Postpartum Abdominal Recovery

Wow! Let me just say I never anticipated just how weak my core would be after delivering my beautiful baby girl. For weeks I felt like jello, and looked a little like it too! Ladies don’t be fooled…you are much stronger PREGNANT than you are after delivery. After delivering my nearly 10 pound baby and ridding my body of all that associated with it my abdomen was a mess. I’m pretty sure I had intestines floating around for weeks and my organs were all in shock trying to make their way back to where they should be. All those ligaments that have been stretched out for the past 6 months were getting some relief (finally no more pain!), but still affected by relaxin they were nowhere near where they should be. Now in order to understand the concept of abdominal rehabilitation after delivery there are a few things you must know first. a) What is relaxin, and b) Basic abdominal anatomy and c) What to do before you hit the gym!

What is relaxin hormone?

Relaxin was discovered in 1926 in pregnant guinea pigs. It was shown to cause the pelvic ligaments to relax, allowing the body to accommodate the strain of pregnancy and ease the passage of offspring through the birth canal. The hormone was later demonstrated to have a role in the softening, or ripening, of the cervix through collagen remodelling. Relaxin is produced in the corpus luteum, the placenta, and the uterus in females, as well as in other reproductive structures; this varies by species. (http://www.britannica.com/EBchecked/topic/496940/relaxin

Relaxin hormone is responsible for many injuries during and after pregnancy as it is present in your body for up to 6 months after delivery! It is important to remember this as you continue your journey of health in order to take extra caution and prevent setbacks due to injury. Your ligaments and joints are loose, particularly in your back and pelvis causing instability and contributing to pain and misalignment. That extra flexibility you gained during pregnancy can work against you when you start training again, so my biggest advice is to not overdo it!

Abdominal Anatomy Overview

Abdominal muscles

Image Source

Your ‘abs’ are actually composed of 4 different muscles, they are arranged in layers stretching in different directions across your abdomen. Your rectus abdominus is the muscle that most people associate with a 6 pack. This is where your diastasis will be if you developed one during pregnancy! See my post here for more information. Then you have your external and internal oblique muscles, your external oblique form that nice V shape you see on the cover of Men’s Health, and the internal oblique muscles run the opposite direction providing added stability, torque, and assistance with side bending. Lastly there is the transverse abdominus which in my case is the most important to be aware of postpartum. This is the deepest muscle of your abdominals. It wraps all the way around your midline in a horizontal fashion acting essentially as a corset keeping everything together. As you can guess, with all that stretching and movement in there during pregnancy this deep core stabilizer is incredibly weak postpartum and makes even simple movements, like a squat or pushup, extremely difficult. You truly do not realize how much you use these stabilizer muscles in everything you do until you lose them!

Before you hit the gym…

Lastly, I will review some things to keep in mind before you hit the gym…this may sound a little intense but I really really want to get my point across because I have seen too many people causing permanent damage while trying desperately to lose that baby weight.
1) If you are like me and feeling good after a few weeks you may just want to jump back into what you were doing before you got pregnant…STOP RIGHT NOW! Your body needs a much needed break after all that torture you put it through! Wait the recommended 4-6 weeks postpartum before working out again or you may find yourself dealing with unnecessary postpartum complications such as bleeding, pelvic pain, incontinence, or worse. This is granted you had a regular delivery, C-section recovery is obviously more challenging and as always, everyone should consult their doctor or midwife before starting any new exercise program.
2) Remember to take it slow, if it hurts, stop, think about it, and modify. Start with a simple walk, personally I couldn’t believe how challenging even walking is after not doing anything for a while!
3) Your baby and your health come first. If you aren’t sleeping, barely eating and trying to go hard at the gym you are going to compromise not just your milk supply (if you are nursing) but also your sanity. Be kind to yourself.
4) If you have any lingering impairements from pregnancy especially diastasis recti, hip instability, pelvic floor dysfunction, healing stiches, broken tailbone, etc, etc. make sure you check with your doctor first and take the proper precautions during your workouts!  Remember, even after you are cleared to workout your body is still healing and is very easily injured. I highly recommend hiring a trainer/kinesiologist/physical therapist educated and experienced in postpartum recovery. They will be able to guide you in doing proper exercises and modifications to avoid injury and gradually get back into a solid workout routine.
5) Lastly, CORE CORE, PELVIC FLOOR & MORE CORE…that is what you need to work on before even attempting any heavy lifts, strenuous movements, jumping, or anything else putting strain on those poor abdominal muscles and pelvic floor. Do you want to be incontinent and have a mummy tummy forever? If the answer is no then start doing those kegels and stay tuned to my next blog post for some exercises to do everyday!,

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Diastasis Recti

Do you have a diastasis? I DO! Surprisingly, being in the medical field I had never heard much of this before becoming pregnant. When I was about 20 weeks along I noticed this strange ‘ridge’ forming in the middle of my stomach every time I leaned backwards or got out of bed. Naturally, I freaked out. I did some research and this is what I learned.

