Today let’s learn a little about diastasis recti (DRA)! Specifically, how to check for it. It is best to get an official diagnosis from a pelvic floor physical therapist but if you are curious about how to check for yourself then here is the easiest way to do so.
Note: it is truly best to check in every position you utilize, and with every exercise you perform just to see what is happening with your abdominal wall. Lie supine (on your back) with knees extended and abs relaxed. Find your belly button, then raise your head without contracting the abs. Can you feel the margins of your rectus abdominis (the “six pack” abs)? How many fingers wide is it? Palpate above and below the belly button? How far down can you feel it, and how far up toward the ribs can you feel it, if at all? Next, repeat the same motion but this time begin by firming up your deep abdominals as if you are bracing against someone trying to tickle you. Then lift your head and re-check. Any different? Is it wider, narrower, soft and squishy, firm? Now how far down and up can you feel a separation, if any? DRA is very common in pregnant and postpartum women but it is not just this population that experiences it. In my clinical experience it has been just as common in men! I am in the habit of checking everyone who mentions low back pain, regardless of gender or childbearing history. It’s an easy check and can help guide rehab and corrective exercise prescriptions. As always, check with a pelvic floor physical therapist for an official diagnosis. This is meant purely as a fun curiosity check and by no means a diagnosis, but you knew that, right? 😎 Further, more and more literature is coming out revealing that the width of the separation is much less important than the depth of the separation and tension beneath it. Soft and squishy between the two sides indicates weakness of the deep transverse abdominis (TA), even if it is just a single finger width. But some people can have several fingers wide and able to create full tension of the TA when cued, and this is seen as being better than a narrow gap with no tension. Also of note, it is considered an "abnormal separation" when the gap is greater than 2.5 cm or two fingers wide. Why? Who knows. Because if the person cannot create tension in the TAs then 2.5 cm is significant. It all just depends! *By the way, I had a video that went along with a portion of this post originally posted on my Instagram account, but it requires far more tech knowledge than I possess to learn how to do that here :)
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Ab gripping. It is way too common, especially in women. AKA “sucking in.” It is something we do so much that we stop even noticing we are doing it.
Are you doing it right now? Take your had and place it on your abdomen, close to the ribs and gently jiggle the abs. Feel relaxing? Or was it hard to do? Probably gripping. Check out your abdomen in the mirror: is there a cinched in area at about the level of the belly button, looking from the side? Gripping/sucking in. Are the top abdominals more defined than the lower half? Gripping. Can you "zip up" your abs from the pubis/crotch without those upper abs firing? Gripping. Looking from the side, does it look like your lower abdomen sticks out farther than the upper half? Gripping and lower abdominal weakness. It is constant, long term tension in a group of muscles (usually upper rectus abdominis/"six pack abs" and upper transverse abdominals (TA)) and over time, those muscles adapt to what we ask of them and shorten/weaken so when you go to ask something of them (a heavy lift, core exercises, weight gain, pregnancy, etc.) they have nothing left to give and the pressure has to leak out somewhere, soooooo...yea, diastasis recti (abnormal separation of the abdominal wall) prolapse, leaking of urine or feces, inability to control gas, disc herniations, herniations of the abdominal wall, hemorrhoids, etc. Fun, huh?! Imagine flexing your biceps muscles all day every day. You wouldn't really be able to use your arms very effectively if your biceps were constantly flexed, ha! What would you expect to happen with those muscles? They would shorten and become very tight. Same idea with your abdominal wall. This sort of abdominal weakness is perfect staging grounds for lots of fun stuff, as mentioned above. Men, too! Women are by no means the only ones suffering these issues. Men are just as likely to develop these kinds of problems via means other than pregnancy. Obviously :) If you can’t just relax your abdomen on command (one way to tell you REALLY need this!) then get down on all fours and allow gravity to assist you. Let your belly relax down toward the floor gradually. I know, it feels really weird at first and you will likely be able to feel your body tensing against it, but work through this. Try to keep the shoulders engaged and don’t sink into them. Keep your spine as neutral as you can, trying not to let your