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A ten to twenty minute, daily exercise regimen should suffice to augment the natural healing process. If the abdominal separation is the width of 2 fingers or more, this is what I consider level 2 diastasis. While a similar routine may be enough to heal it, I like to put emphasis on changing daily behaviors so as to really avoid putting unwanted stress on the tissues in between training sessions. If you’re going to spend an entire hour of your day jogging and then go eat a cheeseburger and fries…I mean, sure, have at it but the burger and fries basically undid all of your mind numbing, boring work running, and then some. Can you tell I love running?
When you get up from sitting or lying down, or you hunch over, pick something up, lean against a counter or wall; these are all moments of opportunity where you can avoid further damage and actually help heal the separation. Up until now we have relied on reflexive activation of our muscles to get us through our daily activities. This is fine and dandy for most of us but when you suffer from any kind of core weakness, be it diastasis recti or slipped discs, you have to switch over to purposeful activation.
The very first step in our postnatal rehab program is learning how to connect to your deep core muscles, primarily the transversus abdominus (TVA) and the anterior pelvic floor. These are the two main muscles we want to use for your “purposeful activation” or your brace. The other, bigger muscles we can allow to act reflexively once the deeper muscles are properly contracted. Creating a connection to these muscles can be difficult. While we can see and touch our biceps ass we contract them, there is no visual feedback for the deep core muscles. Some of us have a small pocket between the rectus abdominus and obliques where you can feel the TVA. But if this isn’t an option there are a few tricks on learning how to feel it contract. Some of the low impact exercises we use in our conditioning program can be used to make the mind/body connection. The TVA muscle is solely involved in stabilization so taking the body just slightly out of stabilization while concentrating on changes within your core can help give you an idea as to where the muscles is and how it feels when in use. Any exercise that requires the bigger muscles in addition to stabilize or move the torso will override any connection to the deep tissues.
There are also some breathing techniques that can help form a connection. Something simple that often works is this –
Lay down on your back, knees bent and feel flat on the floor. Take a breath and then exhale allowing for all the air to leave your lungs without pushing it out forcefully. Before taking another breath, draw in your belly button towards your spine trying not to press your back into the floor. It helps to put your hands on your abdomen to check that your big muscles in the front are not being activated. When successful, it is your TVA being used to draw inwards. Even though this is pretty simple, it takes a lot of practice to properly activate this muscle when you are not laying down and completely focused on it.
Add a pelvic floor hold to the TVA activation and you have got the brace! I suggest that you activate the pelvic floor before activating the TVA. The transversus abdominus contraction, if significant, can put pressure on the pelvic floor and make it difficult to initiate the hold.
The degree at which you need to activate depends on the movement you are performing.
If you are attempting to sit up out of bed, whether you turn over on to your side first or just sit up straight like a creepy vampire, you need to create your core brace first, and a strong one. I would suggest bracing at 75% of capacity or more.
You really have to brace for any kind of crunching motion. Same goes for any time you bend over to pick something up. If the option is there, try to bend into a deep squat to pick whatever it is up. If pelvic floor weakness is part of the issue for you, then be sure to activate your pelvic floor before squatting.
Try and avoid leaning on counters and walls. Use the moment to activate your brace and practice purposeful posture strengthening. A light brace of the TVA will do.
Sitting on the edge of a chair rather than leaning back is another small change you can make. Sitting on the edge tends to put us in proper posture. It keeps our tailbone from tucking in and rolling our pelvis upwards. In this position we can then lightly activate our brace and keep a neutral spine position.
We use dozens of different exercises, all with several progressions to help heal diastasis recti. Every single one involves some sort of movement. It is so rare that we are completely still during every day life, so the isometric exercises, though helpful for creating connection to muscles, are less functional for our purpose here.
The very first exercise I teach is the knee drop –
Lay down on your back, knees bent and feet flat on floor, hip width apart. Do not use anything to support your head, we want to maintain neutral spine. You can keep your hands next to your hips or you can rest them on your abdomen to try and feel the slight activation that occurs. You can start with pelvic floor activation if this is something you need to work on. Often times it is, so it won’t hurt to start there. Lightly draw in your TVA to about 25% capacity. The movement will be the drop of one knee outwards towards the floor. The movement should be as slow as possible trying to maintain a fluid motion rather than a stop and start like motion. This takes time and practice. Go as low to the floor as possible without changing your foot position. While you are dropping your knee to the floor you want to make sure that there is no compensation for change of stability by movement of your opposite leg or your torso. Keep an eye on your stable leg and if you need to you can place a plate or piece of paper on your abdomen to give you some feedback on whether you are moving. And don’t forget to breathe! The TVA can minimize your ability to take deep breaths and often times my clients go red faced not realizing they are holding their breath.