“Diastasis recti is a separation between the left and right side of the rectus abdominis muscle. This muscle covers the front surface of the belly area… Pregnant women may develop the condition because of increased tension on the abdominal wall. The risk is higher if with multiple births or many pregnancies.” (source). “A diastasis recti looks like a ridge, which runs down the middle of the belly area. It stretches from the bottom of the breastbone to the belly button. It increases with muscle straining” (source).


So what to do? First I realized that a lot of what I was doing was all wrong, and had probably made my condition worse, hence why I noticed it so early on in my pregnancy. Being a first time mom I wasn’t showing much at all in my first trimester and therefore decided it would be beneficial to continue an abdominal and core strengthening routine throughout the first trimester. Well, this was a mistake.

There are many exercises that are contraindicated for diastasis recti, including crunches, planks, V sits, and pretty much all your standard ab exercises! Also, I realized that I had an very tight rectus abdominus, that was out of balance with the rest of my core muscles, putting extra strain and pressure on my linea alba (the connective tissue between the two sides of your abdominals), which in turn increased my risk of developing a diastasis.

So first thing I did, I stopped working out my abs. Second thing I did was cry a little, haha kidding, but really I was pretty upset and feeling a little stupid. Lastly, I pulled out my old therapy books and look up what I can do to be proactive about healing this diastasis both before and after this baby is born.

During pregnancy there are a few things you can do in order to prevent this, or in my case prevent it from getting worse. It is important to be aware of how you are moving and how much strain you are putting on your abdominal muscles. For example, the way I would normally get out of bed (simply by sitting up) puts an excessive amount of force on my abs and literally tears them further apart every single time. By using a log rolling technique, where you lie on your side and use your arms and the help of gravity to get up helps to decrease this strain and tension. Also, being aware to engage your transverse abdominus (TA) when doing any lifting or bending also helps protect your abs and distributes the force evenly across your entire core.

What is your TA?

It is the muscle that acts like a corset, supporting your torso and core muscles from the front around to the back. Now, being in my last trimester I am focusing on strengthening my TA and pelvic floor muscles not only to prevent further diastasis but also to aid with labor and delivery. After birth, the same principles still apply. Doing 100 crunches a day will do nothing for your mummy tummy except make it worse! There are many exercises that can hurt a diastasis and cause it to never heal properly, and others that encourage the muscles to heal the way they were before.

Kinesiotaping for Diastasis Recti

The last thing I would like to share with you on this topic is the power of Kinesiotaping. If you haven’t heard of this, it’s a fairly new concept that uses fabric elastic tape applied to the skin in order to aid with recovery and the healing process. A more in depth explanation is supplied below, from here

“The Kinesio Taping® Method is a definitive rehabilitative taping technique that is designed to facilitate the body’s natural healing process while providing support and stability to muscles and joints without restricting the body’s range of motion as well as providing extended soft tissue manipulation to prolong the benefits of manual therapy administered within the clinical setting. Latex-free and wearable for days at a time, Kinesio® Tex Tape is safe for populations ranging from pediatric to geriatric, and successfully treats a variety of orthopedic, neuromuscular, neurological and other medical conditions. The Kinesio® Taping Method is a therapeutic taping technique not only offering your patient the support they are looking for, but also rehabilitating the affected condition as well. By targeting different receptors within the somatosensory system, Kinesio® Tex Tape alleviates pain and facilitates lymphatic drainage by microscopically lifting the skin.  This lifting affect forms convolutions in the skin thus increasing interstitial space and allowing for a decrease in inflammation of the affected areas”.

After reviewing various coursewares from my past and reviewing the application and proper use of Kinesiotape I discovered that this could also be used during and after pregnancy! So here I go, trying anything I can to be proactive about healing my diastasis.

This is me in the picture below, I think I’m around 31 or 32 weeks here, and I have been applying the tape for approximately a month leaving it on for 3 days, then taking it off for one, then back on for 3, etc. By placing the tape in this formation using proper technique, it essentially ‘reminds’ my muscles that they are meant to be together and not pull apart, encouraging proper alignment and decreasing tension on the linea alba.

IMG_3318IMG_3319Yes, I look silly, and I get alot of attention in the pool change room! But it’s a small price to pay for something that really works. When I take off the tape I usually check the status of my diastasis, and after using the tape for 2 months it has not gotten any worse! This is shocking to me considered how much larger my stomach has gotten, and I also have not had any pain associated with it. I also feel it serves as a proprioceptive reminder to keep my core in proper alignment and reminds me to engage my other muscles during activities to protect this fragile connective tissue.

I hope you learned something from this article! Please don’t hesitate to contact me with any questions about my own personal experience so far. I am so pleased with the outcome thus far that I have signed up for a hands on course on how to use Kinesiotape for a multitude of different conditions, so look forward to future posts on this subject!

Read more on some new posts I wrote here and here! Do you have a diastasis and don’t know what to do about it? Contact me today, I can help!

In fitness and good health,
Natasha

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