low back curve too much. Focus on breathing deeply and slowly, in and out🧘♀️ If you can get in the habit of checking in throughout the day and seeing what your abs are doing (particularly in times of stress) make note of it and try to relax. Hate having your belly "pooch" (terrible word, but everyone can picture it!) out? I get it! But that is what loose-fitting shirts are for in this stage of the game, right?! All sorts of things improve when we stop holding tension, particularly in our abdomen. Digestion, breathing, stress response, constipation, you name it. Try it out and I hope you find some relief! Another quick chill trick: left tragus stimulation. The tragus is that part of your ear that sticks out over the opening (in the pic) and tapping or gently rubbing this part of your LEFT ear for *30 seconds* stimulates the “rest and digest” part of the nervous system (parasympathetic, vagus nerve) and will bring you a needed chill out. DO NOT do the other side. LEFT SIDE only :)
Really, that’s it. Seems too simple? I know. But try it and see what you think. Sitting in traffic? Tap away. Kids screaming at you for the 18,472 time today? Tap tap tap. Sitting in a frustrating meeting? Tappity tap tap. Feeling pelvic floor heaviness more? All of the tapping! Watching/reading the news? Turn it off and tap the rest of the day! Kidding, but only a little. As a member of the hypertonic (tight) pelvic floor group it is especially important to continue to add to my relaxation skillset and find ways to make it happen regularly so that I can decrease symptoms. I love this trick for its simplicity and ability to do it anywhere. Unnecessary stress can lead to all sorts of damage and our pelvic floor is one area particularly vulnerable to stress. Tension in your face? Shoulders? Neck? Very likely the same thing is happening down below. Go try it and show that vagus nerve some love! We all need to take a chill pill, multiple times daily. Especially if you are a parent. Or a human. Try this one out for size and see what you think. No side effects, just straight relaxation. The hardest part is remembering to take a step back when you need it.
Did you know that your pelvic floor also responds to your perceived stress? For me, it tenses up and the symptoms can flood in (hello leaking, hello pelvic floor heaviness, hello frustration!). Having awareness helps to keep those things at bay. Luckily, the pelvic floor also responds well to our ability to chill out. And, just because you've had a bad pelvic floor day it does not mean you are ruined for life. Nope. Stop your pity party and start taking care of yourself again. There is not better time to start than now! We all have setbacks, but we all have the power to move past it and improve a little more each time. What is your favorite quick chill movement or stillness? Henry Ford gets credit for this one (though it is a shortened version of the original). And it is completely true. Don’t forget about the ‘mind’ part of the mind-body connection. They work in tandem. You train your body to do all sorts of things but if you don’t mentally buy-in then stop wasting your time. So which will it be today?
I often find that the right track can be the hardest to commit to mentally. Maybe it seems to easy, too tedious, too boring, too hard, too annoying, too whatever! No one can make you do the thing, only you can decide to do it, whatever it is. When I was told I was going to have to start from even before square one (square 1/2?) I felt mentally crushed and was almost tempted to try something way "easier" (but ultimately would have been a short term boost with very long term negative consequences). But then the rational mind took over thankfully and I decided to buy in. I could do this, I will do this. And so, I started to rebuild my body and my mind and started down the path that has ultimately led me here, to The Pelvic Underground. Maybe today isn't your day, and that is totally fine, normal in fact. But the key is believing that maybe it will be tomorrow and trying again. Believe in yourself, believe in the process, then so it shall be. Postpartum rehab is hard when you want to do it the right way. I guarantee is is worth every single tear, expletive, setback, crappy day, and boring workout at the beginning (because, seriously, it can be SO BORING, but SO WORTH IT!). So, again, which will it be today? I can or I can't? Every happy pelvic floor starts with good breathing habits. If you aren’t being chased by a lion then you don’t need to be stress-breathing into your chest and shoulders. Breathe deeply and slowly into your belly, back, and sides 3-5 times as often as you think of it. Reconnect that diaphragm with your pelvic floor. This goes for men, too. Are you a runner? Try this out on your next run. It is magical!
This post is from April 1, 2019, originally posted on my running blog, Serious Case of the Runs. But, I thought it quite appropriate as my first post here. And, WELCOME!