What we want from this is to preemptively activate your stabilizer so that the motion can be carried out without compensation from any other parts of your body. You may need a reflexive increase of activation to maintain proper form. This is great. We want a bit of both purposeful and reactive contraction.
One repetition should take at least 20 seconds – 10 seconds down and 10 seconds back up. I suggest taking a break between each full rep. The relaxation phase is just as important. While we want to train the muscles to contract on command we don’t want to create a tendency to stay tense all day. So take the time to breathe and relax your muscles. 3-5 reps on each side is a good start for this exercise.
A progression to this would be to strap an ankle weight around your knee to add a bit more resistance. A more advanced version would be to create a much stronger brace and lift the “stable” foot off of the floor before beginning the knee drop. This will require involvement of your bigger muscles and so you will want to make sure you have gone through other exercises to get prepared for this one.
There are youtube videos of people flapping both knees up and down like a drunk butterfly. This does not work. Many of the exercises are slow and involve high concentration. Its boring as all hell but this is what works. remember its just 10-20 minutes per day!
There are many progression of this exercise. It is probably the most important one we use but It is important to go through the stages at the right pace.
The first stage is the heel tap –
Lay on your back, knees bent and feet flat, hands at your side. Create your brace, activating your pelvic floor and TVA. You want to maintain neutral spine, so try not to push your lower back into the floor when you draw in your abdomen. From this position you will raise one foot about 12 inches off the floor, hinging at the hips but not bending your knee. You should have about a 90 degree angle in your knee for the entire movement. When you lift your foot off of the floor, the combination of your brace and any reflexive contraction should be enough to keep the rest of your body completely still. Just like the knee drop exercise, we don’t want any compensation for the instability brought on by taking one of your points of contact off of the floor. This is what enhances the activation of the TVA.
The movement should be fairly slow but not as slow as the knee drop, maybe 2 seconds per repetition. You want to just tap your heel on the floor rather than place your foot down. This keeps the stability work going through the entire set. Start with 8-10 repetitions. When you finish with one leg, take time to relax all of your muscles. Take 3-4 deep breaths allowing for slight expansion of your abdomen. Then reset your brace and move onto the next leg.
A note about breathing
In our prenatal fitness training, and really all of our training other than postpartum, abdominal rehabilitation I encourage all of our clients to use diaphragmatic breathing as a way to enhance oxygen intake and stimulate the vagus nerve in order to bring on a relaxation effect, trigger gut/immune response and create elasticity with the abdominal tissues. BUT, too much of this kind of breath work can stretch the linea alba (tissue that has been thinned out in your abdomen) and slow the pace or even stop recovery. A few deep breaths is fine but prolonged diaphragmatic breathing may not be what you need just yet. Allow for some of the healing to happen first.
The two above exercises are a great start and I usually keep them in the mix for the entire recovery process. As you begin to move on to harder progressions, these exercises can be used as an excellent warm up.
The program must evolve. You want to increase your endurance for the brace and be able to hold it under much more pressure than a simple heel tap or knee drop. You want to do these kinds of exercises while on your knees, on your feet and while in movement. Don’t limit yourself to a program that keeps you on you on the floor.
Building solid stability and then working on elasticity will increase your functional health for the rest of our life. And if you plan on having another child, these exercises may save you from sustaining diastasis recti the second time around.
Though we speak of it more as an abstract quality, something inherent that we are either born with or not and subsequently unable to cultivate, I truly believe that motivation is a skill; something you can learn and practice to get better at.
The same line of thought is used when people say things like they aren’t artistically inclined. All it is, is practice, a deep focused practice, but nonetheless, just practice. Have your kids or friends’ kids ever drawn you a picture and you put it on your fridge because its sweet and you’re just happy that someone made you something out of love and without you asking for it? Me too! But did the drawing kinda suck? Of course it did! Because they’re like 3 years old and they just started drawing and they haven’t learned concepts of perspective and dimensions and how to translate that onto paper. And….they haven’t practiced enough yet. But because they are 3 and its adorable, we give them some slack and we don’t criticize them, in fact we encourage them and tell them how great it is. If you are struggling with motivation, that’s where you are with it…the concepts, strategies and perspective hasn’t been practiced enough for you to be good at it – for it to look so natural that we call it inherent. So give yourself some slack, start slow, begin to practice and learn self encouragement. I promise, it will come.
