I have been teaching people to use their pelvic floor properly for years now, and the research shows us that doing our kegels is probably necessary to maintain the health of our pelvic floor.  But in the back of my mind I have always wondered WHY the human body should have to “train” a muscle that is so fundamental to everything we do. To explore this idea more, let’s start with some facts.

Pelvic Floor facts and stats

But in people with back pain or women with incontinence[i], this anticipatory timing appears to be backwards, and the core muscles only switch on after the arm muscle has moved. So the “core” muscles in these populations have adopted different activation patterns that may not actually stabilise the spine.  Which could be why 78% of women with low back pain also report urinary incontinence.[ii]  Or why balance tasks requiring "core stability" are more difficult in women experiencing incontinence versus continent women.[iii]

Incontinence rates in our female population have been shown to be anywhere up to 50%.  In the adolescent years 12% of females struggle with continence issues[iv], and it appears to get worse with age.  Pregnancy and vaginal delivery are both risk factors for incontinence, as is the amount of children a woman has. Pelvic floor changes take place during pregnancy[v], most likely due to increases in Intra-Abdominal Pressure with a growing baby as well as the hormone relaxin creating looser connective tissue.

This muscle group obviously goes through a lot of stress and strain during the baby-growing and baby delivering stages, but is the pregnancy at fault or is it the “straw that breaks the camels back” so to speak?  I often wonder if the way we are rehabilitated post-birth and the habits we adopt throughout our lives are more of an issue than the actual birthing process.  Because our bodies are meant to do this crazy child producing thing, right? 

One study found that 25% of women struggle with continence immediately post-birth, but 49% of women report continence issues 7 years post birth[vi].  To quote Physiotherapist Diane Lee:

“It is apparent that for some women, something happens during pregnancy and delivery that impacts the function of the abdominal canister either immediately, or over time”[vii]

For me it was definitely over time.  I was very happy with my pelvic floor function at 6 weeks postpartum, but it was a different story after a year of carrying a child that continued to gain weight and get more difficult to hold.  I’m sure that a combination of funky postures and carrying positions, not allowing enough time to work on myself, and "hormonal stuff" with pregnancy and breastfeeding all played a part, but my pelvic floor was getting weaker by the month. 

This led me into this line of researching and questioning…if it’s not actually the birth that directly affects the pelvic floor what is it? And what can we do to fix it and/or prevent it from happening? 

Well that’s easy, Kegel of course!  Come on everyone knows that!

What is a Kegel and do they work?

Dr. Arnold Kegel came up with a way to exercise the pelvic floor in the 1940s in hopes of giving women a non-surgical way to improve pelvic floor function. A kegel is basically just a pelvic floor contraction (think lift and close), which many describe as the “stop urinating mid-stream” contraction (if you want a great visual check out this video).  Kegels are meant to be a type of resistance exercise where you learn to contract and relax the muscle group, increasing the ability to control the muscle group (better motor patterns) and eventually increasing the strength and tone of the muscle.  Theoretically this should lead to better bladder/bowel control and prevent Pelvic Organ Prolapse (POP), which is where your organs basically drop into the pelvis due to weakness of the muscle, ligaments and connective tissue.  Pelvic Floor Muscle Training (PFMT) is still seen as the first-line defense against Urinary Incontinence and is the primary tool used to treat the condition.

I would always recommend that women see a professional when starting a pelvic floor exercise program, as a recent study showed that almost 60% of women with incontinence and/or prolapse were actually doing their pelvic floor exercise wrong[viii]; which at best would be a waste of time, and at worst could be detrimental by creating bad habits and bearing down (weakening) the pelvic floor.  If you are unsure about your ability to properly contract your pelvic floor or just want to double check that you are doing it correctly, please go and see a physiotherapist trained in Real Time Ultrasound (Women’s Health Physiotherapists are fantastic).  I think a pelvic floor check-up with your physiotherapist 6-10 weeks postpartum should be a mandatory part of postnatal care...so let’s spread the word!

