Postpartum

  • Healing Diastasis Recti (abdominal separation)

    Diastasis recti would have to be one of the most commonly asked about conditions or concerns from pre and postnatal women. If you’re not familiar with what diastasis recti is it is defined as a the separation of the 2 muscle bellies of the rectus abdominis muscles (the six-pack muscles). Joining the two muscles is connective tissue (the linea alba) which runs from the bottom of your sternum to your pubic bone and connects the left and right side of the six-pack muscles. As your belly begins to expand during pregnancy the connective tissue that joins the abdominal muscles begin to stretch and thin causing the abdominals to separate to accommodate the growth of your baby.

    The above definition of muscle separation can be misleading and confusing to some women as many think the muscles tear when they separate but in fact, they are still joined by the connective tissue. This tissue thins and stretches to allow for the growth of your baby and is a NORMAL part of pregnancy. It’s important to note that some studies report that diastasis occurs in 100% of pregnancies by the third trimester and that athletes, menopausal women and even men can get diastasis.

    For most women, within 12 months after birth (more on birth recovery here) the abdominal muscles and connective tissue will return to a normal state. However, from some women, a diastasis (gap) and increased laxity of the linea alba remains which can lead to decreased function of the core and weakness in the abdominal wall. These changes cause the belly to fall forward from the weight of the abdominal and pelvic organs and often women complain of still looking 6 months pregnant even years postpartum. The great news is if you suffer diastasis recti with the right management and adjusted training strategies and movement you can manage and improve your function!

     

    Can diastasis recti be avoided?

    There is no definitive answer!!! It is not known what causes diastasis recti and we can only guess the risk factors. What we do know is diastasis isn’t caused by ONE specific exercise it’s much more multifactorial and complex than that. A range of factors may contribute such as genetics, inactivity prior to and during pregnancy, the effect of hormones like relaxin on the joints and tissues, posture, breathing and exercises that cause a build-up of intra-abdominal pressure. Diastasis recti is a very hot topic and I see many women concerned about their degree of separation (example I have a 4 finger gap) but it’s important to note that it’s not just about the gap!!! The gap width is just one part of the puzzle. We also need to consider the tension and function of the linea alba and the person’s ability to control intra- abdominal pressure. Intra abdominal pressure is the steady-state of pressure concealed within the abdominal cavity and this pressure if affected by moving our body through daily tasks like moving from sitting to standing, breathing, coughing, sneezing or exercise. When the pressure increases in some cases this causes weakness as it pushes on the abdomen or pelvic floor.

     

    Loss of control of pressure on the abdomen results in doming or bulging of the abdomen and loss of control from pressure on the pelvic floor often results in bladder leakage or exacerbated symptoms of prolapse. The loss of control can be caused by factors such as form, movement pattern, posture, impacts on the body, muscle recruitment or pressure such as breath-holding and doesn’t necessarily mean the abdominal wall or pelvic floor is weak (although sometimes this is the cause) more so that the entire system is out of balance and uncoordinated which causes the pelvic floor or abdominal wall to not function as “normal”.

     

    doming of abdomen diastasis recti

     

    Demonstrating loss of pressure doming or bulging of my abdomen in the third trimester of pregnancy.

    How do you heal diastasis recti?

    I would first challenge you by asking what does healing mean to you? does it mean closing the gap? being pain-free? looking a certain way? being able to do a certain movement? feeling stronger?

    You can still have a “healed” diastasis with a gap. If you are assessing yourself you might want to note how the connective tissue is feeling because its the quality, tension and density of the connective tissues that important. Is the tissue feeling taut? strong? when you press into your belly, exhale and lift your head is the tissue doming or bulging out?

    It’s ideal to try and balance the pressures with their available structure or muscular work so when you do a daily task or exercise you don’t get bulging of the abdomen (loss of control of pressure) or incontinence or other symptoms.

     

    Should I avoid certain exercises if i have diastasis recti?

