including lower core including transverse abdominus, obliques and understand when you are using a rectus dominant pattern

–          Strengthening all the muscles of the core starting with gentle movements showing you can control basics and build on it

–          Typically no full sit ups right away (you can eventually get back to these) or planks but it depends on the patient. I have some patients I allow to do these earlier or immediately with assistance because they actually can engage everything correctly and they are not bearing down or out and they can control the #coning.

–          Strengthening everything around the core

–          Make sure you are breathing correctly

–          Correct poor posture

–          Not jumping back into front loaded exercises like push ups, planks, ski erg, pulls ups, toes to bar, or muscle ups too quickly or without being assessed first

–          Correcting baby holding mechanics

–          Understanding how to contract and relax core through various movements including rotational movements, dumbbell and barbell movements

–          Having a pelvic floor physical therapist that understands and treats diastasis recti help evaluate you, find the source or cause of non healing diastasis recti and guide you along the way to recovery.

– Work with a trained professional during your pregnancy to prevent overloading the rectus and worsening diastasis postpartum.

Just understand it is not the end of the world if you have some “separation” and lots of other assessments should be performed before you freak out OR go back to particular movements too quickly if you are unsure. Don’t be scared to move or fear all these movements.

Seek correct and proper guidance to get you back to doing what you love.

Got more questions?  We love helping our pregnant and postpartum athletes train smart before, during and after pregnancy. Call or text to schedule an appointment.  980-221-9687

photo credit: http://www.vibrant-photography.com/

#diastasis #diastasisrecti #postpartum #postpartumcare #postpartumfitness #crossfit #burnbootcamp #postnatalfitness #fitmoms #momfitness #postnatalcare #pelvichealth

Accessory work

AmazonBasics Cast Iron Kettlebell, 35 lb

What is accessory work? and why is it important?
Accessory work in summary is the small, tedious movements that most athletes do not like to take the time to do but are extremely important for complex movements. Online definitions in the athletic world suggest that accessory work is defined as exercises that compliment larger, more complex movements like a squat.

Within the therapy world accessory work means a couple different things including “accessory movement” which relates to the specific joint mechanics and also accessory exercises that compliment the larger movements as well. I often call accessory work also “prehab”

Why is it important?

It is important to “activate”/ warm up the muscle tissues correctly before you work out. I use the term activate in quotes because the muscles are only truly fully inactive in someone with a spinal cord injury or neurological damage. So really with are warming up the specific muscles and increasing blood flow to them.

It’s not just about everything feeling “warm” but your about your brain connecting with the specific muscles you are asking to work through movements. It’s about creating more neural pathways to those muscles to help you better recruit them.

The accessory work along with prehab exercises can be done on days of working out as well as on days of rest depending on how heavy you are doing loaded accessory work.

For example, your program might call for accessory work of single arm dumbbell overhead press building to heavier weight. As a Physical Therapist, I break that down even more for someone with hx of or current elbow pain and they might do light weight skull crushers to “activate” the tricep muscle as prehab/accessory work before the heavier accessory work.

For the lower body, a great “accessory exercise” is doing single leg deadlifts to improve blood flow to the hamstrings and glutes while the brain is connecting with these muscles knowing it should utilize them more when doing squats or deadlifts. This also helps improve motor control and balance. You could also do them heavier to build strength as well.

The goal is that your choice of exercise compliments your other movements planned.

Train Smarter. Train specific

If you want to HEAR me talk a little bit about this. Head over to the Ultimate Athlete Podcast. Straight about it. Episode 10. “Train Smart and avoid injuries”

https://itunes.apple.com/us/podcast/straightboutit/id1438020494?mt=2

#trainsmart #athletes #ultimateathlete #dpt #sleep #accessorywork #recovery #singlelegdeadlifts #RDL #SLDL #prehab #kettlebellwork

Postpartum Restrictions…What should I do and not do Dr. Jenn??