So do Kegels work?

A big review study in 2015 looked at all the studies using PFMT and whether they made a difference in continence rates if used preventatively (during pregnancy) or as treatment (after birth)[ix].  Depending on the situation, the person and the program, yes, these exercises seem to make a difference. In a supervised program lasting at least 8 weeks with “strength training principles”, these exercises are shown to have a preventative effect and can be an effective treatment for incontinence[ix].

Now looking critically at many of these studies I notice two things;  the first is that the majority of people do not exercise their pelvic floor exercises under these research conditions (supervised, lasting at least 8 weeks, etc).  The second is that most studies are looking at short term effect of PFMT.  Yes these people get better after doing the exercises, but what happens when we stop doing our kegels because we feel better?  The problem most often comes back.  This is where most health professionals tell you it’s a “use it or lose it” muscle and you need to keep up your kegel training.  But I think this is where we have stopped looking at the bigger picture. 

Don’t get me wrong, I think kegels can be a great starting point for a rehabilitation program, I do them and recommend them to most clients.  So please don't give up your kegels yet, especially if they were prescribed to you for continence and/or back pain.  But pelvic floor exercise alone just doesn’t cut it when rehabilitating such an integral part of the body.

Here’s why:

1.     We need to look at the bigger picture of the whole person:
A person with a pelvic floor problem does not just have a pelvic floor problem!  Remember the "foot bone is connected to the..." song? 

If a client came in to see me with knee pain I might start by asking them to squeeze their quad muscles to make sure they have the motor pattern to actively contract the muscle group.  But then I would look at their pelvic stability (core), femur rotation (glutes), and foot mobility among other things, and put it all together in functional exercises.  I would also look for patterns, habits, and tightness in the body that may have caused the knee pain in the first place. 

That is the norm for knee rehab.  Why is it not the norm for pelvic rehab?  Pelvic floor strength is great, but without the strength and alignment of the muscles holding the pelvis and sacrum in place, how can you expect it to stick? We need to start looking outside of the box and treat the pelvic floor as part of a functional WHOLE body.

2.     Different people have different issues with the pelvic floor: 
Remember that many people have a weak pelvic floor because their pelvic floor is too tight, tense or overactive.  Some hold stress and tension in their pelvic floor like others hold tension in their neck and shoulders.  For these people a kegel may actually exacerbate the problem, and yet everyone is told to Kegel?!

3.     We need to look at how our pelvic floor got so weak in the first place:
For some, it may be labour and childbirth that created a weakened pelvic floor, but I don’t think the babies should get all the blame.  Remember the research shows that often the pelvic floor function gets worse with time. And women with no children still have a high percentage of pelvic floor issues. In Part II we will look at a study of tribal women that average 4.3 vaginal deliveries each and maintain very strong, functional pelvic floor muscles.  Lifestyle plays a big factor in the health of any muscle group, and exploring the parts of our lifestyle that are not conducive to maintaining strength and function may be the key to real pelvic floor health.  Leading me to my next point… 

4.     What are you up to the rest of the day? It’s like an hour of exercise at the end of the work day to make up for 10 hours of sitting.  It’s just not cutting it.  At best the kegel happens 3 sets of 10 reps, maybe 10 mintues of your entire day.  What happens the other 23 hours and 50 minutes of your day…do you have bad habits (like sitting on your tailbone) that are reeking havoc with your pelvic floor and is there a way to get more strength naturally throughout the day?

5.     Kegels are boring (that’s right I said it). This is probably why adherence rates to pelvic floor programs are so low.

6.     Is it natural for the human body to have to “kegel”? How have we got to the point that we need to squeeze a muscle (that should be working all of the time) to keep it working?  Where are we going wrong?  Are these rates similar across cultures and lifestyles?  And if we were able to look back at our hunter-gather ancestors would we see the same issues?

