Tag Archives: injury prevention

Exercise Tips for the Flat-Footed

This may seem like a strange topic, especially if you aren’t sure whether or not you’re flat-footed. Unfortunately, statistics point to there being a strong chance that you fall into the flat-footed crowd, also called individuals who “overpronate.” Running Warehouse claims that between 50-60% of people overpronate and 20-30% do so severely. So forgive me for nerding out on you today…this science is important.

 

Pronation (also called eversion) is a desirable movement of the foot as it strikes the ground. The foot’s arch “collapses” in a controlled manner towards the ground and helps the body absorb shock and send the force up through the muscles of the body. This is an integral part of anyone’s gait cycle in both walking and running.

When someone overpronates their foot’s arch flattens excessively and their tibia (lower leg bone) is driven into unnecessary rotation that leads to torque on the knee, stress on the hips, poor utilization of the gluteal muscles and more (see diagram below). There’s a classic chain of muscular compensations that occur up through the body in response to overpronation. Unfortunately, this places excessive stress on the joints and causes some muscles to be overly tight and others to be inappropriately weak. Hence, overpronators are highly susceptible to running injuries, the formation of bunions, medial ankle sprains, shin splints, plantar fasciitis, MCL and meniscus tears, hamstring and hip flexor tightness, IT-band syndrome, lower back pain and more.

 

Image Source: http://healthlifemedia.com/healthy/what-foot-ankle-over-or-underpronation/

(Note: This is a basic diagram for a complex foot movement and does not accurately reflect what’s happening at the forefoot in addition to rearfoot.)

 

Traditional remedies for overpronation include getting custom orthotics, wearing supportive athletic shoes and kinesio taping of the foot to control pronation. These are all great and generally effective but I notice that they don’t solve the issue entirely. A lot of regaining comfort and function in the body comes down to awareness of how to intentionally correct misalignments and gait patterns, and how to appropriately strengthen and release muscles that are negatively impacted by this pattern.

I’ve taken people in their 60s and 70s and helped them correct overpronation simply by focusing on how they walk – and I’ve got to say, I feel confident that these corrections are going to keep them walking longer and without the use of aids like a cane. I’ve helped strengthen weakened muscles in young athletes who are overpronators and seen them take their performance to the next level – qualifying for the Boston marathon, passing military physical assessments with flying colors, and entering athletic competitions free of injuries for the first time in seasons. This stuff is powerful. It can mean the difference between daily comfort and function or pain and diminished performance.

 

Read on for how to correct overpronation and strengthen/stretch affected muscles in the body.

 

 

Gait Control

It’s very common for people who overpronate to walk with their feet “pigeon-toed” out, almost like a dancer in plie (though not quite so dramatic). Some people are only flat-footed/overpronators on one foot and thus, one foot finds a way to turn out while walking, running and even standing still. The problem with this is the asymmetry it creates throughout the whole body, leading to the aforementioned cascade of injuries, aches and pains. The nice thing is that it’s quite easy to correct for this turning out of the foot through active awareness. In other words, watch your feet while you move throughout your day and/or workout and make sure that both toes are pointing straight so that the feet are both in a neutral stance. You’ll be shocked at how unnatural it feels to walk with both feet straight at first but with some increased awareness and effort over time, this can do wonders for injury prevention and balanced strength.

(Fun fact – I’ve helped fix shoulder pain by teaching someone how to walk without turning out the feet. That’s how connected the muscles in our bodies are – that an issue at the foot can affect all the way up to the shoulder and neck!)

 

Go Barefoot

Walking and exercising barefoot (when safe and sanitary) can actually help overpronators. That’s because it forces people to avoid a heavy heel strike, which is something many flat-footed folks do without realizing it. You see, there’s not much soft cushioning in our heels but we can’t feel how much discomfort this causes when we wear heavy running shoes. By ditching the sneakers we can suddenly acknowledge that striking the ground heavy with our heels doesn’t feel so great. We naturally adjust our foot strike so that ground force is absorbed through the arch (which was “built” for just this purpose) and the muscles of the foot and leg.

Note: If a physical therapist determines that you have a bony alignment problem in your foot then going barefoot won’t help anything. So if barefoot work feels like it’s worsening the problem then go see a professional to get an accurate diagnosis.