I have so many questions about postpartum rehab and postpartum care from patients, friends, family members, acquaintances, personal trainers, Instagram and facebook followers and the list goes on. I wish I could say it’s clear cut A, B, C but it’s not. Everyone is different. Every woman’s delivery is different as well as her health and fitness and strength levels are prior to pregnancy and during no matter what sports area they are in. Genetics play a factor as well, as do prior birth histories, and other medical histories including a person’s pelvic health even prior to pregnancy. Really?? That matters prior to pregnancy..YEP.

The best tool for EACH PERSON is individualized care including individualized evaluation from and Pelvic Floor Physical Therapist that includes a thorough history on past medical information. I am very bias in that I think it is crucial that the pelvic floor therapist is active herself and understands physical activity and fitness as well to truly understand the patient and the demands they place on their body. I truly believe every woman should have at least one pelvic floor Physical Therapy Evaluation from a licensed Physical Therapist whether you are postpartum or not. It just gives a woman so much information on how this area, that has 5 huge daily functions, should be working and coordinated and communicating properly do the brain.

One of the BEST things a pregnant or woman thinking about becoming pregnant can do, is see and pelvic floor PT. It can help you understand how your pelvic floor is currently functioning but also ways to help you with safety during your pregnancy, modifications for your workout routine, preparation for your delivery as well as immediate plans for you to do as soon as you return home with a brand new baby for those 1^st 6 weeks until cleared by MD to return to the pelvic floor physical therapist. It is then, she can guide you even more specifically for YOUR needs, goals and recovery based on your findings postpartum and the affects your pregnancy had on your body. Everyone can be similar in some ways, but also very different in others.

Depending on a patient’s pelvic floor strength, core strength pain, hip strength, knee strength, back strength, awareness, posture, weaknesses as well as their degree of ab separation (diastasis recti) , their plan and full return to physical activity WILL ALL look a little different.

However, I will share some general guidelines and restrictions for those active women that want to get back to doing everything they love ASAP. What you need to understand and I must highlight is the importance of proper tissue healing and why these restrictions should be in place. There is ALWAYS a reason.  Pregnancy places a lot of stress on the human body in many ways unlike other events or injuries. On top of that, a childbirth is a traumatic event in so many ways that deeply affects the nerves, muscles, ligaments, and fascia in and around the pelvic floor. The muscles, nervous tissue, and connective tissue can all be damaged which changes the sensation, support and stability of the pelvis. Ligament laxity is also present still when a woman is breastfeeding. When stability is lost, more stress is placed in other areas including down on the pelvic floor increasing risk for prolapse, pelvic floor dysfunction, low back pain, hip pain, groin pain and even neck pain.

In general muscle tissue strains can take 3 weeks to 6 months and ligamentous strains (depending on the grade) take 3 weeks to 1 year (if a grade 3 strain) in order to heal so a lot of postpartum restrictions are most limited in the first 3-4 MONTHS with GRADUAL return to be safe, careful and allow the tissues time to heal. To be safe, gradual return should occur with test and retesting for the first 6 months at a minimum. I say 3-4 months meaning at that marker a woman could try a 200 meter run for example and see how she feels the next day. It also does not mean at 3-4 months the woman should now go as hard as she would like in a workout like she was before she was pregnant and go run 4 miles.  These first 6 months should be focused more on strengthening, mobility and correcting posture with a gradual return in the 3-6 month window up to a year depending on pelvic floor strength, diagnosis or prolapse or nerve injury.

Exercises I recommend NOT to do before 2 months postpartum:

-running

-jumping

-includes box jumps, jumping rope, jumping jacks..ANY jumping

-kipping or butterfly pull ups

-sit ups

-GHD sit ups

-ski erg- wait at least 4-6 weeks possibly more especially if prolapse symptoms

-kipping Handstand push ups

-toes to bar

-heavy lifting

-front planks (depending on the patient)

-handstand push ups without controlled descent

-snatches

-muscle ups

-tumbling

Please understand this list is not all inclusive and each person may have greater restrictions.

Be safe. Train Smart. It will be worth it

-Dr. Jenn

#postpartumfitnesss #postpartumrecovery #diastasisrecti #postpartumrestrictions #postpartumrehab #pelvicfloor #pelvicfloorPT #PFPT #concord #charlotte

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279110/

https://www.sciencedirect.com/science/article/pii/S0161475410001211