I ran up a hill last weekend and again yesterday. I ACTUALLY BROKE A SWEAT. I am positively victorious!! And would you be shocked to know that is the first time since October, 2018? Probably. After all, I have a Serious Case of the Runs, right? *EDIT: Since posting this back in April I have been running most weekends pending PFM cooperation. Can we say 'running is magical?' Yes, yes it is.* **Warning: this is a very open and honest post.** Holy s***. I have been on a RIDE people. In fact just writing this I can’t help but cry. It is startling how much one can lose by creating life. In no way do I regret being a great creator of two gorgeous lives, so stop right there. But, I get to sometimes lament completely losing myself in the process. I get to have that. These days, I have come to terms with life as it is and no longer feel anger or body betrayal or self-pity, but I have my days just like any other human being. I will never be who I was again, and that could make me sad, but what I can now counter that thought with is that I look forward to learning more about who I am now, each day, and who I will become. I have had very dark days. Very low lows, but I am grateful to come out of those times, and each time it is a little brighter and slightly less low. It’s sort of amazing, but I meditate now. I actually can’t do a day without it. I love it so much, why did I wait so long to start?! I am in a better place with it. And, I enjoy the challenge of quieting the crazy. We could all use a little less crazy, no? I have missed all of the things. Most of all I have missed running. I have missed identifying as a runner, talking about running, wearing my running clothes, the smell of a new pair of kicks. At first I felt pure rage and incredulity. I was just out for a run in the most beautiful place I have ever been (Kauai, Hawaii), when the bottom quite literally fell out. Pelvic organ prolapse. What. The. F***. Mother. Nature. I am among the 50% of women that this sort of thing happens to. In fact, over the age of 37 the odds of experiencing POP skyrocket. Be nice to your pelvic floors, people!! (This includes men. Obviously, men won’t get it from below, it manifests slightly differently but equally as devastating feeling.) And, for the love of God, stop sucking in your belly. You are beautiful just as you are, all of you! Please, if you or someone you know has experienced POP, first of all know you can do something about it! Not everyone will have the same outcomes, but it is absolutely worth trying. It is an insane amount of work but worth it. Second, *talk* about it! I felt so ashamed at first, like a failure, but then slowly people started to come out of the woodwork and shared their own experience and it is HUGE to know you aren’t alone in a struggle. Hence, this blog post. If anyone has questions, email me, I am happy to chat. Third, find a pelvic floor PT to help you. If you don’t like the first one find another one. A solid PFPT could just change your life. Not to be dramatic, but seriously. I am now working with my fifth(!!) PFPT and not because I didn’t like some but because I have been on a quest to learn *everything* and each one has taught me more and led me to the next, plummeting me further down a rabbit hole :) It has been [22] very long months of getting myself on track and restoring my body to something slightly resembling a functioning human being. I was well on track last September. And then I wasn’t. Some days I am really tired of it all and I just want to toss in the towel, tear up every home exercise program I’ve been issued by various PTs, scream expletives to the universe, and just resign myself to being a motionless blob, rolling through life, sucking at everything. But, that’s just not me. So I get back on the horse and do all of the things. An old friend of mine said recently, “I am so far down the rabbit hole I can’t see the light anymore. And I love it.” Me too, sister, me too. When truly taking your health into your own hands you can’t help but fall down the rabbit hole. I don’t like stones left unturned. Because it isn’t just strength, it is core control, pelvic floor health/strength/mobility/connection, breathing, rib mobility, alignment of EVERYTHING, foot mobility, balance, shoulder mobility, upper body strength, pressure management, glute strength, hip flexor management... Then, maybe one day, a run will happen. I even signed up for a 12 week class to learn more about all the crap that comes with the postpartum body and am now a Postpartum Corrective Exercise Specialist. I have virtually met (because do we really meet face-to-face anymore?) the most amazing group of people imaginable, with similar and varied experiences from similar and varied backgrounds, but all with the same goal in mind: to make ourselves better and stronger and to help others do the same. I have never been more inspired in my life. I am now in a place where I am thankful for my journey. I love where I am now and my exact journey was the only way I would ever have gotten here. Besides, I always had the most success with the PTs who *really* got it, the ones who had walked that walk. I will share that I went from a three finger width diastasis recti (abdominal separation) to one finger width and full tension, and a grade 2 prolapse to now undetectable. Two PTs have been unable to find any evidence of it. Which is crazy because it was definitely there, but then I have worked my a rear off so that makes me feel pretty good. It is a never-ending road of self-care and maintenance, though, so I will just keep chugging along, doing what I need to do to stay on track. And, eventually I hope to help others going through this same sort of thing. Because, I get it. I am a runner again, it looks a little different than it used to. I feel okay with that. In fact, it sort of excites me to focus on running short, fast, and light. Are you a runner? Have you experienced pelvic pain or issues since giving birth that have changed the way you move and feel in your body? Maybe you despise running, but you are a walker, yogi, skater, lifter, gym rat, swimmer, cyclist, mom who picks up increasingly heavier children every day (!), whatever it might be! Comment below, email, or DM me on Instagram. Need to find a good practitioner or trainer in your area? Check out my resources tab! I will be updating this regularly as I come across stuff. |
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