 

 

Lace Up Those Shoes

This tip is pretty straightforward. To help correct overpronation you can lace your shoes all the way to the top eyelet and make sure the fit is snug. Many shoes come out of the box without being laced all the way to the top because it’s easier to try them on this way but don’t be afraid to lace farther up. You may decide you need to swap the shoe laces for a longer pair or you can try a few workouts with the current laces and tug on them to help them stretch out (which most do).

 

Roll Out the Foot & Lower Leg

Foam rolling or using a firm tennis or lacrosse ball can be very useful in helping tight muscles release. The flat-footed crowd is notorious for tight calf muscles and for shin splints, so applying gentle pressure (pressing upwards – not downwards – to avoid varicose veins) will help release fascial tissue and prevent/help heal shin splints. I also recommend rolling out the arches because as someone works to correct overpronation they are strengthening through the arch and causing new tightness that we want to be sure doesn’t become plantar fasciitis (again, this is all assuming the pronation isn’t caused by a mechanical/bony alignment issue that can’t be corrected via exercise).

 

Roll Out IT Band

Foam rolling the IT band in a combination of long and short/pinpointed strokes (like near the top of the hip) can help release this long band of fascial tissue. When the IT band is tight (which it often is due to the excessive rotation that’s happening with overpronation) then the knee is placed under undue stress and the glutes can’t function optimally. It’s common for foam rolling to be very uncomfortable due to extreme tightness of the IT band so it may help to start by having someone else move the roller up and down the sides of your legs while applying the amount of pressure you can handle.

 

Calf Raises

Although the calf muscles are generally tight for overpronators, they are often tight due to weakness, not strength. In my professional opinion, it’s important to work on calf raises and other exercises (such as practicing running on the balls of the feet while sprinting) to increase strength and thereby decrease tightness associated with weak muscles. It’s kind of a paradox, I know. But this is how muscles work – they can be tight from being over-utilized OR underutilized. *Pause for confused head scratch.* 

 

 

Balance Exercises

Something that’s highly interesting to the exercise science nerds in the world (ahem, like myself) is that overpronators overuse their big and second toes for balance instead of all the toes. While it’s true that the big toe’s primary role is to aid in balance, it’s detrimental to muscular balance to only or heavily rely on that for balance aid and “pushing off” the ground while walking and running. So, exercises focusing on using all the toes evenly for balance is a great start for strengthening neglected body parts.

 

Strengthen Quads (& VMO)

Many flat-footed individuals run with a tiny bit more flexion in their knees than their counterparts. Often there is also medial stress added to the knee thanks to the excessive rotation happening in the lower leg that drives rotation of the upper leg (femur). Thus, it’s important to strengthen the quads through isolated quad extensions and other functional movements such as squats and lunges. To help correct the medial knee stress, strengthen the most medial compartment of your quads (the vastus medialus oblique – VMO) by doing quad extensions with the feet turned out. This targets that medial muscle and allows it to activate. You can even try pulsing up and down gently to get this muscle to burn – which in this case, will be a very positive thing for your body.

 

 

Stretch Hamstrings and Hip Flexors

Tight hamstrings and hip flexors are routinely the result of glute (aka booty) muscles that aren’t working at full steam. Holding 60-120 second stretches will help release these tight muscles and any associated pressure they’ve created on the lower back and glutes. These long sustained stretches should be done at the end of a workout but you can do shorter stretches of 15 seconds or less to help them limber before a workout.

 

Glute Med Exercises

Think clam shells, side lunges and side lying leg lift series from Pilates. These exercises will help strengthen the “outer thigh” muscles located at the top and side of your legs. This area is a part of your glute muscle group and it helps decelerate rotation of the leg when walking and running. As mentioned, with overpronation there is excessive rotation and thus, these muscles are often stretched out and weak. When they’re strong we can better control overpronation and also decrease IT band tightness. Woo! 

 

 

Glute Max Exercises

The powerhouse muscle in the body (aka booty muscle) needs to be strong and in control at all times. The musculoskeletal system’s chain of command gets thrown off for the flat-footed crew so it’s important to place strength back where it belongs. Exercises can include hip bridges (see above pic with the modification of adding a leg lift – which makes it harder), squats, lunges, plie squats, side lunges, leg press, hip extensions, dead lifts, single leg dead lifts, incline work on cardio machines, and more. Don’t forget to do these with the toes pointing straight – not turned out!

