Monday, August 18, 2014

5 Things Women Need to Understand About Diastasis Recti

Diastasis Recti - This is a scary word when a mom first hears it. It's a word moms rarely hear from their Obgyn and if they do..they are usually offered only one solution - surgery.  No exercise restrictions are given out and instead moms are given the go ahead at 6 weeks post partum to return to any exercise. Some are actually told to go ahead and do crunches. Please don't. There is a lot that can be improved about this protocol, but in the mean time, here is what moms need to know to take charge of their health. P.S...I know there are some great OBGYN's & midwives out there. If you had a great one..mention them below!!


Diastasis Recti


Understanding Diastasis Recti

1. Diastasis recti (DR) is not an actual separation of the muscles. A lot of health professionals do know this one, but some don't. DR is a certain degree of "abdominal separation." 3 finger widths or more is considered DR. Really, it should be called "excessive abdominal strain." The muscles have not actually separated from the connective tissue. The connective tissue (linea alba) has just stretched, thinned and weakened. Occasionally there can be some tearing of the tissue and hernias can then develop.

2. Diastasis Recti or ab separation is only about 25% of the core weakness issues that moms are dealing with postpartum. Many think if they don't have DR after pregnancy, they are good to go.  After pregnancy though, all moms have some degree of separation, thinning and weakness. It may not be a full 3 fingerwidths or more, but it may stretch further if ignored or contraindicated exercises are performed. What are the other 3 big issues?

  • Misfiring of muscles (disconnect between pelvic floor, transverse abdominal muscles, diaphragm and multifidus) Often postpartum, core muscles do not fire in the correct order..or muscles do not contract like they should and other muscles compensate instead. Waking up the muscles to regain proper muscle coordination is key.
  • Deflated muscles -Picture what a ballon looks like after it deflates. It does not go back to its original shape. Good thing is... we are not rubber, our muscles and tissue can shorten and get pretty close to original length. Every mom has excessive elongation of the muscles that are stretched and weakened . This contributes to the "belly bulge." even if their separation is minimal. 
  • Core Instability -When moms return to their typical exercise, they are often challenging the body to perform without stabilizing and strengthening their inner core first. This unbalance creates a ripe environment for injury or weakness issues down the line. Prolapse, incontinence, hip injuries, back pain, pelvic pain,  (which may be present before delivery) will be stressed considerably when many of these issues can be avoided if reconditioning the core is done first. P.P.S -Have you reconditioned the core properly and still have issues? Some women may need to be referred out to a pelvic floor physical therapist. Know a great one? Share below!

3. Measuring Diastasis Recti accurately is challenging.  Just like calculating body fat, there is room for error depending on the methods used before and after.  To get the most accurate measurements, it should be done the exact same way by the same person in order to note any change happening.(VIDEO - how to check for Diastasis Recti) Not sure you are measuring accurately or maybe you don't have anyone to help you? Don't stress! Just like body fat %, it is not the only measurement that can show progress.  I use 4 other measurements with ReCORE to document change and progress.

4. Moms can get full function and strength back even if their separation doesn't close all the way.  Yes, it is true! Moms are often told that their separation needs to close all the way. And while it is important to get the connective tissue to shorten the best it can..it just might not. {GASP} If it doesn't, it usually comes very close with proper exercises and/or splinting.  Women CAN regain full function of their inner/outer core with a separation. It is not ONLY about the width of the connective tissue separation, but whether the muscles engage and contract properly and whether a person can maintain proper form. 


5. Moms CAN do any core exercise again. What?  No restrictions?  I may just get some crazy emails after this. But after having trained moms exclusively with separations for over 4 years and dealing with it myself,  I've learned that women can safely do any core exercise again (if 3 important criteria are met). Would I say to my ReCORE graduates, "Congrats! Go ahead and return to your 100's of crunches." Absolutely not.. not necessary, not needed. There are many other more effective ways to strengthen the core.  Crunches are not on the top of my list, but doing a few here or there correctly (meeting the 3 criteria) is key.  The simple act of curling the body forward is a useful functional movement when done correctly.

These points are mentioned not to scare (and there are a lot of scare tactics out there)..but to educate and inspire women to take charge of their core health.  Corrective exercise and splinting can help minimize or close Diastasis Recti. Surgery is not the only option. Surgery will not restore your core strength. Surgery may possibly be needed in some cases, however the core needs to be strengthened properly before and after surgery to see how the muscles will respond.  Give your body a chance to respond with corrective, progressive exercises and splinting first (yes, there are many benefits to splinting). It does take some time and effort, but reconditioning the inner core is the first step to getting back your core strength, stability and function.


Celeste Goodson is an ACE Advanced Health and Fitness Specialist & Pre  Post Natal Trainer, certified to train those with musculoskeletal, neuromuscular and metabolic conditions cleared by a physician. Celeste has a B.S. in Fitness and Wellness and has worked in physical therapy, cardiac rehab, and numerous fitness settings for over 15 years.  Celeste is a runner and mom of 3. Celeste has designed the ReCORE Program™  and the Maternity and Post-Natal FITsplint™  to help moms strengthen, support and splint the core during and after pregnancy. 

