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Diastasis Rectus Abdominis: Filling The Gap Part 3

This final post in the three part blog series will help you bring everything together and allow you to move forward with training.

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With a strong core, you will be able to effectively and efficiently transfer load. Obviously when I mention “strong core” I am not talking about a six pack. As good as that may look, it screams dysfunction. Sit-ups and crunches should be banned in all 50 states. Yes, I am serious.  When I say strong, I am talking about moving with activation of your diaphragm, pelvic floor, and all abdominal and lumbar musculature with proper movement patterns as mentioned in Part 1 and 2 of this series. During pregnancy, I work with women to train for the “big event.” This means assessing women in movements she is frequently doing and making sure they are being done well. Any movement that exacerbates an already present diastasis needs to be avoided. This applies to both pregnancy and postpartum. For any of you that have already trained for any event, you know that great training leads to better recovery. Birth is the biggest athletic event of a woman’s life, and – trust me – you will appreciate a quicker recovery.

While the exercises demonstrated in the functional progression video seem simple, I guarantee you will find the challenge in actually performing these clean movements; especially as you are just starting. It is crucial to focus on the movement itself and not how many repetitions or sets you are getting in.  Once this foundation is solid, resistance and weight can be added to the extremities. (Watch for videos coming soon.)

Focused core work should be done on a regular basis and I recommend adding at least one of the functional progression steps into each warm-up as well as spending 2-3 days per week moving through the entire progression. This may be body weight only or with resistance and or added weight.

Why should you continue to work through this progression and what will this help? Other than the obvious benefits listed in the previous blogs, it will be helping you literally all of the time. To prove this to you all you need to do is answer one question for me: How often do you breathe? Okay, point proven. Really though, it is that important. Yes, I could go on about the benefits of strength training and the benefits of hiking or biking or even running and how your core function is DIRECTLY related to each of these, but I will not. I will not because when it comes to core health, it does not matter what form of activity you choose. You need this stability to walk to your car. Hell, you need this stability to sit at your desk all day.

As chiropractors, my husband and I work with all levels of athletes (females and males), from amateurs to world champions. It can be humbling when the weights are taken away to perfect these basic movements. But time and time again, we see the benefit. Performance gains are made faster and injuries are reduced. Gaining this stability and strength can help to reach performance levels that may even be beyond what our athletes expected. And truly, we are all athletes; the variation is to what degree we utilize our athletic capability. Again, birth is the biggest athletic event of a woman’s life! Improving “performance gains” in birth means improved labor outcomes and “reduced injury” translates to faster healing postpartum!

Your body is incredibly intelligent and you will move from point A to point B if needed. The question is whether you are both effective and efficient. If you are moving with compensation (or birthing with compensation) instead of function you are setting yourself up for injury. You may not see the side effects of compensation immediately, but I guarantee you will eventually. The side effects show up in numerous ways: shoulder injuries, knee injuries, low back pain, neck pain, pelvic floor dysfunction, DIASTASIS!

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Compensations, also known as poor movement patterns, lead to what I call “energy leaks.” This is a forced (instead of smooth) transfer of load, taking more energy and causing decreased performance.  If you are healing a diastasis postpartum, know that leaving this untreated is not without further issues. DRA not only causes troubles for mom but can potentially affect future pregnancies, including positioning of baby and labor. When we apply this idea of forced transfer of load instead of smooth transfer of load, we’re talking about physically transferring the load (weight) of your baby from internal to external.

Please look at the big picture. Your body moves as a whole unit. Train it that way. Whether you want to move heavy weight, run a mile, walk up a flight of stairs to work, or give birth, you need your entire core to be stable! An injury will cause you to realize how much your core is needed in EVERY. SINGLE. MOVEMENT.  As you return to or start activity, this is work you should continue to improve for the rest of your life. Implement these changes. Pay attention to the form you are perfecting during your core work and make sure it is as clean when you deadlift that weight from the ground. It is going to take being mindful to make this habitual, but you will reap the rewards.

Ideally, you won’t know the full extent of these rewards because ideally, years from now you will still be implementing these functional movements and making time for this habit instead of worrying about bathroom stops on your one hour drive, peeing your pants at the bottom of a snatch, and last but not least, your “gap” will be filled.