 

Back Extensions

Last but not least, maintaining flexibility and strength in the lower back is important for preventing lower back pain that may result from excessive strain and ground-force impact associated with flat-footedness. Try back extension exercises on the mat such as supermans, roman chair back exercises, yoga extensions and chest openers, and more.

 

Cheers to moving better and feeling great!

 

Yours in health and wellness,

Maggie

 

 

 

 

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Different Types of Exercise: Pros and Cons

Exercise variety can maximize your health returns and reduce your risk of injury. On the flip side, focusing on one modality at a time can enhance your sport or exercise-specific performance. So, the decision is yours. Without further ado, let’s look at the pros and cons of focusing your physical efforts on endurance training, high-intensity interval training, Pilates, yoga, light weightlifting, and heavy strength training.

Pros & Cons Endurance

Endurance Training

Pros – Endurance training is when you exercise in an aerobic zone. This includes a wide range of movements and sports, from walking to riding a bike, and more. Generally speaking, when you’re exercising in this zone, you can sustain your effort for longer periods of time, possibly even while carrying on a light conversation. The ability to sustain energy in this zone means that you can oftentimes handle both longer workouts and more frequent endurance workouts. Either of these scenarios can help you stick to a training plan, burn calories and improve cardiovascular health. Endurance training is great for fat burning and individuals of all fitness levels.

Cons – Although endurance training usually yields fat-metabolism for fuel, too much of this exercise can also deplete muscle stores. This can happen when individuals overtrain, do not supplement their exercise with proper nutrition, and/or do not balance their regimens with strength training. Also, in recent history, there has been some evidence that extreme endurance exercise training may cause abnormalities in the heart. Hey! What do ya know? You don’t have to make yourself feel guilty for not being an ultra-marathoner! 

 

Pros & Cons HIIT

High-Intensity Interval Training (HIIT)

Pros – HIIT is an awesome, time-efficient way to get in your workout. It involves high-intensity bouts of exercise interspersed with moderate to light-intensity exercises for recovery. Not only is this exercise format a time-saver, but it also causes Excess Post-Oxygen Consumption (EPOC). EPOC is a term used to describe the extra oxygen that your body demands and consumes following rigorous exercises. While consuming this extra oxygen, your body’s metabolism is elevated. This means that you’re continuing to burn calories for as much as 36 hours following a HIIT workout! Not bad, I must say!

Cons – There is no standard formula for a HIIT workout, even though there are some commonly used routines (for example, a 2:1 work-to-rest ratio). This means that you could walk into an exercise class and be asked to perform any number of different exercise regimens. While this keeps things fresh and full of variety, it also means that unqualified fitness professionals could lead you – and your body –  astray. This is especially true if you’re a beginner or have a low level of fitness since HIIT is very intense, putting individuals at a higher risk for injury if left unsupervised or asked to perform exercises to the point of fatigue (which causes many people to lose form). My advice: trust your gut. Always recognize your right to step out of class or choose an exercise modification that better suits your needs, if you’re not comfortable. 

 

Pros & Cons Yoga

Yoga

Pros – Yoga is one of the oldest exercise practicies, dating back at least 5,000 years ago! Something with staying power like that is bound to be worthy of our attention, right?! Various yoga disciplines and formats can be great for different goals. You can attend a class that focuses on breathing and find that it helps you with stress management and mental clarity. You can also attend a power yoga class to exert some energy, challenge muscles and improve flexibility. Specific poses can improve your balance, core strength, hip flexibility, shoulder stability, and more.

Cons – The trickiest thing about yoga is finding a class that suits all of your physical, mental and spiritual needs. Certain westernized yoga practices focus more exclusively on the physical, while branches of Ashtanga yoga and Hatha yoga may take you a bit deeper. Some people love repeating mantras, learning sanskrit and being encouraged to do service yoga, while others just want to zone out during some sun salutations. Whatever your yogi-cup-of-tea, keep at it until you find one you love! A little research on the formats never hurts. One last thing worth noting though; you won’t have the same muscle and cardiovascular gains doing yoga as you will in other exercise formats. In fact, some people increase their risk of injury by doing prolonged stretches too often. So, since yoga is all about union and harmony, try to find some balance between your yoga sessions and other exercises each week.

 

Pros & Cons Pilates

Pilates

Pros – Pilates traditionally focuses on the core muscles, so anything between your hips and neck. This means that you will be extra vigilent in your awareness about proper posture and core control during one of these workouts. Pilates can be done on a mat, with or without props, and on specialized machinery (most commonly the reformer, cadillac and barrel). If you’re looking to achieve spinal alignment, Pilates is for you! If you’re eager to reduce back pain or increase your core strength, give it a try!

Cons – Several traditional Pilates disciplines focus on the same exercise series for every workout. While these exercises can be scaled for your fitness level, you may reach a plateau after regularly performing them. Some people feel that they don’t get great weight-loss or strength gains from Pilates. Thus, it’s important to get individual advice from your instructor on how to get the most out of each movement and/or how to find a new, more challenging (or less challenging) class. Another drawback worth noting is that it can be difficult to find affordable options for exercising on Pilates-specific equipment. Group classes on reformers are becoming more common and help reduce the costs of participation when compared with paying for one-on-one instruction, but they can be hard to find depending on the diversity of options in your neighborhood.

 

Pros & Cons Light Weightlifting

Light Weightlifting

Pros – Light weightlifting is a great way to workout on days when you don’t have a lot of energy or if you’re new to exercise. Lifting light weights will pump blood to your muscles and stabilize your body. It may also give you a little cardiovascular training effect. Lighter weights are also great if you’re recovering from an injury, tapering down your training regimen, or in need of practicing exercise form/technique before graduating to higher weight classes. These weights may be little, but they can lead to strength! Plus, little dumbbells are kinda cute, right?! Or is that really weird of me to say?…

Cons – While lighter weights are certainly the way to go when you’re learning a new exercise, they aren’t what you need forever. Unfortunately, a lot of women get into a comfort zone with 2.5-15 lb weights and fear that grabbing heavier weights will cause them to bulk up (which is not true…just read the next section below!). This can hold women back from gaining more muscle and reaping greater metabolic and strength benefits. Interestingly, only 10 reps or less is considered strength training – and that’s 10 hard reps, not casual ones. So, if you’re looking for more gains, you can’t pump out 15+ easy-to-moderate reps with five pounders forever. I know, I know, they’ll miss you too!

 

Pros & Cons Heavy Weightlifting

Heavy Strength Training

Pros – Strength training with weights that feel subjectively heavy to you is an excellent way to stimulate your body to adapt. It can lead to muscle gains, bone mass gains, increased metabolism, decreased risk of injury, improvements in joint health, and more! Strength training is an anaerobic activity. In other words, your body uses different energy for this exercise when compared with endurance training, which is aerobic (see explanation above). Perhaps the biggest bonus to strength training is the impact on your physique. That’s right, this exercise format more than any other can help you feel amazing in a strapless gown or bikini. Time to make friends with the barbell! 

Cons – Strength training is very technique-intensive. Without proper form you can easily go wrong in this exercise category. Also, various weight-lifting methods can be complicated to understand for the non-professional. Split training, progressive overload, periodization, and other approaches can feel confusing. This can discourage people who are looking for something effective and straightforward. Thus, if you’re interested in strength training and you’ve never worked with a professional, I suggest that you invest in a few training sessions and make your goals clear to the trainer you’re working with. He or she will respect your desire to get a “crash course” in weight lifting basics so that you can practice them on your own. The trainer can also help decipher what kind of regimen will be best for your body, goals, time commitment, and schedule.

 

Pick your exercise poison and enjoy! Just keep in mind that even if you’re an awesome marathon runner or a heavy-weight champ in the gym, you will need to build in what’s called taper or recovery weeks where you exert less effort and allow your body to restore. Generally, if we don’t balance out our training a little bit, the pendulum is liable to swing in a direction away from optimal performance (often into injury or fatigue).

Have another exercise format (or sport) you’re wondering about?! Fire away in the comments section or email me directly via the Contact form! I’m happy to answer questions about kickboxing, tai chi, skiing, cycling, contact sports, and more!

 

Yours in health and wellness,

Maggie

wellnesswinz blue sea

Two Sources of Pain for Women

At some point in life, lots of women experience pain in their stomach, back, hips and/or knees. The sources of these pain points may feel elusive, but in many scenarios, there are two culprits to blame. I’m here today to help you identify whether you, or a woman you care about, has one of these conditions.