    Until research identifies the cause it may be best to modify or omit exercises that cause discomfort or increase symptoms like leaking, downward pressure on the pelvic floor or doming or coning of the abdominal wall. We know that exercises like front planks, sit-ups or other high impact activities increase intra-abdominal pressure but just going from a seated to a standing position increases your abdominal pressure MORE than any of those exercises and we are not over here telling pregnant women not to stand up!

    Each of us are individuals, no woman or woman’s body is the same so a blanket restriction and flat out NO you can’t do these things or to claim that by doing them you will get diastasis recti or pelvic floor dysfunction doesn’t make sense! This attitude is why many Women end up BLAMING THEMSELVES for their condition or symptoms. Some women can plank in pregnancy or postpartum with diastasis without creating a loss of control of the intra- abdominal pressure or experiencing symptoms so why tell the woman who can that she should stop?

    What to can i do if i experience doming, bulging, other symptoms of loss of control in pressure?

     

    If you experience bulging in the middle of the abdomen, pelvic pain, incontinence, back pain during or after exercising then the exercise you are doing may require modification. It may be as simple as changing your posture, position, breathing, reducing the load, impacts or finding a strategy that works for you. This is why working with a pre and postnatal coach can be so beneficial because your coach will help you identify these issues and help you adopt a strategy so you can improve your function, reduce or eliminate symptoms or help you do the things you love! For further assessment and diagnosis it may be beneficial to see a women’s health physiotherapist to help get further information to assist in your recovery.

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  • Return to exercise postpartum: How to get started

    How soon after giving birth can you exercise? How soon is too soon? Figuring out how to safely return to exercise postpartum can be an overwhelming task, not to mention confusing because there is SO much information available at the touch of your fingertips [thanks smart phones].

    Although having such amazing resources can be handy and an absolute life saver in some ways it can also be filled with unfiltered and incorrect information which can lead you to rush back into an exercise activity or program that isn’t ideal for your postpartum body.

    Exercise postpartum can be different in many ways.  Your body has changed, it’s grown and birthed a baby and you now have other demands like a newborn or older children, lack of time and the days where you feel so tired you need to hold your eyelids open with toothpicks.

    As a general rule of thumb, each mum should follow a 3 R protocol to aid in their postpartum recovery and return to exercise.

    1. Rest & recover
    2. Rehabilitation
    3. Return

    Rest and Recover

    If you have just had your baby one of the best things you can do for the first month (plus) is rest and recover, particularly if you have more than one child to care for. This does not mean you can’t do any movement at all but for the first month at least try to minimise lengthy activity to allow for optimal healing and recovery ( this includes being on your feet for extended periods of time). You may feel great post birth and that’s awesome, but your body is still healing inside and out.

    Pregnancy alone places additional load and stress on the core and pelvic floor due to the weight of baby, placenta and increases in fluid, not to mention labour and delivery. There are also additional changes that occur during pregnancy and postpartum that affect your bodies alignment and hormones like relaxin that soften the joints, ligaments and muscles to prepare your body for labour and delivery. 

    Relaxin is still present in small amounts postpartum and even though it is yet to be proven if the increase in this hormone increases joint laxity postpartum the risk of injury for some women may be increased for reasons unknown. This includes pelvic floor injuries in particular pelvic organ prolapse ( where one on more of the pelvic organs such as the bladder, uterus or rectum drop into the vagina due to weakness from the supporting muscles and ligaments).

    Recovering from pregnancy and birth is no different to recovering from a major injury such as an ACL reconstruction or shoulder reconstruction and it should be treated with the same respect and be overseen by your medical team and other allied health professionals. Recovery can take up to 12 months after birth!

    Rehabilitation

    Before you start your return to exercise postpartum it’s important you have been cleared to exercise by your medical provider. The gold standard is to see a women’s health physiotherapist for assessment and diagnosis to ensure you have no pelvic floor dysfunction or diastasis recti (abdominal separation) 

    Some key elements to rehabilitation are your A, B, C’s

    Alignement

    postpartum-exercise-alignment
    1. Alignment -. Alignment is referring to your bodies position so ideally, you should always try to have your ribs stacked over your hips. If you are unsure take a photo of yourself! You ideally want a neutral position that is the ribs stacked over hips. Look closely, is your bottom tucked under (posterior pelvic tilt) or your bottom sticking out (anterior pelvic tilt)? If so, move your pelvis so your hips align with your ribs, take note of this position and whenever you remember or catch yourself out of alignment try to correct it.