Share this information with others. Be part of this paradigm shift by exposing others to information that can truly be life changing.

Remember, postpartum lasts a lifetime and movement is life. Do not settle or own dysfunction because you are female, age X and/or have had children. You deserve a quality life and this is certainly going to help you achieve that!

 

QUICK TIPS REFERENCE LIST

 

Top 3 Exercises for Pregnancy:

Functional progression

Squat

Farmers Carry

 

Top 3 Exercises for Postpartum:

Functional progression

Good Morning

Banded rows

 

Avoid: (During pregnancy and postpartum)

Sit-ups

Crunches

Toes-to-bar

Poor Posture & Prolonged Sitting

ANY exercise that aggravates DRA (this may include, but not limited to, planks, push-ups, and pullups)

 

Please, if you have any questions at all, then I encourage you to set-up a phone consultation with me, or we can schedule a consultation in person at Coulee Health. I’m super eager to discuss all things pelvic floor and core related. And, I’m even more motivated to help you get moving again. After all, MOVEMENT IS LIFE!

-Dr. Erica Boland, DC

@EMOMDC

Mother of 4

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Diastasis Rectus Abdominis: Filling the Gap Part 2

As discussed in Part 1 of the DRA blog series, in order to understand how to heal diastasis and properly train the core, we need to understand how our bodies were made to function in the first place. Babies are born with immature motor patterns. You will notice newborns tend to have knees tucked and hands and arms often flexed close to body and even near the face. Development begins with the drive to learn more and explore the surrounding environment. As babies are exposed to lights, sounds, and touch, they have the desire to discover more of this world and begin to integrate different parts of their body into learning.

Babies are not taught to roll, hold or grasp objects, sit up, crawl, or walk. Movements do, however, occur in a typical sequence and it is crucial that each milestone is met. Our movement patterns in the first year of life are the basis for function in movement as adults. As we watch the movements of babies and toddlers we can teach ourselves. If milestones are not met, the area is not used properly with movement patterns and can lead to problems later on. For example if support on elbow during tummy time, rolling or crawling does not happen, the scapula (shoulder blade) is not secure within movement and can eventually lead to impingement issues or even tears in the rotator cuff, etc. This is also one reason a patient can have surgery on that same shoulder and end up with the same problem. If the movement pattern is not addressed, the problem remains. Meeting milestones seems exciting as the little ones progress but the saying holds true “let them be little.” Let them do it on their own and do not push before they are ready.

 

Developmental Milestones:

 

6 weeks:

Thumbs move from inside closed fist to outside closed fists

Eye contact begins

 

3 months:Big Mac

Open fist

Support on elbows

Can rotate head without moving trunk

Spine starts to upright from mid to upper back

 

 

 

4.5 months:

Start support on opposite knee and elbow (helping to begin closure of DRA)

Diaphragm flattens and mature breathing patterns begin

Free hand grabs objects but cannot cross midline

Hands can touch hips and groin

 

6 months:

Oblique muscle activation occurs

Able to roll from back to belly

Can grab feet with hands

 

 

7 months:

Can bring toes to mouth

Rocking from base of support on hands up to all fours: video example

 

 

7-8 months:

Start to creep forward with use of upper body

Oblique sit occurs (first elbow and down thigh, eventual open hand and down thigh)

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8 months:

Crawling

Sitting upright

 

9-10 months:

Further crawling development

Stepping forward to standing

Side walking along furniture

 

10-12 months:

Stand freely after standing with support

Walking between objects (side to side)

Walking in sagittal (forward) plane

 

14-16 months:

Stand independently from “bear” position

 

The movements attained in the first year of life are the foundation of all basic human movements. Following a major event like childbirth (or surgery or other major trauma), re-learning these movements IN ORDER helps heal the body as well as establish a solid foundation to build strength on. The diaphragm is used for both breathing and postural support. At 4.5 months as the diaphragm flattens and a more mature breathing pattern begins. When addressing the core, especially postpartum, the first step is establishing a strong breathing pattern. (Check out Dr. Mumma’s video here.) This is key in reconnecting to your core. After creating a human in that space for the the majority of a year, a woman needs to discover her new normal. Working on diaphragm activation can and should be done in the first day after birth while bonding with baby. This does not mean you need to start exercise but just focusing on what you are already doing, BREATHE!