I think it’s time to change the way we look at this muscle group and the way we are rehabilitating women in the pregnancy and postpartum period.  There are fantastic therapists out there that integrate PFMT into a full body program that can help you recover from childbirth and show you how to find the strength you need to be a mum.  If you are having some big issues after having a baby chances are you will receive some fabulous help. 

But I would say most of us are still falling through the cracks of the healthcare system, we are doing “OK” so we are told to do our kegels, go home doing them wrong, get bored so we stop doing them, our kids get heavier and life gets busier and all of sudden we have issues that were never there before.  

So I say it’s time for a change.  Let’s explore why our pelvic floors aren’t doing their job from a whole body, holistic perspective that takes the “whole you” into account.  Please stay tuned for Part II where we look at the effects of lifestyle and “natural movement” on Pelvic floor health, and I will suggest 10 tips for whole-body pelvic floor awesomeness. 

For regular updates check out my facebook page, or sign up here to get Part II and future blog posts emailed direct to your inbox.  And please get in touch to tell me about your pelvic floor and kegel experiences!

Stacey x

References
[i] Smith MD1, Coppieters MW, Hodges PW. (2007). Postural activity of the pelvic floor muscles is delayed during rapid arm movements in women with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct, 18(8), 901-11.

[ii] Eliasson K., Elfving B., Nordgren B., Mattsson E. (2007). Urinary incontinence in women with low back pain. Man Ther, 13(3):206-12

[iii] Smith M.D., Coppieters M.W., Hodges P.W. (2008) Is balance different in women with and without stress urinary incontinence? Neurourol Urodyn, 27(1), 71-8

[iv] Bardino M., Di Martino M., Ricci E., Parazzini F. (2015). Frequency and Determinants of Urinary Incontinence in Adolescent and Young Nulliparous Women. J Pediatr Adolesc Gynecol,  pii: S1083-3188(15)00004-2. doi: 10.1016/j.jpag.2015.01.003. [Epub ahead of print]

[v] Chan S.S. Cheung R.Y., Yiu K.W., Lee L.L., Leung T.Y., Chung T.K. (2014). Pelvic floor biometry during a first singleton pregnancy and the relationship with symptoms of pelvic floor disorders: a prospective observational study. BJOG, 121(1): 121-9.

[vi] Wilson, P.D., Herbison, P., Glazener, C., McGee, M., MacArthur, C. (2002). Obstetric practice and urinary incontinence 5-7 years after delivery. ICS Proceedings of the Neurourology and Urodynamics, 21(4), 284-300.

[viI] Lee D.G., Lee L.J., McLaughlin L. (2008). Stability, continence and breathing: the role of fascia following pregnancy and delivery. J Bodyw Mov Ther, 12(4), 333-48

[viiI] Thompson J.A., O’Sullivan PB. (2003) Levator plate movement during voluntary pelvic floor muscle contraction in subjects with incontinence and prolapse: a cross-sectional study and review. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:84-88.

[ix] Mørkved S., Bø K. (2014). Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br J Sports Med, 48(4), 299-310

I am very often asked to give a new mother an exercise to fix her separated abdominals.  I decided to write this article in response to that question, as Diastasis Recti Abdominis (or DR as I will call it for simplicity) is a misunderstood, under-researched and often mistreated condition.   What I am finding in my search for answers is that there is no quick fix; DR is a whole-body problem needing a whole-body solution.  Healing your abdominals may not be as simple as a single exercise, but it can be a journey that is rewarding for the entire body and your overall health.

What is DR and is it normal?

You have a line of connective tissue running from your sternum to your pelvis called the linea alba (see a cross-sectional view below).  This long ligament connects the two halves of your abdominals, and it is this connective tissue that stretches to create the separation between the two halves in a DR.  The linea alba is almost like the waistband in your pants; it has a lot of stretch in one direction (sternum to pubic bone), but if you put too much pressure on the horizontal direction it can tear and cause distortions in the fibers.  A DR is usually defined as a separation greater than 2cm (or 2 fingers width) and can occur at any place along the length of the linea alba (just above or below the belly button is common).  It also has a depth; so the wider and deeper your DR, the longer it will take to heal.  