SOURCES
Boxer, S. Intra-rater reliability of rectus abdominis diastasis measurement using dial calipers. The Australian journal of physiotherapy 43.2 (1997): 109-114. 
Bursch SG . Interrater reliability of diastasis recti abdominis measurement. Phys Ther. 1987 ; 67 : 1077 – 1079.
Chiarello CM , Falzone LA , McCaslin KE , Patel MN , Ulery KR . The effects of an exercise program on diastasis recti abdominis in pregnant women . J Women’s Health Phys Ther. 2005 ; 29 : 11 – 16.
Lee D G, Lee LJ, McLaughlin L 2008 Stability, continence and breathing - The role of fascia in both function and dysfunction and the potential consequences following pregnancy and delivery. Journal of Bodywork and Movement Therapies 12, 333-348.
Oren Cheifetz, S. Deborah Lucy, Tom J. Overend, Jean Crowe. The Effect of Abdominal Support on Functional Outcomes in Patients Following Major Abdominal Surgery: A Randomized Controlled Trial. Physiotherapy Can. 2010; 62:242–25. 
Rath A M, Attali P, Dumas J L, et al 1996 The abdominal linea alba: an anatomo-radiologic and biomechanical study. Surgical Radiologic Anatomy 18:281-28.



Wednesday, January 22, 2014

Outie belly button now an innie!

 Here is an excellent illustration of how the "outie" belly button can return to normal again. This is usually caused by diastasis recti, but it doesn't have to last forever and it doesn't always have to be corrected by surgery.

Before ReCORE and the FITsplint (5 months postpartum)

After ReCORE and the FITsplint (6 weeks later)




Before ReCORE and the FITsplint (5 months postpartum)
After ReCORE and the FITsplint (6 weeks later)


  This mom worked hard. This client started ReCORE at almost 5 months postpartum and has 1 child. She started ReCORE and wore the FITsplint , beginning measurements were 3, 3, 1/2 diastasis and finished 6 weeks later with 1, 1, 0!  So around her belly button, which is the area that responds the slowest, it went from a 3 finger width to a 1 in 6 weeks. Her before waist measurements were 36.5" and 36" and after they were 33" and 35", so quite an improvement there also.  These pictures show how much a umbilical hernia (outie belly button) can improve in just 6 weeks. Umbilical hernias sometimes occur because of diastasis recti. Once diastasis recti is resolved, so is the umbilical hernia. 

TESTIMONIAL

"The tissues are a lot stronger now and tighter. The depth is now shallow, not as deep as it was. Overall everything improved nicely. I love the program and the overall result I achieved… I just wish i found it before or as soon after i gave birth."




**It is typically recommended to wear the FITsplint if a client has finger width separation of 2 fingers or more (or is within 3 months postpartum) and it is recommended to wear it 8 hours a day and then at night as well. Watch the video to learn how to check for your separation or diastasis recti here.


MEDICAL DISCLAIMER
Content is for informational purposes only and is not intended to offer medical advice or replace the recommendations of your physician or midwife. Please consult a physician before beginning an exercise program.


Tuesday, January 7, 2014

Bounce back after baby with ReCORE!

What is the first thing you should do for yourself after having a baby? Besides snuggling and feeding your baby and sleeping, it should be to recondition your core. Not from a vain standpoint, but from a functional standpoint. Don't focus on losing baby weight or getting that "perfect body." Stretch marks are not possible to change… but those are beauty marks to forever remember you brought life into this world! But what you can change and get back is your core strength and function.   Trying to lose weight and exercise intensely with a weak core is a disaster waiting to happen (think injuries, back pain, hip pain, pelvic weakness issues, making diastasis worse and possibly prolapse)

Here are a few amazing moms who finished ReCORE before jumping back into running or other higher impact exercises

Client #1

Bio - Started ReCORE 5.5 weeks post partum. Gave birth to twins! This client just happened to find this program after she had her twins.She purchased and wore the FITsplint during the 6 weeks of ReCORE.

Before ReCORE Measurements
             Above Belly - 2
             At Belly Button - 2-3
             Below Belly Button - 2

             Belly Button Circumference - 37"
             Below Belly Button Circumference - 40"



After ReCORE Measurements
             Above Belly - 1/2 (Closed)
             At Belly Button - 1/2 (Closed)
             Below Belly Button - 1/2 (Closed)

             Belly Button Circumference - 34"
             Below Belly Button Circumference - 35.5"



It's amazing all that improved that you can't see by the pictures. Besides tightening up the loose ab muscles, she lost 3-4" off the waist at 2 different areas. She took care of the big issues..her diastasis recti separation and getting her core stable and strong! She closed everything in 6 weeks. She noted that her stress incontinence issues are now gone. Heavy pelvic feeling gone also. Of course there is more core strength progression that she can do and she was given tips on how to keep going.

TESTIMONIAL "I really enjoyed the program and am very happy with the results!"