    Breathing

    the-connection-breath
    2. Diaphragmatic breathing – As you breath in your diaphragm contracts and descends allowing your ribs to fill with air, as your breath out your diaphragm ascends forcing the air back out, working in synergy to this is your pelvic floor. Your pelvic floor constantly responds to the loads you place on your body. As you move from sitting to standing, pick up your baby or weight in the gym your pelvic floor contracts to respond to the change in intra-abdominal pressure. When you sneeze or cough which is normally something that is quite forcefully your pelvic floor responds by forcefully contracting the pelvic floor to match the increase in pressure.

    This coordinated system often requires reprogramming as injury, illness, pregnancy and habits we adopt tend to affect our breathing patterns which in turn affects the function of the pelvic floor and our overall movement. To check your breathing patterns sit on a hard chair, in neutral alignment with the ribs stacked over the hips. Place a hand either side of the ribs and take a deep breath in. You should feel your hands move with your ribs up and out to the side as the air fills your lungs. As you exhale the hands should return to starting position. Keep your shoulders, neck and jaw relaxed as you inhale and breathe deeply filling the ribs and belly with air. You could try this in front of the mirror so you can see your breathing pattern.

    Connection

    3. Connection Breathing – connecting your breath to your pelvic floor (not just a kegel exercise). The final piece of the puzzle is connecting the pelvic floor to your core breathing.

    As you inhale the pelvic floor should remain relaxed.

    As you exhale gently contract ( about 30% of a maximum contraction) your pelvic floor.

    Cues- Try picturing your pelvic floor as a diamond shape with points attaching to the front of the pelvis, the back, the left and right. As you exhale gently draw those points up and in moving them closer together Or picture pulling a tissue out of a tissue box or picking up a marble with the vagina and anus. If you are unsure if you are doing this correctly please see your women’s health physiotherapist as they can provide the best feedback to you to ensure you are activating your pelvic floor and breathing muscles correctly.

    Above is a video showing the connection breath when I was 36 weeks pregnant.

    Return to exercise postpartum

    Your return to exercise postpartum should commence once have been cleared to exercise and you have the above foundation set as it helps ensure you set yourself up with a stable foundation for safe and effective movement.

    Starting an exercise program that has a strong focus on connecting to the pelvic floor and core and restoring function to your body in a safe and effective way is key to ensuring the best recovery both short term and long term [start here] Even if you had an uncomplicated pregnancy and delivery its important to allow time for your pelvic floor and core to heal and return to exercise in a way that doesn’t increase the load and stress on your body too soon.

    To ensure a safe return to exercise postpartum the exercise program should aim to increase your strength, function and movement patterns. It’s best to work with your women’s health physiotherapist or a pre and postnatal coach for your exercise programming.  This way you are not hindering or increasing your risk of pelvic floor dysfunction by exercising incorrectly.

    To begin with, the exercises should be gentle, low impact and of short duration with the aim of gently challenging your core and pelvic floor to help regain connection and function. If you experience any pelvic floor symptoms (incontinence, pain, pressure or dragging sensation in the vagina) during and after your exercise then it’s important to respect and listen to these sensations and see a women’s health physiotherapist. If you experience no symptoms during or after your workout your next workout you can try increasing the intensity and the length slightly (by around 10%).

    It’s important to remember that healing, recovery and rehabilitation isn’t always a linear process. At times you make one step forward and two steps back and that’s ok! Please be mindful that other factors will impact your return to exercise and your performance.

    Stress hormones like adrenaline and cortisol from lack of sleep can cause changes to performance, energy and impact your results. If you have gained excess weight and are now considered overweight this can cause an increased risk to the pelvic floor as the load and the demand has increased. Your breathing may be impaired particularly if you have not yet regained connection the pelvic floor and core with connection breathing and scar tissue from both c section and perineal trauma may cause discomfort and restrict muscle function around the scar tissue sites (your women’s health physiotherapist can help you with scar mobilisation to help reduce adhesion, inflammation, fibrosis and improve remodelling) if this is the case.

    Often the journey is slow, and it may take time until you truly feel like yourself but the slow path is the fast path in birth recovery. If you take the time, listen to your body and do all that you can to rest, recover, rehabilitate and retrain your body for your return to exercise you set yourself up with the best chance long term.

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  • How to return to running postpartum

    So, you have just had a baby and you are dying to hit the pavement running again or for some reason have this itch to start! It’s amazing you are feeling keen to resume things or to increase your activity and return to running postpartum but its key to short and long-term recovery that you go about it the right way.

    During pregnancy and regardless of how you gave birth your body underwent massive physiological changes. Your heart, lungs, hormones, muscles, muscle recruitment and movement patterns, centre of gravity, and pelvic floor all changed. And on top of that, your body is still changing and recovering from pregnancy for up to 12 months after birth! Recovering from pregnancy and birth is no different to recovering from a major injury such as ACL reconstruction or shoulder reconstruction and it should be treated with the same respect and be overseen by your medical team and other allied health professionals.

    In general, if you are wanting to return to running postpartum the timeline is around 3 to 6 months providing you have NO pelvic floor dysfunction. That is pelvic floor weakness or pelvic organ prolapse (POP) which may include symptoms of pressure, pain, feeling of fullness/bulging in the vagina or downward dragging sensations (like your insides are falling out), incontinence (leaking urine or faeces ), constipation, lack of sexual sensation, painful intercourse or other pelvic pain.

    pelvic-floor-core-and-more

    First and foremost, seek an assessment from a women’s health physiotherapist to ensure your pelvic floor and core are functioning correctly. This ensures no dysfunction and even if you are not feeling any symptoms (which doesn’t mean you have no dysfunction) is the gold standard for diagnosis and treatment. Once you are cleared to exercise by your women’s health physio and there is no dysfunction it’s ideal to resume exercise that is low impact for the first 3 to 6 months. This is part of the rehabilitation process where you can work on things like connection breathing (reconnecting with the pelvic floor and core), alignment and exercises that focus on functional movement while gently challenging and restoring function to the pelvic floor and core. When returning to running start small and interval style. This may be 30-second jog and 30-second rest for 10 minutes. If this feels ok during and AFTER (no pelvic floor pain or symptoms) then increase your distance and decrease the rest time SLOWLY.

    Be aware of what sensations you are looking for;

    • Pressure
    • Pain
    • A feeling of fullness or bulging in the vagina
    • A feeling of a downward dragging
    • Heaviness or like your “insides are falling out
    • Incontinence (urinary or fecal)

    If you experience this, then please STOP and seek HELP from your women’s health physio. There is no shame in listening to your body, talking about your symptoms and seeking help!

    Please be mindful that other factors will impact your return to running postpartum and your performance.

    Hormones

    Pregnancy hormones like relaxin are present however it’s yet to be proven if the increase in this hormone increases joint laxity and the risk of injury. Some women however for reasons unknown do have increased joint laxity and therefore may increase your risk of injury and this includes pelvic floor injury. Stress hormones like adrenaline and cortisol from lack of sleep can cause changes to performance, energy and impact your results. If you have gained weight and are now considered overweight this can cause an increased risk to the pelvic floor and more stress on your joints as the load and the demand on your body has increased. Your breathing may be impaired partially if you have not yet regained connection the pelvic floor and core with connection breathing (my postpartum coaching dives into connection breathing to help you reconnect).

    Diastasis Recti (abdominal separation)

    The debate between the relationship of diastasis recti and pelvic floor function continues and there is no conclusive evidence on running with diastasis recti. However, if you have non-functional diastasis recti then it seems counter-initiative to resume running until you have proper function of the abdominals (intra-abdominal pressure and load transfer across the abdominal wall) to not place extra load on the pelvic floor.