Remember that your body is amazing and fabulous and has evolved this way over millions of years…so I would like to believe that your body is meant to stretch this way  *to a point* to accommodate your growing baby and it can be a natural process to heal it.  Unfortunately you can stretch connective tissue so far that it loses its ability “bounce back”, and you may need additional help in the recovery process.  If you are concerned about your DR or have any adverse symptoms (pelvic/back pain, incontinence, bulging in the front of your abdomen, etc) I would strongly recommend seeing a Women’s Health Physiotherapist to advise you in your rehabilitation. 

Up to 99% of women have been shown to have DR by their third trimester of pregnancy[i].  Depending on the research this drops from 35%[ii] to 56% immediately postpartum.  It has been shown that without any intervention, your abdominal separation at 8weeks is pretty much what you can expect to have at a year postpartum[iii].  The research is still severely lacking on what impact exercise can have on helping you heal your DR or how long it can take[iv]. 

While we are waiting for some awesome DR research to be produced, we can use a bit of logic in designing our postnatal programs so that they encourage abdominal wall healing by:

a)    Not doing things that will make our DR worse by increasing load or strain to the area.  Removing the stress factor from the injured connective tissue will promote healing and allow the body to do what it does best…heal itself without us getting in the way.

b)   Make sure everything surrounding the site of injury (so your whole body) is functioning properly so that load, strain and pressure are evenly distributed and ALL of the muscles required for posture and stability are doing their jobs. If you think of it like a sprained ankle, a comprehensive exercise rehabilitation program will improve proprioception and motor control in the area and help to prevent re-injury, but it has nothing to do with healing the actual ligament that has been stretched/torn.  It is all about restoring optimum control, balance and strength to the area to make up for any damage to the connective tissue.

Diastasis Recti (as well as many pelvic floor issues) is often a condition of excess pressure.  To understand more about healing your DR, we need to talk a bit about Intra-abdominal pressure. 

Intra-abdominal pressure (IAP)                               

Think of your abdominal region as a fluid filled cylinder.  The walls of the sac are made of the Transversus Abdominis (TrA) and the connective tissue it attaches to in the front and back, the floor is the pelvic floor and the respiratory diaphragm is the ceiling.  All of these “postural” muscles have an extremely important role in core stability. If you make the abdominal cylinder smaller (by lifting pelvic floor and contracting TrA for example) you will increase IAP. Increasing IAP can be a good and very important natural mechanism of the body, as this extra pressure is what creates  a “girdle”  or “corset” around the lumbar spine to effectively stabilize the area[v]. 

The problems with IAP arise when we start to increase the pressure in the abdomen TOO MUCH and TOO OFTEN.  The excess pressure places mechanical stress on the abdominal wall, which starts to wear and tear on the weakest links; usually the connective tissue that holds us together.  A lot of pressure in the abdominal area will usually push down on the pelvic floor and force pressure outwards, straining the linea alba.  Connective tissue that is over-stretched can lose the ability to rebound and become permanently changed, so this excess pressure can be very damaging.

Here are some things that can increase IAP:

• Holding the breath (especially while lifting or exercising)
• Dysfunctional breathing patterns
• Abdominal exercises with improper technique or “too much too soon”

• Improper posture/alignment

• Sucking your stomach in

• Straining for bowel movements

• Carrying a baby

• Pushing a baby out

• Sneezing and coughing

Of course some of "the above" are inevitable.  But we can definitely make an effort to reduce excess IAP and strain to our abdominals during pregnancy and the early postpartum period.  To reduce the IAP we need to look at our cultural abdominal habits, the way we train and use our abdominals, and our whole-body alignment.

Start working on these 3 Steps to promote healing throughout your "core cylinder":

1.    Stop sucking in

“Sucking in” has become normalized in our Western culture (think of the action you would do if someone was taking a picture of you in your bikini) and many people even confuse this action with stabilizing their core.  In a neuro-muscular sense “sucking in” is very different to core stability, and can be debilitating when it becomes a long-term habit. 

