Tuesday, December 16, 2014

Can my Diastasis Recti close all the way?

Common question. Complicated answer. First off,  there is hope! But if someone is promising you that your D.R will close all the way, please find another health professional that won't guarantee something they can't guarantee.

What is Diastasis Recti or DR? Simply put, it is stretching (not a separation) of the linea alba between the rectus abdominus muscles,  2-3 finger widths or more apart.

Illustration of Diastasis Recti


What is a normal width?  The linea alba in a normal adult is about 1 finger width, although this can vary a little. The linea alba is also normally tight instead of lax.

So can my diastasis close all the way? 
Simple answer:
Possibly and….it probably will get close enough to not need surgery.
Long Answer:
While I specifically help women strengthen their core after pregnancy and work with many that have  diastasis recti, this really shouldn't be the ultimate goal. Why? Because there are many other factors and variables to healing and measuring diastasis recti.  While some can "close it," some will not and do not need to. Yes, it is true.

DIASTASIS RECTI does not have to close all the way to restore core strength, stability and function.


So this means I don't need to address my DR, I can just do any core exercise? No, it means we need to stop obsessing over getting it closed ALL the way and focus on restoring core function, strength and stability. Waiting for it to heal naturally, meaning do nothing, is very slow, risky and unproductive. Research has shown that being proactive makes a difference in tissue response.

Research by Diane Lee has demonstrated that core function can be restored without a separation closing all the way. I have also seen this with some of my clients over the last 5 years and I have experienced it myself.  DR may not close completely, but with progressive core exercise it can improve and "close" when the core engages. I along with many of my clients can perform any core exercise safely without risk of the linea alba stretching out further. From my experience, most women can get it to a 2 or less with proper exercise progression and splinting. No one knows how your connective tissue will respond. Give your tissue the best chance possible to heal. Muscle, tissue, breathing, alignment, genetics and hormones are all involved in the process. Muscles coordination can improve, strengthen and engage properly to help protect or improve any laxity in the linea alba.  


IDEAL HEALING ENVIRONMENT
1-Gradual progressive inner/outer core exercises
2-Splinting (recommended if within 3 months post-partum or have a separation 2 fingerwidths or more)
3-Alignment
4-Avoiding contraindicated exercise (temporarily)

Gradual progressive core exercise is key. Building inner and outer core coordination and strength progressively is important in order to help increase blood flow, strengthen fibers and load the tissue.  Too many moms are just doing basic transverse abdominal  (TVA) exercises over and over and while it is helpful, it isn't enough to stimulate change in muscle or tissue length and strength. So while they see some improvement, they don't restrengthen the core enough to engage well during exercise, putting them at risk for DR to return. Many also jump from basic TVA exercises to difficult core exercises such as plank variations or full push-ups before the core is strong enough to handle that exercise resulting in poor form or risk of further separation. Gradual strength progression is key.

Timing - Connective tissue has a remodeling phase and while this can last from one month or many months, it begins within a few weeks post pregnancy. While pregnancy is different than a quick onset injury, it is still somewhat similar. Tissue is trying to remodel whether the separation is minimal or large. Regardless of a degree of separation, the linea alba is vulnerable and weak postpartum. Yes, hormones from pregnancy and breastfeeding are present postpartum, but it doesn't mean strengthening can't happen. This is the time to restore core coordination and strength before returning to more vigorous exercise.

Splinting - While I do not require my clients to splint, splinting does help speed the healing process. I do recommend it for my post-natal clients (within 3 months) regardless of separation.  It can help align, protect, support and load the tissue.  *Splinting for up to 4-6 weeks is recommended while doing progressive core exercises. Most can get it their separation to a 2 or below in that time, stop splinting, and continue strengthen their core and move on to more challenging core exercises.
*Not all splints or binders are created equal and yes, some are harmful (corsets)

Sometimes the tissue doesn't actually tighten, but the muscles learn to engage well, making a separation appear"smaller". This isn't a bad thing! Core activation, coordination and strength can improve and minimize a separation temporarily the when core is engaged. This protects the core when more difficult exercises are performed.

So I don't have to have exercise restrictions the rest of my life? Right! As long as you can first:
1) minimize abdominal separation
2) re-establish core coordination
3) engage core well
4) improve core strength gradually
4) maintain proper form
YES! The majority of moms that recondition their core properly even with some abdominal separation can move on to other core exercises safely. I know there are some cases that need surgery, but I have yet to work with a client that could not move on to more challenging exercises or that needed surgery to restore function.

Is it too late? No, it really isn't ever too late to reconditioning the core. While there are ideal times for proper healing, strengthening can still take place with the connective tissue when given the right environment. Muscle will respond the fastest and help engage and protect the tissue. Tissue may respond slower, but it just may respond.

It's not all about DR postpartum. While DR seems to be the big weakness issue, it really is only one of several postpartum. These other weakness issues are just as important.





