I recently watched an online discussion where a professional in the field of Women's Wellness posted a question on 'belly binding' and post birth recovery from Rectus Diastasis and by the time I stopped watching the feed....76 posts later!!!! guess what? Not ONE definitive answer regarding the SOLUTION but of course lots of great suggestions and theories regarding best practice for the KEY elements of the entire puzzle but as I said, NO MAGIC BULLET! In a time of both mass off and on-line magic bullets such as the much famed '6 pack in 6 weeks' programme and celebrities flaunting airbrushed Post Natal bodies before their stitches have even healed, it's pretty hard to convince the average 16 week Post Natal woman that the Pelvic Floor and Disastsis issues that she's experience might just take a little time and actual effort on her part to resolve.
It's usually when our bodies 'fail us' that we are presented with a fork in the road, we either see this as a time to get mindful and serious about our health or feel let down and oppressed by an imaginary foe. Ironically, illness, poor health, diminished abilities and a body that won't play ball can be portal to a life of deeper respect for the brilliance of the human body and how it has supported us for many years without attention on our part OR it can be the beginning of a war on self....I am thankful that my work (and that of many amazing colleagues around me) is firmly in the previous camp and hopefully on a daily basis we empower women through education and speaking truth to navigate this sometimes challenging life phase. This blog is about my thoughts on the 'Big Rocks' of Diastasis and Post Natal healing and this is Part 1, Part 2 can be found here.....
1. Postural Alignment/Biomechanics/Biotensegrity/Fascia - How a woman ends up standing, sitting, lying and moving in the post birth period will most definitely have a direct influence on her Diastasis recovery, pelvic floor healing and global well-being. The entire abdominal wall and pelvic basin both in terms of muscles and connective tissues have experienced gross expansion/stretching and in some cases trauma (C-Section, birth canal & Pelvic Floor) that compromise the functionality of the woman's local and global myofascial biotensegrity (her fascial/soft tissue tensional network) and boney support system. This has a direct and negative impact on her ability to transfer load and manage intra-abdominal/pelvic pressure and set's up the potential for not only ongoing Diastasis but incontinence issues and backpain.
Assessing for these changes using sight and hands-on strategies is essential before a single squat is every prescribed and as a Bodyworker/Remedial Therapist, I feel strongly that a period of restorative bodywork where the soft tissue/force-closure kinks are worked out in order to create an awesome foundation on which we then eventually load with exercise is essential. I know from my own practice that there is not a Post Natal woman on this planet that would not gladly take the opportunity to lie down and have someone lay healing hands on her before resuming 'battle' in the gym. Someone once said, 'you can't shoot a cannon from a canoe' and in the case of the Post Natal woman in recovery, I don't think a truer sentence has ever been uttered. A deep and thorough assessment will also give you an opportunity to assess whether your strategies will be able to solve your clients' problems or whether you need to refer her onto a trusted colleague who can. In my personal work SIJ and SPD issues have always been confounding and these clients are always swiftly dispatched to specialist colleagues.
Post birth, many women present for an exercise programme with a very poor capacity to withstand the loading that a typical exercise programme will offer. Usually their breathing and centre of mass is still 'off' and load travelling through their abdominal wall/pelvis is poorly managed. For many women, this requires a period of education that we shouldn't shrink from. Women are smart, they make babies 😉 and they can take some 'science-stuff'. This is so important because ultimately, we want them to truly buy into the concept of 'restoration of function & nutrition first' for the deepest and most enduring results rather than hitting the burpees.
Both an anterior or posterior tilted pelvis will put the entire core into a non-optimal position for great function....sitting posture needs to be addressed, as most new moms do this for a significant portion of their day during feeding and even after their return to desk bound jobs.
2. Breathing Strategies and Intrinsic Core Synergy® - All varieties of non-optimal breathing strategies need to be assessed for including, excessive belly breathing and clavical breathing and a deep awareness and appreciating for the fact that our God-given 'core' system in its original form will perform a synergyistic chain reaction driven by the respiratory system that goes like this....on the out-breath, the respiratory Diaphragm will rise, the abdominal wall will contract, the lumbar muscles and connective tissue will contract also and the Pelvic Floor will tension and the reverse occurs on the in breath. The perfect cycle of compression and expansion. The problem occurs when this system doesn't work so well in the Post Natal period and we quite literally have to re-teach this instrinsic synergy to the woman as a priority because her continence and healing are wholly dependent on her getting connected again and regaining/retraining 'core consciousness'.
Point in case, the client below initially presented with virtually no TVA activation on her out-breath and a breathing strategy that was left over from a period of panic attacks which she no longer experienced....the first job was to correct the breathing strategy, the second was to re-teach Intrinsic Core Synergy®, the third job was a few sessions of soft tissue work, forth job was a postural alignment re-set and THEN exercise was only applied once her system was ready to be loaded. Click picture to enlarge.
3. Nutrition & Hydration - this is a biggie that's often neglected and I'm not sure why. With EVERY cell in your body requiring optimal nutrition in order to grow and function. What you eat and drink is CRUCIAL to either promoting the healing of your Diastasis or retarding healing as are other factors such as the taking of anti-coagulant medication, chronically elevated stress levels (more below) and taking up smoking again. Click the diagram below to enlarge and view. Guiding clients towards pro-healing behaviour and minimizing factors that will take them away from healing (and explaining the why's well) is essential.
4. Stress/Elevated Cortisol - Psychological stress leads to the activation of the hypothalamic-pituitary-adrenal and the sympathetic-adrenal-medullary axes and the enhanced glucocorticoids and catecholamines production can directly influence several components of the healing process. Substantial evidence from animal and humans studies indicate that physiological stress responses can retard the initial inflammatory phase of wound healing. Cortisol has been found to be naturally elevated in Pregnancy and immediately after childbirth and for sure remains elevated thanks to the rigours of standard Post Natal life......self-care strategies that enable as much rest and stress reduction are a vital part of the puzzle and maybe swapping out the coffee for a mug of Tulsi Tea might be a good idea too. Link to Study and illustration of the pathways linking psychological stress and poor wound healing. And view the diagram above which illustrated the 4 Phases of Wound Healing - the Inflammatory Phase is first.
5. Genetics & Age - currently the fastest growing demographic for first time births in the western world are.......women in their late 30's to early 40's. Women right on the cusp of Peri-menopause when the body is doing the opposite of puberty and collagen and Oestrogen production amongst so many other 'growth' factors are in decline. Genetic issues which retard/inhibit collagen production such as Ehlers-Danlos Syndrome (for which there is no known cure) will also have a significant effect on Diastasis healing and potential for developing prolapse and incontinence issues and need to be screened for during your Initial Consultation so that client expectations can be managed.
If you enjoyed this blog, you'll probably really enjoy the newest offering from Burrell Education......
Advanced CPD in Modern Post Natal Assessment, Core Restore & Functional Exercise Programming – ON-LINE/GLOBAL CERTIFICATION
Classes starting throughout the year, click the link above to see the next start date and don't worry, you can always start within the first month of doors opening.... Hopefully see you in the cyberspace classroom soon................