Client #2

Bio - This client started ReCORE at 4 weeks postpartum (cleared by physician). This was her first baby. Client used the FITsplint during pregnancy as well as after while doing the ReCORE program.

Before ReCORE Measurements
             Above Belly - 1
             At Belly Button - 1.5
             Below Belly Button - 0

             Belly Button Circumference - 32"
             Below Belly Button Circumference - 32 3/4"



After ReCORE Measurements
             Above Belly - Closed
             At Belly Button - <1 nbsp="" p="">             Below Belly Button - Closed

             Belly Button Circumference - 28.5"
             Below Belly Button Circumference - 30.5"





This client also worked really hard, she moved through the exercises fairly fast and I had to pull out some other ones for her as well :) She noticed that her core strength and posture improved. She started with a pretty small separation but still had some inner core instability and weakness. She understood that by returning to crunches or other higher risk core exercises that the separation could get worse. The tissue is very vulnerable postpartum and can stretch farther or just not close after pregnancy if the inner core is ignored or stressed incorrectly.

*You may notice the client's pelvis and spine shift to her left. I've recommended to her to have a therapist check it out

TESTIMONIAL"Thanks so much Celeste! I'm so happy I found you on the internet. Using the FITsplint throughout my pregnancy helped me protect my abs and feel more stable as I exercised. After finishing ReCORE at 10 weeks post partum, my abs look and feel stronger. I feel more confident returning to exercising the correct way!"

Now both these clients can safely return to more difficult exercises and programs knowing they have a strong core foundation that functions properly and are at a much lower risk for injury. Way to go MOMS!

Remember, it is never too late to do ReCORE and get your inner core strength and stability back but if you know a mom who just had a baby..


ReCORE before
P90x, CrossFIT, running, the gym etc..
You're body will thank you later!


More info on ReCORE and the FITsplint 


Tuesday, November 5, 2013

More ReCORE results!

I'm having a hard time finding the time to post ReCORE results from clients, but I know it help moms see exactly the type of progress women can make in 6 weeks.

For those of you new here...ReCORE is strickly a core - reconditioning program. We do not focus on improving cardio or diet at the same time, just inner core strength. Its the one thing that needs to improve in post-partum workouts. Please moms, focus on getting your core strength back first! ReCORE before returning to the gym or anything else (running, p90x, and especially something like cross fit) Post-partum is a vulnerable time for the weak stretched out core muscles. If you put too much stress on the core before the tissue regains strength and it can contract and be used properly...you are asking for core weakness issues (leaking, diastasis, low back pain etc, prolapse) etc. You may be dealing with some of these issues from pregnancy..just another reason to get that inner core working properly before adding more strenous exercise to it.

CLIENT #1



I apologize for the grainy pictures, but this is what I have. Clients are instructed to relax the belly for the pictures and measurements. You can see the difference in the 2nd picture after the client wore the FITsplint and followed the ReCORE program about 95%. She ended up wearing the FITsplint for just the first 4 weeks because I worked with her in-home and was able to re-measure her separation. After 4 weeks of ReCORE and the FITsplint, her separation was below a 2, so she did the last 2 weeks of ReCORE with out the FITsplint.

BIO
Started ReCORE: 6 months postpartum

BEFORE
Above Belly button: 2
At belly button: 2
Below belly button: 1
Belly circumference: 32"
Below belly circumference: 34"
TVA Drop Test: approx. 35 degrees

AFTER
Above Belly button: Closed
At belly button: Closed
Below belly button: Closed
Belly circumference: 29 1/2"
Below belly circumference: 30 1/2"
TVA Drop Test: approx. 80 degrees

She has taken care of her ab separation! She has improved her core strength considerably as well. Now…this client did put in the work and the results and core strength improvements are obvious. Almost 3-4" off the waist just from shortening the weak stretched out core muscles. Also her TVA drop   text (a new test I am piloting with my in-home clients) improved from 35 degree drop to 80 degree drop while being able to keep the core engaged (not bulge and keep back in neutral)
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CLIENT #2

BIO: Client had tried 2 very popular programs out there to get her diastasis smaller.  She had also done physical therapy.  Guess what? She didn't have any improvements with her separation until doing ReCORE and wearing the FITsplint. Also, the FITsplint was her favorite among the numerous supports she had worn.

BEFORE:
Above Belly button: 3.5
At belly button: 4
Below belly button: 3.5
Belly circumference: 29"
Below belly circumference: 30.5 -31"

AFTER:
Above Belly button: 2.5
At belly button: 2.5
Below belly button: 2.5
Belly circumference: 28"
Below belly circumference: 30"

TESTIMONIAL: "I will say I tried [ name of program] three different times and my diastasis never improved, so I'm very pleased it got a little smaller this time. And I also thought your exercises were easy to incorporate into my life (as opposed to programs with tons of reps). The FITsplint was the best of all the splints I've tried, and I've tried them all."


With all clients, they can continue another 6 weeks of progressive core exercises with me or continue on their own. My goal is to get them on their own…with a good understanding what exercises to do and how to progress. 
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Purchase or find more info on ReCORE and the FITsplint on the website mombodfitness.com!