Instead of making your goal to close it ALL the way, give it your best shot, but realize that the finger width isn't the most important data. Make the goal to restore core activation, coordination, strength, stability and function so you can regain your life and move on to your favorite sports or exercise.  While a diagnosis of DR is scary at first, it doesn't have to be once it is understood.


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Celeste Goodson is an ACE Advanced Health and Fitness Specialist, Pre/ Post Natal Trainer, certified to train those with musculoskeletal, neuromuscular and metabolic conditions.  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, exclusively training post natal women for the last 5 years.  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 for a more effective recovery. Celeste enjoys running, being outdoors with the family.



SOURCES

Almekinders LC, Gilbert JA.  Healing of experimental muscle strains and the effects of nonsteroidal anti-inflammatory medication.  Am J Sports Med 1986, (14):303-308
Cook JL. Purdam C. Is compressive load a factor in the development of tendionpathy? Br J Sports Med. 2012 Mar: 46(3): 163-8
Docking, Samiric, Scase, Purdam, Cook. Relationship between compressive loading and ECM changes in tendons. Muscles Ligaments Tendons Journal: 2013 Jan-Mar 3(1): 7-11 

Lee DG, Lee LJ 2007 Bridging the Gap: The role of the pelvic floor in musculoskeletal and urogynecological function. Proceedings of the World Physical Therapy Conference, Vancouver, Canada

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
Lemos, Andrea PhD, PT. Impieri De Souza, Ariani PhD, MD. Dornelas De Andrade, Armele PhD, PT. Figueiroa, Jose Natal PhD. Cabral-Filho, Jose Eulalio PhD, MD. Pregnancy Inter Recti Abdominis Distance has no impact on Respiratory Strength 2001 J. Phys. Ther. Science 23: 757-760, 2011 
Liaw LJ, Hsu MJ, Liao CF, Liu MF, Hsu AT. The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. J Orthop Sports Phys Ther. 2011 Jun;41(6):435-43
Lin TW, Cardenas L, Soslowsky LJ. Biomechanics of tendon injury and repair. J Biomech. 2004;37(6):865–77.
Mota P, Pascoal AG, Sancho F, Bø K. Test-retest and intrarater reliability of 2- dimensional ultrasound measurements of distance between rectus abdominis in women. J Orthop Sports Phys Ther. 2012;42(11):940-6

Okada T, Huxel KC, Nesser TW. Relationship between core stability, functional movement, and performance. J Strength Cond Res 25: 252–261, 2011.


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 

Teyhen DS, Williamson JN, Carlson NH, Suttles ST, O'Laughlin SJ, Whittaker JL, Goffar SL, Childs JD. Ultrasound characteristics of the deep abdominal muscles during the active straight leg raise test. Arch Phys Med Rehabil 90: 761–767, 2009.








Friday, November 7, 2014

ReCORE Results!


 CLIENT #1

2 Weeks pp

 
Before ReCORE and FITsplint ™
3, 2.75, 3 Fingerwidth Separation  
32", 34" Waist measurements



  
12 weeks pp 
After ReCORE and FITsplint (10 weeks total, extra 4 weeks)
1.5, .5, 1        Fingerwidth Separation
26.5", 27.75" Waist Measurements

This in-home client received permission from her OBGyn to start ReCORE at 2 weeks postpartum. This was the 2nd vaginal pregnancy and was dealing with diastasis recti, weak knees and intermittent back aches. This mom was determined to wear the FITsplint and do the exercises. As you can see she made quite a bit of progress in 10 weeks! She wore the FITsplint for the first 4 weeks.. enough protect, load and align the tissue and help speed the process while tissue is trying to remodel itself in the 3 months postpartum.  She chose to extend the program and do an additional 4 weeks of ReCORE. I continued to progress her through more challenging core exercises. At the end of the program, her knee and back issues had dissolved, the connective tissue had tightened up well and she has moved on! She improved her core strength considerably with the core strength TVA test.


 -------------------------------------------------------------------------------------------------------------------
CLIENT #2

 
8 weeks pp
Before ReCORE and FITsplint™ 
3.5, 3, 2.5  Fingerwidth Separation   
34.5", 35.5" Waist measurements


  

After ReCORE (6 weeks total)
.75, 1.5, .75  Fingerwidth Separation
31.5", 33.5" Waist Measurements

This is another in-home client. Notice how asymmetrical the clients stance is before ReCORE?  ReCORE address total core reconditioning, coordination, breathing patterns and stabilization, including inner, outer abs, back, pelvic floor, glutes, adductors, quad, hamstring and postural muscles.  This client was definitely dealing with some muscle imbalances and misalignment. Her stance after ReCORE is quite different and more balanced.  This client had a c-section and had some definite numbness with ab sets. After a few weeks, she had full control and coordination of her abs and we were able to work on progressive strengthening. She also improved considerably with connective tissue tightening and core strength TVA test.


Celeste Goodson is an ACE Advanced Health and Fitness Specialist, Pre/ Post Natal Trainer, certified to train those with musculoskeletal, neuromuscular and metabolic conditions. 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 for a more effective recovery. 