 

12-16 times per minute: BREATHE.

In through your nose, out through your nose or mouth, filling your entire abdomen with air. When you inhale, your chest should not rise, but rather your belly should expand 360 degrees. This begins the healing process of the postpartum period internally.

Healing of the core needs to come from within. This occurs only after proper diaphragm activation which is a movement downward of the diaphragm during inhalation and upward during exhalation. From the outside, there will be expansion of the chest and abdomen in an outward direction as opposed to a dysfunctional upward motion of the chest and shoulders, as you saw in Dr. Mumma’s video above. As diaphragm moves downward, abdominal and lumbar musculature are contracted eccentrically (bracing outward, NOT SUCKING IN) and simultaneously counteracted by pressure of the pelvic floor. How awesome is it that we can gain a strong core by doing exactly what the baby just born will be doing?! Start with diaphragm activation, gaining proper intra-abdominal pressure, and move through the sequence of developmental movements, and the core will be strong enough to support day to day movements and eventually more vigorous exercise.

 

Functional Progression Demonstration Video

 

Breathing and movement patterns need to be discussed before birth and definitely assessed postpartum. Change is needed. It starts NOW.

As a practitioner, my work with pregnant and postpartum women continues to grow. This is where I not only see the literal gap in the body’s system (DRA) but also see the figurative gap in our system.

Consider this scenario: mom has baby, mom and baby are both healthy, mom presents for postpartum check up and pending no major issues is “cleared” for exercise. The evaluation being done of the core function at the postpartum visit is minimal at best and often completely overlooked. In fact, full movement patterns are never assessed. There is occasionally a check for diastasis rectus abdominis but not the entire core function. This leads to mom turning to online forums for help with a “gap” in her stomach or she may have been told to do crunches and sit-ups to help. The fact that our society has made “mommy tummy” a marketing ploy is an entirely different topic.

Let’s think about this though. In a hospital setting, as most births in our country are, practitioners are allowed limited time with patients as it is. For them to take on a thorough, functional physical would not only add appointment length but also require further education. My opinion is this is the point that collaboration in postpartum care must occur. Furthermore, my experience has proven time and time again that restoring core function in the immediate postpartum period launches moms into better recovery postpartum and overall better movement patterns. Long term, this leads to everything from less leaking when she sneezes (or runs, or laughs) to reduction in neck and back issues.

Beyond that, when assessing and treating the DRA, we must recognize that this is related to the entire movement patterns of the mother and not the diastasis alone. Sit-ups, crunches, holding the belly together during a contraction of the abs, and “zipping” the waist are not exercises that will be relatable to true movement. These are exercises towards strengthening single muscle groups and while they may seem to be beneficial temporarily, long term problems are likely to remain. We do not decide to get up from the chair and use transverse abdominus to walk to the yard. We also don’t consciously think about using our pelvic floor to stand at the park and watch our kids play. We need these muscles to be working together without conscious thought and in order for the muscles to work together they need to be trained through movement patterns we will use. Often that means taking it back to the basics of moving like a three or four month old infant. Trust me, even athletes moving heavy weights are humbled by this training and while they may be frustrated at the idea of dropping their weights, they are happy with the eventual improved strength and reduced risk of injury.

 

How does this all relate to your pelvic floor? Your core function is directly related to your pelvic floor function (fun fact: your pelvic floor is part of your core). It is actually directly related to ALL movement. Your core is your powerhouse. Without stability in your core, your foundation is off and eventually the pieces will crumble.

BIRTHFIT is education! We refer to the postpartum period as Queen in Training, and expect this specific healing time to last 9-12 months. Postpartum lasts a lifetime, but we want you to focus on the movement milestones to meet as a mother and hold yourself accountable to this. Approach your immediate postpartum period with intention and purpose. Know your body and understand how it functions as one unit. You will heal in less than a year and you will function better than before. If you can grasp this concept and share this with others, together we will create the shift in care that we need.

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Dr. Erica Boland, DC

BIRTHFIT Wisconsin

@EMOMDC

 

 

 

 

 

 

PART THREE… next week, relating core function to training

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