Q Angle

 PAIN SOURCE #1: LARGER Q-ANGLE

Women have wider hips than men. This is not surprising information. In some women, a wider pelvis results in a steeper angle between two landmarks: the ASIS and the patella.

The ASIS stands for Anterior Superior Iliac Spine. Don’t be intimidated – this is easier to identify on your body than it is to pronounce. Place your hands on your hips, like you’re standing with a little sass (thumbs pointing back and fingers forward). Feel where your middle and ring finger fall on the front of your hips. Slide your fingers slightly inwards and you will feel a bony part of your pelvis if you push into your flesh. You found it!

Next, place two fingers on your kneecap. You found the patella! So much easier. 

The Q-Angle is an angle measured between these two landmarks. It’s best done by a physical therapist or qualified fitness professional using a goniometer. Yuck, so many dull scientific words.

For a great visual, check out the illustration on this website: http://bit.ly/1CWkk4X (scroll down just a little on the page)

Why is this relevant to you? 

If you’ve experienced knee pain or instability, ACL issues, pain with running or jumping, and/or hip pain, then you may have a “large” Q-Angle. This doesn’t mean there is anything wrong with you, so don’t panic! It simply means that your kneecap tends to be pulled at a harsh angle, causing stress on the surrounding soft-tissue structures.

Although it’s super unfair that nature has made women more prone to knee pain than men, there are simple ways to ensure knee health. Here are a few:

1) Strengthen your quadriceps. Your quads are the large muscles on the front side of your thighs. These muscles are above the knee and help stabilize your kneecap’s movement. You can strengthen these muscles through controlled leg extensions, leg presses, and squats.

Leg Extension

2) Foam roll your IT bands. Your IT-bands are dense, connective tissue on the outside/lateral aspect of your thigh. Tight IT-bands can add tension and stress to the knee.  Since there is already a strong pull on your kneecap based on a large Q-Angle, it’s important not to add any unnecessary tension to the knee.

A foam roller is a cylinder made of densely packed foam. You can roll your body back and forth on the roam roller to relieve tension in any area. It’s like you’re a big ball of dough on a rolling pin! Not what a woman wants to imagine herself as, I know, but the analogy works!

If foam rolling hurts a lot, it’s a sign your connective tissue is really tense and needs this release. You can reduce discomfort by placing one leg in front of the other, distributing your body weight into the assisting leg.

Note: It’s really important that you don’t roll directly over joints. Ouch. 

3) Control knee stability during lower body exercises. If you watch yourself in a mirror, or even look down at your knees, while performing a lower body exercise, you may notice that your knees drift slightly inwards. When your knees drift towards one another, it creates stress on the joint capsule. Although this may improve with leg strengthening exercises, it may also be a factor of form.

You can increase your awareness by simply being mindful of your form. If you notice that your knees are drifting inwards, simply exert a little effort and move them wider. It doesn’t have to be excessive. It should feel more comfortable and will help you feel better balanced.

4) Strengthen your “outer thighs.” This may surprise you, but there aren’t any “outer thigh” muscles per say. When you perform exercises to target this area, you’re actually working muscles in the outer region of your hips/gluts. More specifically, muscles called your gluteus medius and gluteus minimus. 

A wider Q-Angle means that these muscles are pulled and elongated a bit more than usual, resulting in them being less stable and strong. Since knee health depends a lot on ankle and hip stability, it’s a good idea to strengthen these oft-forgotten muscles. You can do this through side lunges, lateral movements, lying side leg lifts, clams, and more.

 

PAIN SOURCE #2: DIASTASIS RECTI

Even if your baby-making years are far ahead or behind you, this is relevant information because it may impact you some day, or it may have taken place during pregnancy without your awareness. For women who plan to have children soon, or who are currently pregnant, listen even closer.

Diastasis Recti

We’ve all admired another person’s six-pack at some time or another, right? Well, imagine that the rippled six pack has an enormous split down the middle, separating and pulling the two halves away from one another so that the abdomen looks a little more like two three packs. This is what Diastasis Recti looks like. For a great visual, click here: http://bit.ly/1JQoYaS

Why does this happen?

When a woman gains weight with pregnancy and extra pressure is placed on the abdomen as it stretches, the core muscles are under great strain. The six-pack muscle naturally stretches with a growing uterus, but in the case of Diastasis Recti, the connective tissue that coats your core (the linea alba) gets stretched to a greater degree. The split can sometimes appear as a ridge in the abdomen and can be felt by placing fingers into the crevice. Diastasis Recti is usually diagnosed when the space is two finger widths.