Wednesday, September 24, 2014

Are you "sucking it in"?

Okay, so you've probably heard the term "suck it in." Maybe your trainer has even cue'd you to do it. Hopefully instead though, you hear the term "engage the core." But really...these terms only mean something if you know what they mean and know how to do them properly, right?

First of all, lets explain the difference. Sucking it in is NOT the same as engaging your core.

"Suck it in" is synonymous for "rib flaring" or "rib thrusting" It's easy to remember what "sucking it in" means, because you can picture all those beach photos where guys or gals try to suck in their abs to make them look thinner. Instead they look obviously ridiculous because their chest is sticking way out. Yeah..they are just thrusting their ribs.



Here is the difference between a Relaxed Core, Engaged Core and Rib Flare (a.k.a sucking it in)
ReCORE Fitness
RELAXED CORE - SIDE VIEW

ENGAGED CORE - SIDE VIEW


ReCORE Fitness
SUCKING IT IN - SIDE VIEW
Now for the Front Views
ReCORE Fitness
RELAXED CORE - FRONT VIEW
Recore fitness
ENGAGED CORE -FRONT VIEW

ReCORE Fitness
SUCKING IT IN -FRONT VIEW



Now I didn't really exaggerate my rib thrust, but you can still see the ribs flaring. Some do it even more than this.

Do you see the ribs flaring with a person "sucks it in?" When a person rib flares, they are not actively contracting the core muscles. They are just bringing the air from their belly up into their ribs. 

Why should you not rib thrust or "suck it in?"
1- PAIN/INJURY Some people are chronic rib thrusters and this stresses the nervous system, contribute to misalignment and back/neck pain etc.
2- INCORRECT BREATHING - Belly breathing is important and if you are breathing heavy through the chest and not using the belly, you are messing with proper breathing patterns.
3- NOT ACTUALLY USING CORE MUSCLES PROPERLY - If you suck it in, you are not contracting or using the core muscles properly. This means you are not using your your core strength when you need it..ie, lifting heavy weights, stabilizing the body etc..  If you are trying to re-activate or strengthen core muscles, you will be wasting your time with constant rib thrusting or "sucking it in"
4. IT LOOKS RIDICULOUS - We can all tell in those photos if you are trying to suck it in and hide that gut..so avoid the embarrassment and just don't do it :) 

So are you "sucking it in", or are you actually "engaging your core"?

WATCH this VIDEO to learn how to engage your core. It's an oldie but goodie. Proper breathing is important. You can learn laying down, sitting or standing with good posture. The pelvic floor is involved too, but one step at a time :)

P.S. - Once you get the breathing and form down with engaging the core, then you need to work on progressively and specifically strengthening the inner core.




Celeste Goodson is an ACE Advanced Health and Fitness Specialist, Pre/Post Natal Trainer, certified to train those with musculoskeletal, neuromuscular and metabolic conditions. 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 and support core if needed during and after pregnancy.

Tuesday, September 16, 2014

Expert Course on Diastasis Recti LAUNCHES!!

I'm really excited to help announce the official launch of the Expert Course on Diastasis Recti over at FIT2b! There is nothing else out there quite like this. Women can now have access to numerous e-courses online and learn from world renowned experts from their home. Beth has done an amazing job putting this together. If you want to know the latest on research and help yourself make informed decisions on your diastasis recti, I would encourage you to watch all the courses. You will walk away knowing more than most health professionals!!





For some reason, I couldn't get a snap shot of all the people involved, so here is a listing of the Experts and topics from the FIT2B page.

It’s about what you feed your core, and nutritionist Dave Barnas will exlain how what you eat affects your belly.
It’s about what your core does to support your bones and how the position of your bones affects your core, and Dr. Shannon Anhorn will help you understand what good chiropractic care can do for your core.
It’s about what thoughts you hold in your core, and psychotherapist health coach Anita Bentata will enlighten you on the mind-body connection.
It’s about what is supporting your core, and splinting guru Celeste Goodson will help you know if you need to bind your belly or not.
It’s about what rehab means to your core, and world-renowned physical therapist Kelly Deanwill help you visualize your abdominal anatomy.
It’s about what your core and pelvic floor do together, and the founder of Pelvienne WellnessKim Vopni will delicately demonstrate this intimate bond.
It’s about what certain poses can do to help or hinder your progress, and Holy Yoga trainerChristina Mroz will lead you through a safe, relaxing routine.
It’s about what fitness movements are safe and which are not for a healing diastasis recti, and the founder of this very website Bethany Learn will give you the clarity you need.
It’s about what happens to the core during c-section and other surgeries, and Lorraine Scapens who founded turningbaby.com will teach you how to heal from that.
Click below to learn more and purchase if interested! If you take the course, I'd love to hear about it!!
Experts on Diastasis Recti Online CourseExperts on Diastasis Recti Online Course



Also, if you haven't already, follow us over on our Facebook and Twitter page!! FIT2B will be having some great giveaways and I'll announce those later today :)









Module One: