Monday, August 29, 2011

Wrong diagnosis of Diastasis recti

I have been motivated to write yet another blog on this subject after the poor testing by a midwife on my client.

I’m not sure how many post natal women are aware of diastasis recti- abdominal separation.

Diastasis recti is a condition where the two right and left sides of the rectus abdominis (your "six-pack" muscle) spreads apart at the body's mid-line (the linea alba). Separation occurs in response to your uterus pushing against the abdominal wall and pregnancy hormones soften connective tissue. Separation can occur at any time in the last half of pregnancy but is most problematic after pregnancy when the abdominal wall is weak, when there is no longer a baby inside to aid support.
As separation occurs during late pregnancy women who give birth prematurely before 33 weeks may have minimal separation were as women who carry up to 40 weeks, carry a multi and are not aware of posture or the benefits of exercise can increase the separation during their pregnancy.
Many women aren’t aware of the separation occurring as you feel no symptoms or pain during pregnancy it is only when baby is out that many women start to suffer from lower back and hip pain or notice many months late that they can’t get rid of their post baby tummy.

My client had a 2nd emergency C section and after being recommended by her specialist to wear a surgical belt for 2 weeks post her midwife tested her separation at 3 weeks post operation and said she was fine. I had my doubts but my client was very happy so I didn’t want to disappoint her just yet.

It was the following week at 4 weeks post baby that I tested her. She had a 6-7 cm vertical gap and a 3 cm horizontal gap. Her midwife had completely misdiagnosed her separation, fortunately for my client she has me as her trainer so has now been recommend to do the correct exercises to re-hab her correctly and she should have minimal if any gap in 6 weeks.

If my client was not under a post natal specialist after the diagnosis from her midwife she had the right to assume that she could go back to any form of exercise and possible do exercises that can increase the separation.

Education and the correct testing of this condition is the key. If you exercise correctly and have good post natal posture then you can decrease your diastasis recti completely. If you do the wrong exercises such as planks and crunches, continually hold poor post natal posture, push a buggy with poor form and technique then you are setting yourself up to have lower back pain and a tummy that won’t go away. Along with a gap in your tummy that could still be there 5 years later.

I am not suggesting that all midwives wrongly diagnose this condition what I am saying is that your midwife or LMC needs to correctly assess if testing you for diastasis recti. If in doubt get checked by a professional or contact me for further advice on testing for separation

12 week post natal exercise programs which include exercises to decrease diastasis recti and correct poor post natal posture available on my website

Sunday, August 7, 2011

When and How to Exercise Post a 'C' Section

It is crucial following a 'C' section that you allow your body to not only recovery from your pregnancy but also from abdominal surgery.

You have just had major surgery and depending on how your baby was delivered will affect your recovery.

If you elected or had to have an elected ‘C ‘ section your body has possibly not gone in to labour naturally so it can be a little harder preparing mentally for this and your body and baby may not be ready on the selected date of surgery.

If you have gone in to labour and then had to have and emergency C section your body responds better post as it had gone into labour naturally, you and your baby were ready. Your brain and body had registered that pregnancy was ending.

In the days that follow a ' C' you can be in minimal to quite a lot of pain. You need to take pain killers during the first 1-10 days.
You should not have increasing pain from  4-5 days post you should at this stage be able to get out of bed carefully and move around a little easier. This is normally when you are allowed to go home.

If you exercised during your pregnancy you are now at a huge advantage you will recover quicker and up to 80% quicker than women who didn't exercise during pregnancy.

To protect your tender areas you can use your upper body and leg strength to lift you up out of bed or a chair avoiding stretching the area where your stitches are.

The first exercise to do to promote recovery when you have minimal pain is to have a look at your tummy muscles and see if you can activate your transverse abdominal muscles this is a very simple activation exercise.

See if you can pull your belly button in towards your spine activating your T.V.A-transverse abdominal muscle and rectus abdominal, just gently, no quick and fast pull ins. Just see if you can do it slowly. Avoid trying to contract all the way in, just a little is all you need to do. You should feel no pain. You should not be activating any other muscle or tilting your pelvis underneath you.

If you do feel pain try the activation exercise 1-2 days later.
For more information on how to connect with your T.V.A muscles post birth go to on this site

Try to do this early activation exercise each time you lift your baby up, when you change and carry them.

From 2-3 weeks post you should try to activate your tummy muscles as often as you can.
You should not feel any pain. At this stage you are ready to start a Post Natal Corrective exercise Program. Have a look at the very popular Birth2FitMum program that I sell on my website 

Can I go for a Walk?
You may feel you are ready for a walk from days 10-14 post depending on the exercise you did prior to birth if you are still sore it may take another 7-10 days before you feel like steping out. It may even take another 4 weeks if you are unfit from lack of exercise or bed rest prior to giving birth.

Walking Post ‘C’ Section
Start with a small 10-15 minute walk by yourself, don't go with baby in the buggy just yet! Pushing baby in a buggy can add too much stress too soon to the delicate area as you need to try to control the buggy with your muscles especially going downhill. You can add the buggy from 4-5 weeks and starting off with a flat route can be best. 

This is a walking program that you can follow post:
Walk by yourself from day 12-21

Start with 10-15 minutes. If you feel ANY pain stop, try again in 2-3 days. If you have no pain you can repeat 48 hours later. Repeat the same walk time 3 times, each time leaving 48 hours between. If after the 3x 10-15 minute walks there is no pain you can increase your time by 5 minutes and then repeat the program.
Now you can walk 15 minutes every other day, do this 3 times. Again adding 5 minutes after every 3 walks of the same time.
Do this until you are walking 3-4 times a week for 45 minutes with no pain.

This walking program is just walking. It is not exercise and there is minimal effort required it is just a WALK.

Once you can walk pain free for 30 minutes 3-4 times a week you can try to push your baby in a buggy. If you are less than 8 weeks post take it easy and try to stay on the flat. It is a good idea if you can go with a friend so they can take over on the up and down-hills. It is hard to push your baby up-hill as this puts a huge strain on your core muscles and down-hill is just as hard as you have to try to stabilize your buggy with weak muscles. Try to avoid.

After 8 weeks you can increase your walking pace and intensity, don’t go out and walk fast for 45 minutes, you need to build slowly. Try 10 minutes at 70-75% Intensity -aerobic intensity exercise, you know you are exercising but you are not pushing yourself too hard- If this feels ok and you experience no pain try 20 minutes fast on your next walk and then try 30 minutes the following week.
You don’t need to walk hard on every walk, try to do 3 walks a week when you walk faster and at a higher intensity.

Remember everyone is different and recovers at different levels, if you are following my Birth2fitmum program you may feel like you can do more especially if you are sleeping! Listen to your body and use this as your guide, just like you did during your pregnancy

Strength Exercise over Cardio Post C section?
Your strength and rehabilitation exercises are more important than your cardio fitness post birth but its nice to be able to get out of the house and be pain free.

You should do a specific strengthening exercise program 3-4 times a week post a C section starting from 7-14 days post. If you can do this you would be back to full core strength within 14-20 weeks depending on when you started your abdominal separation and core strength. Test your post pregnancy abdominal muscle separation-diastasis recti here.

A good program will decrease abdominal separation, increase core and glute strength and focus on postural muscle strengthening exercises.

The benefit of not pushing your baby out is that your pelvic floor muscles are probably ok! You still need to do your pelvic floor muscle exercises post birth as they help to activate your TVA's!

Please feel free to comment and ask further questions. This is just a short guide.

If you want to purchase your own specific and safe post pregnancy 12 week program please contact me for a FREE 2 week Trial
Remember the golden rule. You need to check with your G.P or LMC before starting any exercise program.

Tuesday, August 2, 2011

Mel B- Eating for England

Headlines today August 2nd is Melanie Brown aka Scary spice is “Eating for England” during her 3rd pregnancy.

Mel admits she has put on a whopping 64lbs which is 29kg. This is reported not to worry her as she knows she is active and will be able to get the extra pregnancy weight off.

What are your thoughts on this?

Here are mine:
Firstly she has put on a lot of extra pregnancy weight and may have increased her chances of developing gestational diabetes with such rapid weight gains.
She may have also increased diastasis recti-abdominal separation and increased her chances of developing stretch marks. These are just 3 reasons why not to put on extra pregnancy weight.

I don’t think this is a good advert for other pregnant women. Although on the other hand we generally see the opposite of stars, so which is best? We need to see the middle ground more often as I know women are influenced by the stars.

Mel B may have also started off at a lower weight than most women and if she was underweight at the start of her pregnancy then she may have not packed on as many extra kilos as the recent article suggests?

Women have to remember that Mel B is normally active and will have lots of professional help after the birth of her baby. So although it will not be easy for Mel to lose the extra weight, she will have many helpers.

What do you think, has Mel B put on too much weight?