    Scar Tissue

    Scar mobilisation both c -section and perineal may case restriction and pain and restrict muscle functions around the scar tissue sites. You can discuss this with your women’s health physiotherapist and they can shown you how to continue massage on the scar tissue at home. Scar mobilisation helps to reduce adhesion, inflammation, fibrosis and improve remodelling.

    Sports Wear 

    Supportive clothing like high waist leggings to support the abdominal wall, lower back and pelvis with GENTLE compression can help with recovery postpartum and are great to wear when you resume exercising . It should provide a little support and still allow you to take a deep breath in, you should still be able to move, squat, sit and eat! A good sports bras is essential particularly if you are breastfeeding or have larger breasts as it can help reduce pain and discomfort.

    Returning to exercise postpartum often looks different for each woman. The key to recovery (short and long term) is to listen to your body, have an assessment with a women’s health physiotherapist, take things slowly and work on rehabilitation (connection breathing, alignment and functional exercise) before retraining your body to hit the pavement!

    Not sure how to achieve your health and fitness goals?

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  • The Use of Magnesium Spray During Pregnancy and for Exercise Recovery

    Magnesium is an essential mineral that is used by the body for regulation of muscular contraction, insulin metabolism, blood pressure regulation, cardiac excitability, nerve transmission and neuromuscular conduction. The use of magnesium compounds have been widely used as medicinal and dietary supplementation, and its positive effects have been well documented. Along with being essential for many physiological processes it also plays a role in sleep, relieving muscle cramping, improving mood and reducing anxiety and depression. It can help relieve restless leg syndrome and is important for pregnancy and lactation. Talk about a super mineral!

    Magnesium During Pregnancy and for exercise recovery

    Magnesium helps contribute to a healthy pregnancy and has been shown to decrease the occurrence of certain complications like preventing pre-eclampsia (high blood pressure) and low birth weight. Its need during pregnancy is increased therefore many women don’t receive enough magnesium during this time.  One of the most common signs of magnesium deficiency is leg cramping which is experienced by 30- 45% of women, mostly at night and often becomes more prevalent from the second trimester onwards.  Using magnesium during pregnancy can help to decrease muscle cramps and can also help give relief from the muscular pain that persists days after a cramp.

    With magnesium helping to assist in muscle recovery its use after training can be an excellent way to gain relief from the pain and discomforts when DOMS (delayed onset muscle soreness) sets in. During exercise, magnesium levels are depleted with loss through sweat, urine and alterations in blood magnesium levels. This makes magnesium supplementation important for athletes or those who work out regularly as they will have a higher magnesium needs than the sedentary population. Many studies have shown that loss of magnesium affects performance however they haven’t yet been able to show that supplementation with magnesium will increase performance!

    So apart from oral supplement which most of us would receive from a basic multivitamin how else can you ensure you’re getting enough magnesium?

    Ever heard of Transdermal magnesium application? Transdermal magnesium is applied directly to and absorbed by the skin. This may sound like a new fad but transdermal application itself isn’t a new way to administer products with certain medications like pain relief and smoking cessation patches having been used for some time. The difference is magnesium isn’t a drug it’s an essential mineral to the body and its delivered in a natural form. Applying it transdermally ensures it doesn’t have to pass the gastrointestinal tract and can be delivered straight to the body’s cells and tissues. This is a quick and easy way to reap the benefits of this product particularly, if taking magnesium orally gives you gastrointestinal upsets.

    What happened when I started using magnesium spray?

    It wasn’t until I was about 19 weeks pregnant that I started getting muscle cramps during the middle of the night partially in my calves. My sleep also started being affected by more restlessness and frequent waking which meant feeling more fatigued throughout the day.  Wanting to improve my sleep and ease the cramping I went on the hunt for a magnesium spray to use and came across base recovery spray.  A lovely small business based in Geelong who sources their magnesium chloride (the main ingredient in magnesium spray) naturally from the dead sea. One thing I liked about the products that set them apart from other brands is the addition of essential oils. The sleep recovery spray has a hint of lavender to assist with sleep, relieving tension and calming the mind. Whereas the recovery spray has a touch of peppermint oil which assists in clearing the airways, boosting digestion and enhancing energy levels. I hate deciding on one product and felt these products had different purposes, so I decided to try both! The sleep spray to help with my leg cramps and restless sleep and the recovery spray to assist with muscle soreness from my workouts.