What are the consequences?

Diastasis Recti can compromise a woman’s overall core strength, leading to secondary conditions that challenge overall health and wellbeing. Some women also experience a post-pregnancy “pooch” that they just can’t seem to get rid of because it isn’t a factor of weight loss. Diastasis Recti may present with multiple other conditions such as:

  • Back pain and instability
  • Compromising posture
  • Pelvic floor dysfunctions Hernia
  • Pelvic pain and instability
  • Gas and Digestive problems
  • Fecal incontinence (Constipation)
  • Pelvic floor dysfunction (SPFD)
  • Urinary incontinence
  • Pelvic organ prolapsed

One of our readers shares her personal experience…

When Jenna knew something was wrong:

“Sometime in the middle of my third trimester (while pregnant with my first child), I realized that I had Diastasis Recti. I was only aware of the condition because of my background in nursing school. The particular activity that made me aware of my abdominal separation was trying to sit up in bed (the wrong way). As my stretched-out abs attempted to engage, I saw what looked like a mountain ridge down the middle of my abdomen. This was a little frightening to see and though I was not experiencing pain, I could tell something was not right. When I mentioned this event to my caregiver, I received no concern and no education was given regarding how to protect myself when bearing weight or how to properly exercise my core post pregnancy.

Roughly two years later, I gave birth to my second child and suffered three tears. Even after my injuries healed, my pelvic pain lingered. It was noticeable with long periods of standing at my kitchen counter or when taking long walks outside. The pain was especially acute when I would sit up from a reclined position in bed after nursing my newborn for night-time feedings. I made an appointment to discuss the pain with my provider. She recommended pelvic physical therapy for my ‘pubic symphysis dysfunction.'”

How Jenna got better:

“I am so thankful that I took this recommendation! My pelvic PT taught me about the anatomy of the female pelvis and how childbirth impacts and often compromises core strength. I learned how to measure my diastasis recti and what exercises I could practice to help approximate the abdominal muscles. I learned how to protect my core by creating a “pelvic brace” for exercising and weight lifting. I also learned the proper posture for carrying my baby, how to get in and out of bed, and safe body mechanics for lifting my car seat.

Over a five week period, my pain significantly improved and was rarely noticeable! Only after a two week period of not exercising did my pain return (minimally). I discovered the reason for this is because I’m still breastfeeding my baby and this allows the relaxin hormone to linger, thereby creating instability at the pubic symphysis and also making it difficult to build muscle. While breastfeeding, maintaining my core stability means that I have to exercise regularly (4-5 times a week) and practice Kegel exercises daily. If I can commit to these practices, I remain pain free!”

Thank you, Jenna, a million times over for sharing this personal journey!!! It takes a lot of courage to share it and no doubt other women will benefit from hearing it. 

How do I exercise to prevent or correct Diastasis Recti?

If you believe that you have diastasis recti, then I suggest you work with a reputable physical therapist for at least a few sessions, to get on the right track. As mentioned in the former testimonial, it’s important to learn proper biomechanics for sitting up in bed, lifting heavy objects, and bracing your core during exercises. A great place to start is by checking these exercises, performed by my lovely former colleague, Alison, and presented by my wonderful friend and former PT Cari: http://www.releasept.com/videos/low-back-core/ (The first nine videos work on core bracing in a gentle, but effective, way.)

Jenna’s PT, Stephanie Fournier, has also been extremely generous with her time, and has offered us some answers to important questions about this condition. See her interview below.

 

INTERVIEW WITH WOMEN’S HEALTH CLINICAL SPECIALIST

Maternal Health

1) How many women do you encounter postpartum who have severe pelvic and core instability, and/or a diagnosable condition?

First, I would define severe pelvic and core instability as any pain or dysfunction in the postpartum period that is affecting activities of daily living. This could include severe pain, restriction in activities, avoidance of activities, or slowing a woman down in her normal activities. That being said, the exact number is hard to quantify since I treat in an outpatient clinic where I am only going to encounter those women who do have problems (core instability and/or pain) and who are coming to me via doctor or self-referral. However, I do believe that pain and dysfunction in the postpartum period go largely under diagnosed. What I hear most often from patients is that they tried to talk to a friend, family member, or healthcare provider about their pain/instability/limitation and they are told things such as, “That is normal, you just had a baby,”… “It will get better after the pregnancy,”… “You just have to live with it.”