When you “suck in” you are effectively using pressure to draw your organs and belly in and up towards your diaphragm.  Think Physics 101: every action has an equal and opposite reaction, so you draw your insides up, pressure is forced downwards (and outwards).  Remember those weak links taking the brunt of these extra forces; icky for your pelvic floor, no good for your DR, and creates “bad habits” in your muscle patterning (example: every time you go to lift something, instead of  your body naturally contracting your inner abdominals and lifting pelvic floor to create stability through your lower spine, you suck your guts in and up, creating pressures down and out, having the exact opposite effect of the natural muscle reaction to such a task). 
Sucking your stomach in once is pretty harmless.  Doing it for 30 years (from the time your dance teacher trained you to stand up straight and suck it in) can create lifelong habits that will increase your IAP and strain your connective tissue. 

Toddlers are fantastic to watch for their ability to use their abdominals in the way they were designed to function.  Observe them moving around, and how they let their lovely soft bellies hang out, but when they go into a more difficult position or plank-type pose they naturally contract and you can see the amazing strength and tone in their core. I only hope we can find more ways for the next generation to keep this natural strength and ability. 

As a culture we need to start valuing true inner strength and supple, tension-free bellies rather than some fictional appearance that culture and media teach us to strive for.  The extra stuff on your belly may just be needed to feed your growing child, and any excess can be taken care of with a healthy diet and a variety of whole-body movement.  Please remember that when you “suck in” you are only temporarily trying to hide whatever is hanging out on your abdomen, at the expense of your internal organs, breathing, and very important connective tissue.  Learn to let your stomach “go” and allow the abdominals to stabilize the way they were designed to (without us trying so hard), and your entire body, including your DR, will see the benefits.

2.    Relearn how to naturally use your abdominals

“By the time toddlers are upright and walking they will have all of the core strength they will need in their lifetime.”
-Kathleen Porter, Natural Posture Solutions[vii]

Post-birth is the perfect time to re-learn how to use our abdominals in the way they were designed to be used.  This time of healing and restoration can be ideal to take us back to a place where we had incredible strength and natural muscle patterning without years of modern technology and culture affecting the way we move.  To accomplish this we must start from scratch, ignore the big bulky muscles for a while and rediscover our true “inner core”.  Something you will need as a mother in more ways than one.

The first step is learning how to properly contract your Pelvic Floor and TrA without sucking in or overusing the “big guns”.  Our smaller, postural muscles (like TrA and pelvic floor) normally work without conscious contraction needed.  The body is in fact so amazing that if you move your arm, your core muscles will activate just before your arm muscles to stabilize the spine.  Unfortunately the research has found that for people with back pain or general trauma in the area of the core (eg pregnancy/childbirth), often this mechanism is no longer working[viii].  So your body tends to “splint” with the big muscles instead of activating the small subtle stabilizers, thus creating a cascade of negative effects to your core stability. 

If you’ve been splinting your core or have developed some abnormal patterning (kind of like any bad habit really), you will often need a period of retraining to remind your brain and body how/when to use these subtle stabilizers. This is a lot easier said than done, and I strongly recommend seeing a professional (Physios/EPs with access to Real Time Ultrasound can be very helpful here) to guide you through the process.

To get started try the following exercise:

• Get on your hands and knees with hands under shoulders and knees under hips

• Flex and extend your spine a few times (cat stretch) and find middle/neutral
  

• Many or us that live with a tucked tailbone will still be tucked here.  Try this:  Without letting your ribcage drop to the floor, let your coccyx (bottom of your tailbone) float up towards the ceiling and think of spreading your sit bones.  

• Many people that feel they have a "big curve" in their lumbar spine are actually just letting their ribs thrust forward, so really be conscious of having a stable rib cage while letting your bum "go" (rather than forcing over-extension of your low back).