    I first used the magnesium sleep spray before bed with a spray on the sole of each foot and one on my abdomen.  It smelt amazing, not too much lavender which meant it was not overpowering to my sensitive pregnancy nose. The spray left a cool tingly sensation on my tummy and feet and I jumped into bed. I felt the soles of my feet become more relaxed and it didn’t take too long to drift off to sleep. I still had a few night waking’s that night and a small foot cramp which I would take over a leg cramp any day! Night two of using the spray I applied the spray to my feet and tummy and again got a slight tingly feeling. I also decided to spray the sleep spray on the bottom of my toddler’s feet to see if it helped him with his night waking also. I have now been using the sleep spray on us both daily, and it’s become one of his favourite bedtime routines. I am happy to say our sleep has improved and I’m not waking in pain from muscle cramps (insert happy dance)!

    The recovery spray I use for muscle soreness after my training and have been carrying in my handbag to use whilst at work. I reentered the workforce at 24 weeks pregnant as an oral health therapist after having almost 2 years off staying at home to raise my son. Dentistry is a demanding job both physically and mentally and although you sit down for a lot of the procedure the use of your arms, head and neck in sometimes awkward positioning can cause pain and strain. My first day back was exhausting and the next morning my upper back muscles felt practically sore, just like I’d done a workout. So before work the next day I sprayed the recovery spray on my back, neck and upper traps. Again, I felt a tingly sensation, but it felt like it took the edge off my discomfort and relaxed these areas. I had read that the tingling feeling was a sign that you are deficient in magnesium, however, I wasn’t able to find any evidence to support this claim so did a small experiment on myself. From personal experience, I have found the tingling sensation to decrease even when applying the spray to different areas (testing to see if the skin somehow got used to the feeling when applying in the same spot). So perhaps as I have increased my magnesium levels with regular use the sensation has gone away.

    How to use magnesium spray

    Magnesium sprays are incredibly easy to use. Simply spray the magnesium oil onto your skin and massage in. Or, for harder to reach areas, spray into your hands first before rubbing in.  If you don’t enjoy the tingly sensation you can dilute the spray with some water or coconut oil or rinse off after 20 minutes. I have been using the sleep spray about half an hour before bed with a spray on the sole of each foot and one on my tummy and the recovery spray I spray directly to sore muscles after work or exercising. Since using base recovery magnesium spray I am no longer getting muscle cramps at night, which is, in turn, improving my sleep and the muscle pain is eased after training and work.

    If you’re looking for an inexpensive, easy to use product to help relieve cramping, aches and pains and improve your mood and most importantly your sleep. Then you need to get yourself some magnesium spray!

    My top picks on where to buy magnesium spray

    Note: base recovery no longer supply their amazing product so a few other recommendations are 

    salt lab 

    hermosa and co

    References:

    KASS, L., Skinner, P. and Poeira, F. (2013). A pilot study on the effects of magnesium supplementation with high and low habitual dietary magnesium intake on resting and recovery from aerobic and resistance exercise and systolic blood pressure. J Sports Sci Med, 12(1), pp.144-50.

    Ragnar, R. (2015). Treatment with Magnesium in Pregnancy. AIMS Public Health, 2(4), pp.804–809.

    Tarjan, A. and Zarean, E. (2017). Effect of Magnesium Supplement on Pregnancy Outcomes: A Randomized Control Trial. Advanced Biomedical Research, 6(1), p.109.

    Tarleton, E., Littenberg, B., MacLean, C., Kennedy, A. and Daley, C. (2017). Role of magnesium supplementation in the treatment of depression: A randomized clinical trial. PLOS ONE, 12(6), p.e0180067

    Supakatisant, C. and Phupong, V. (2012). Oral magnesium for relief in pregnancy-induced leg cramps: a randomised controlled trial. Maternal & Child Nutrition, 11(2), pp.139-145

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