Some research numbers to reflect on:

  • Incidence of lower back pain and pelvic girdle pain (PGP) in pregnancy range from 68.5% to 76% in prospective studies (Wang, 2004; Kristiansson, 1996; Ostgaard, 1991). And the incidence of PGP alone in pregnancy was 20%, in one prospective ,study (Vleeming, 2008). Why the discrepancy? Most likely pain is under reported.
  • 70% of women experience some sort of lower back or pelvic pain during pregnancy.
  • 1/3 of women report severe limitations in activities of daily living as a result of back and pelvic pain (Ostgaard, 1991). The risk for back pain increases postpartum (Ostgaard, 1997).
  • Most importantly, women having back and pelvic pain are 3x as likely to have postpartum depressive symptoms than those without pain (Gutke, 2007).

2) How do most women identify that they have Diastasis Recti? What tips do you have for identifying it as early as possible?

Most women that I see in the clinic do not realize that they have a diastasis recti (DrA). Often, they are coming to me for pelvic pain (posterior pelvic girdle pain, pubic symphysis dysfunction, lateral hip pain, or abdominal pain) and it is something that we find during our evaluation. They might have noticed a tent or pooch in their abdominal area with sits ups, supine to sit (getting in and out of bed) but didn’t exactly know what it meant. For identifying early on, women can measure themselves with their fingers or a tape measure or just look at their tummy when they are rolling in bed or sitting up in bed.

To measure; the patient starts in supine with their knees flexed. They can place their fingers horizontally in the umbilicus and raise their head up. They are measuring how many fingers they can place inside the gap in the rectus abdominis. [It should be noted that this finger method is highly unreliable and it is better to use a tape measure, however the tape measure is hard to do on yourself]

Some more research numbers to be aware of:

  • 66% of women develop a DrA by their 3rd trimester.
  • 39% of women have a significant DrA several years after delivery. Significant is defined as separation of 2.5cm or more (Ranney, 1990).
  • More than 50% of women presenting for urogynecological examination presented with a DrA. These are postmenopausal women. Likely, the DrA developed during the child bearing years and never fully resolved postpartum, leading to poor core stability and pelvic organ prolapse (Spitznagle, 2007) .
  • DrA is associated with varying degrees of stress urinary incontinence, fecal incontinence, and pelvic organ prolapse (Spitznagle, 2007). This is why treating DrA early on in the postpartum period is so important to me. We could potentially be helping women to avoid major symptoms and even surgery.

Also, Parker (2008) found that women with DrA tend to have higher degrees of pelvic or abdominal pain.

3) How soon after pregnancy can women start working their core muscles again? How do you suggest they start?

I recommend that women return to activity postpartum as they feel comfortable. However, I do have a few recommendations for those women who do have a DrA [separation of 2.5cm or more at the umbilicus, 4.5cm superior to the umbilicus, and 4.5cm inferior to the umbilicus].

  • Avoid obliques, regular crunches/situps, and planks until the DrA is reduced to 2.5cm or less OR the woman can affectively activate a co contraction (transverse abdominis + pelvic floor muscle contraction)
  • When treating a DrA, I start with initiation of TrA (transverse abdominis) which they can start day one postpartum with or without a c-section
  • Progress to DrA curlup (Neville, 2008)
  • Various TrA stabilization activities or progressions, depending on the individual
  • Consider corset or elastic binder per the individual
  • Avoid bearing down (valsalva) and sitting straight up (in bed/jack-knife)
  • As always, ensure proper pelvic floor muscle activation (including power, endurance, and coordination)

Thank you, Stephanie, for sharing your wisdom and expertise! You went above and beyond!

If you have any questions about this content and/or exercises to improve your health, then please don’t hesitate to reach out! Upon request, I’m happy to share the medical studies that Stephanie referenced too.

Being a woman can be tough stuff, but there’s no reason why we can’t feel amazing and pain free!

Yours in health and wellness,

Maggie

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References:

https://www.abdominalconnections.com/diastasis-recti/

http://gregnuckols.com/2013/07/17/do-women-need-to-train-any-differently/

http://www.webmd.com/baby/guide/abdominal-separation-diastasis-recti