• You should look something like the picture below (left):

 

• Now the fun part.  Hold your spine where it is and let your abs "go".  That's right, no more sucking in.  Let all your abdominal contents relax toward the floor and breathe.

• As you exhale, you should feel the natural lift of your abdomen away from the floor (not forced and your spine shouldn't move).  

• Add a pelvic floor contraction to this natural breathing pattern.  Inhale, let everything relax, and exhale, gently lift pelvic floor.  As you lift pelvic floor you should feel a gentle lift of your abdomen away from the floor, almost like a piece of glad wrap inside those big bulky muscles is ever-so-slightly tightening around your waist (TA contraction). 

• So your PF and TA should be able to work without any movement happening in your pelvis or spine, without any big bulky muscles contracting (no bums please), and it will really feel like you’re not doing anything.  Because it’s supposed to be natural and we’re not supposed to have to think about it.  Except sometimes we do.  So practice this a few times a day until your body remembers what it feels like to use those lovely little stabilizers!

Once you’ve done a bit of retraining/corrective exercise on your abdominals and you’ve had an adequate period of rest to allow your DR to heal, (this can take 6 months depending on the person, please don’t rush it!) you can build your way back to your old workouts or favorite core exercises as long as you ensure that you are layering your abdominals properly.  This means that TA and pelvic floor fires first, and that you never feel your abdominals “popping” (pushing outward) or downward pressure on your pelvic floor.  Think of how your abdominals feel if you were lying on your back and suddenly decided to jack-knife yourself to sitting…most people "pop" with this movement.  “Popping abdominals” means that you are either doing an exercise that is too hard for you at this point in time, you are holding your breath, or you haven’t mastered those inner muscles yet.  That’s fine, just back off to an exercise you know you can do well and take baby-steps back to those bigger/harder exercises.

Once your abdominals are “retrained” and/or if you are in a proper alignment (see the next point), the magical thing about the body is that you should not have to consciously contract your abdominals.  Modern life often takes us out of these good habits and alignments, so a daily dose of corrective exercise certainly won’t hurt.  But I DO NOT think you should ever walk around contracting your abs all day, that will do more harm than good and mess with these amazing natural processes.


3.    Work on your Whole Body Alignment

Theoretically, when your bones are in the “right place” in respect to each-other and the ground, your core and postural muscles should work naturally – meaning you shouldn’t have to consciously contract them.  When you were a kid running around I’m sure you didn’t think about lifting your pelvic floor before you jumped, right?  We can take our bodies back to this magical place of natural stability but it will take a move back towards natural alignment.

The other great thing about natural alignment is the way the body distributes pressure throughout the system.  Katy Bowman, a biomechanist, a valued teacher and role model of mine, explains this much better than me, please see these posts for more info:

http://www.katysays.com/under-pressure-part-1/
http://www.katysays.com/under-pressure-part-2/

To sum it up: good alignment=natural distribution of pressures=less pressure on our DR and pelvic floor, allowing the core to heal naturally.

Dodgy alignment + carrying a child = excess IAP = more pressure pushing on the linea alba and pelvic floor, preventing it from healing and closing.

There is an ideal alignment for the human body that would have been the norm for our ancestors living in nature.  Shoes, chairs, desks, cars, computers, etc have changed much of our alignment, which is why we often need an exercise regime to try and put us back where we belong.  We also need to look at what we are doing all day long to exacerbate these alignment issues, as one hour of exercise does not take away the negative effects induced by 8-hours of sitting and staring at a computer screen.
*If you are wanting to find more ways to work on your alignment, please see "next steps" below.

To start working on your alignment, try this simple awareness exercise:

• Check out the picture on the left.  This is where many of us normally live, exacerbated further by pregnancy and carrying around a child (the ball is my pretend baby). 