So where do you begin? Do you have a big goal? Something that may take months or even years? Is it so lofty and vague that it causes anxiety because there is no specific pinnacle that defines your achievement? That’s fine, all we need to define are the steps that get you there or on the right path. Everything is in flux so sometimes its best to keep the big goals vague but define the means to the general end.
Visualization is a tool often talked about by successful people. You hear them describe how they visualized a championship bout, holding the belt or trophy, or doing a victory lap before having it happen. There seems to be a correlation between visualizing victory and achieving it.
One day. a broke and depressed Jim Carey sat in his car daydreaming of success. He thought about what success would meant to him at the time and he wrote himself a cheque for 10 million dollars, post dated it for 10 years from that day and put it in his wallet. He visualized something that symbolized his future achievement (though somewhat vague), put it in writing and with a lot of hard work (practice) he eventually made it a reality. This is a great story, one that inspires us and goes to show what belief in oneself, even whilst in the midst of struggle, can accomplish. But the story does a slight disservice in that it glosses over the actual work that was necessary for the achievement and how belief in oneself is actually harnessed.
Belief in oneself can start with visualization and is reinforced through repetition. Visualizing your big goal is great because it can reignite the spark that got us excited to begin with. But it can be a bit overwhelming when it seems so far away. I like to think that success comes in increments rather than being defined by the big splash moments. The same goes for confidence and motivation. You have to practice the path and not just the goal.
Take some time out of your day and envision yourself going through the simplest of tasks, the things you need to do to achieve the loftier goals. Want to have an exhibit of your artwork? Visualize the path. Go through the steps you need to take, see yourself setting time aside to sign up for painting lessons, see yourself buying supplies and making room in your house for a little art space/studio, see yourself practicing, painting the pieces, prepare yourself for setbacks, envision the struggle but know that each of these simple steps is achievable. Use visualization to break the path up to its smallest challenges and see yourself getting past each one. This is how you can use visualization to help build self belief and it is backed by science!
In 1999, research by psychologists Lien Pham and Shelley Taylor showed that visualization of the process of studying made for better grades compared to students who visualized simply getting a good grade or not visualizing anything at all. Not only did it reduce anxiety linked to studying for exams it also improved organization and increased time spent studying. Since then, more research has shown similar results for athletes who spent time visualizing training more so than those who visualized winning.
There is a lot to be said about visualizing the struggle and set backs. It makes things slightly more visceral. Research has also shown that those who imagine possible problems in a positive manner have more benefits than visualizing everything just going well, or simply focusing on the negative. Thinking the path is going to be a smooth one, is a recipe for being overwhelmed.
You can start really small by using visualization to help yourself accomplish a simple physical exercise, like a plank.
Begin by kneeling on the floor. Focus in on your breath, try to elongate each breath just by a little bit, prolong your inhalation and exhalation so that it becomes purposeful rather than just reflexive. This in itself is great practice, it brings attention inwards and allows you to focus on a single goal. To make this slightly more complex, run through the following steps to visualize each component of the plank, once you’ve visualized each step, follow through with the action
1 – Draw in your abdomen to create a brace
2 – Place your hands on the floor and walk out until your body is extended, but you are still on your knees. Hands directly under your shoulders.
3 – Brace your core as much as you can to prepare for lifting your knees off of the floor.
4 – Activate your shoulder blades so that they are not collapsed.
5 – Stretch out one leg and squeeze your quad and glute.
6 – Stretch out your other leg and squeeze that side.
7 – Tuck in your pelvis slightly as to not put pressure on your lower back.
8 – Hold for as long as you can maintain this perfect position, Go back to focusing on your breathing but stay aware of your body.
This simple exercise of visualization and execution can do wonders. You can then take it to another level and try and use it for an exercise that you can’t complete just yet. The progress will be surprising. You may just need some guidance for the proper steps to use.
The next part is to recognize each successful moment. As I do with clients who have been struggling with a certain movement pattern (which is just a step in the path to reach a bigger goal of higher fitness or weight loss or rehabilitation) I try and take the time to point out the effort it took to get there. We go over the progressions we used, the time it took and most importantly the effort they exerted. Each session is a challenge overcome. If you get in the habit of recognizing all the mini successes, you begin to cultivate self belief, you build on motivation and perpetuate good habits. So take the time to reinforce your effort and then visualize the next steps. Practice the path and it will all come together into something you are proud enough to put on your fridge.
Looking for help with your own customized workout and/or meal plan? Contact Joey. Online coaching available for everyone and personal training/coaching available to Montreal residents.