• The picture on the right is more of a natural alignment, notice how you can draw a line through the centre of the foot, knee, hip and ribcage.  Imagine the diaphragm and where it would be in relation to the pelvis.  Our core muscles function best when we are in this alignment and the diaphragm sits on top of the pelvic floor with a neutral pelvis relative to the ground

• SO…stand by a mirror side-on.  Check out where your ribs sit in relation to your pelvis and your pelvis in relation to your feet.  See if you can back your pelvis up over the centre of your ankle joint without falling over backwards, and then bring your ribcage balanced over the pelvis.

• Understand the natural alignment, play with it and become aware of how you stand (and carry your child) in relation to how you should be standing.  Do not try to force yourself into “natural alignment” if your body doesn’t go there yet.  Be aware that it can take years of work to be able to get yourself there, but the closer you get the better you will feel.

• If you feel unable to get into a better alignment I would highly recommend getting some bodywork done (find a KMI or Myofascial Release practitioner near you) and combining it with some corrective exercise (find a trusted exercise professional or start with Katy’s snackbytes on the Restorative Exercise website).  Even tension in the bottom of your feet and the top of your neck can affect your pelvic floor so remember to treat the body as a whole! 

So it’s not too hard right?  We only need to learn to let something go we may have been holding our entire lives, use muscles we haven’t properly engaged since we were carefree children, and work on our entire body alignment.  Simple really.

Our body has amazing, untapped potential and I firmly believe we can heal most DR and pelvic floor issues naturally. But like anything else in life it needs to be seen as a process.  The same way that developing good nutrition and eating habits can be a process of discovery and invention.  Or the way mindfulness and meditation can continue to improve your mental and emotional state the longer that you practice.  The physical body and movement is no different.   Like anything good in life, there is no quick fix or short answer, no single exercise that is going to put us back together after having a child. And if someone tells you there is, I hope it raises red flags for you after reading this article. 

Postnatal rehabilitation can be an amazing time to rebuild our bodies from the inside-out, find that inner strength that we are so badly going to need, and nurture and love our bodies for everything that they are and all that they have the potential to become.

Enjoy the journey and let me know how you’re traveling xx


The next steps:

• Look for my “Restore Your Core and Pelvic Floor” 30-Day Online Program launching next year!  Sign up to the newsletter here and/or like my facebook page to keep updated.
  
• Look for more awesome info and “movement snacks” on Katy Bowman’s website: http://www.restorativeexercise.com
  
• For a more comprehensive exercise program that encompasses the principles listed in this article, check out MUTU systems: https://mutusystem.com

• Nothing beats 1:1 care.  Please go see a healthcare professional trained in postnatal care, and if you’re having any pain/issues make sure it’s a Women’s Health Physiotherapist!

References
[i] Fernandes de Mota, P.G., Pascoal, A.G.B.A., Carita, A.I.A.D.C., & Bo, K. (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy,20(1), 200-205
[ii] Candido, G., Lo, T., & Janssen, P. (2005). Risk factors for diastasis of the recti abdominis. J Assoc Chart Physiother Womens Health, 97: 49–54
[iii] Coldron, Y., Stokes, M.J., Newham, D.J., and Cook, K. (2008). Postpartum characteristics of rectus abdominis on ultrasound imaging. Man Ther. 2008, 13(2), 112–121.
[iv] Benjamin D.R., van de Water A.T., & Peiris C.L. (2014). Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy, 100(1), 1-8.
[v] Hodges PW, Eriksson AEM, Shirley D, Gandevia SC. (2004) Intra-abdominal pressure increases stiffness of the lumbar spine. J Biomech, 34 (3), 347-53
[vi] Spitznagle, T.M., Leong, F.C., and Van Dillen, L.R. (2007). Prevalence of diastasis recti abdominis in a urogynecolgical patient population. Int Urogynecol J Pelvic Floor Dysfunct, 18(3), 321–328
[vii]  Katheleen Porter, quoted from Liberated Body podcast: http://www.liberatedbody.com/kathleen-porter-lbp-042/
[viii] Hodges P.W, Richardson C.A. (1996) Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of Transversus Abdominis. Spine, 21(22) 2640-2650.