When it comes to training the pelvic floor muscles during pregnancy and after birth, I’m here to tell you, things in the ‘downstairs’ department in recent years have most definitely changed.
I use a full-body approach to rehabilitating pelvic floor dysfunction and it all starts with the foot.
You can find out more about what techniques I use here.
When I see a new client with front or back bottom issues, the first thing I ask them to do as they enter my treatment room is take off their shoes.
The next thing I invariably say is:
“No, no, DON’T sit on the chair – I’ll explain why in a moment. For now, let’s pop you down here instead…”
…and I proffer her a Yoga bolster or big pile of firm cushions to sit on on the floor instead.
So, I was having a chat to 2 postnatal clients after Mummies and Buggies this week, and quite honestly, their postnatal recoveries could not be different from one another.
One client had a pretty straightforward delivery, is feeling fabulous and asked me:
“When am I no longer postnatal, Claire, because I went to a class the other day at my gym and wasn’t sure whether I should say something to the instructor or not…”.
The second client had every intervention possible to get her baby out of her naturally, she has pelvic floor dysfunction, she is desperate to lose her baby weight.
Knowing that she has stress incontinence on impact, I asked what other exercise classes she’s doing and she said:
“Well, I’ve signed up for this other postnatal class, and Claire…I think some of the moves are a bit too hard for me really…so, after week 2, I had to mention it to the instructor that I can’t do burpees…and I can’t run or do sprints and stuff…”.
…and, obviously I’m trying NOT to make that emoji with the big bulging surprised eyes, but I just couldn’t.
Both clients are getting close to the 6-month after birth mark, but seriously – their postnatal recovery experiences are poles apart.
Every pregnancy is different, and therefore I view every postnatal person’s recovery as very individual too.
This is how you should see clients also, in my professional opinion.
I checked a client’s abdominals for abdominal separation before my Mummies and Buggies postnatal indoor buggy class there last week, and it occurred to me that sit ups aren’t a great thing for mums with a tummy distension to be doing.
And, I appreciate this probably isn’t groundbreaking news to you, but just hear me out, alrighty?
This particular client has a toddler, and her new baby isn’t just one, it’s twins, so she’s got her work cut out for her here, hasn’t she?
I detected a bit of a separation (just over 2 finger widths, but I must point out my fingers are quite narrow), and I was relatively pleased with the tension in her linea alba when I tested it.
You know sometimes you dig your fingers around for DR (diastasis recti) and you get that squishy, non-grabbing sensation at the separation site itself?
Yeah, that’s not such good news, and when it comes to closing the gap – I’m little less interested in the gap itself, and much more focussed on the tensile strength of things going on here.
The client and I continued to chat, and when we were done, how did my client instinctively get up off the floor from supine/bent knees?
That’s right – she just automatically sat up to carry on talking to me.
Is it best to avoid a forward flexion with a separation present?
Following on from my earlier blog – Can You Lessen The Chances Of Your PREGNANT Clients Getting Abdominal Separation Part 1?
Well, here are the final 2 ways pregnant women can deform their linea alba.
You’ll obviously want to educate them about all of these:
4) CROUCHING TIGER, TWISTED PELVIS
Maybe your client has been relatively active, but they have a pelvis that’s slightly twisted to the right, and a ribcage that’s slightly shifted to the left?
This means their umbilicus s no longer exactly in the centre.
If you think about the fabric t-shirts are made from – sometimes, you can pull and stretch it in certain ways much better than others, and it bounces back evenly.
It enjoys being pulled one way, but when you try and stretch it from another angle, it doesn’t pull so easily, does it?
There’s only so much tugging the linea alba is going to tolerate too, so getting the pelvis and ribcage better aligned is your job as their prenatal instructor/bodyworker.
Can you lessen the chances of your pregnant clients getting abdominal separation?
In a simple answer: yes.
Yes, you can.
Very easily indeed.
I’ve worked with over 1,000 pre/postnatal women, and over the past 3 years, I’ve seen a lesser incidence of abdominal separation in the clients who train with me during pregnancy, and return to exercise after birth.
Don’t get me wrong – there’s certainly the odd case of a client who meets me in her second or third pregnancy, having had no exercise history with me previously, who presents with a diastasis post-baby.
Was she certain she rehabilitated herself in between pregnancies?
Possibly, yes, possibly not.
And, sure you might have been taught to only teach your pregnant clients to follow a ‘maintenance’ program only.
That’s fair enough.
That’s the safe and effective answer.
Pregnancy isn’t the time to try something new.
Or is it though if it’s going to prevent someone getting abdominal separation, pelvic floor dysfunction or back pain?
Is pregnancy the time to build muscle, release tension, alter alignment and build better habits?
I’d say yes – yes it is.
Something I said in my pregnancy class just this week was:
“How your body copes with pregnancy, really depends on how much baggage you come to pregnancy with.”
Pregnancy doesn’t really cause abdominal separation…
…although it’s often seen as a postnatal ‘injury’.
I’m going to be talking a lot about pressure and the linea alba today.
Anatomically speaking, ALL of the core muscles connect indirectly to the linea alba.
This means that repetitive motions or chronic tension in ANY of these muscles (the obliques and transverse abdominals included) – can slowly deform the linea alba.
What habits should you be teaching your pregnant clients to enable them to avoid getting a diastasis?
Well, here are 5 ways pregnant women can deform their linea alba.
In a previous blog, I listed a number of exercises that WON’T fix abdominal separation.
One of the movements I would’ve most definitely AVOIDED in my early days of training pre/postnatal clients was ROTATION.
Maybe you still do, and that’s fine. They’re your clients. It’s their welfare. I get it.
It’s just that in the whole grand scheme of rehabilitating a diastasis, I can tell you now…
…you will absolutely, most definitely, want to add some unloaded, non-dynamic, static hold, twisting movements into your clients’ program, to help release out the oblique muscles.
‘Release’ and ‘stretch’ are 2 separate things, in my language you see.
One’s active. The other’s passive. I’ll let you decide which one’s which.
I entered the fitness industry via the jumpy-jumpy aerobics, personal trainer, fitness route, then soon got injured and realised that Pilates enabled me to understand the body a little better…
…and it really helped me take a step back from hi-impact to take the load off my poor painful feet.
Pilates is actually a great form of exercise for both our pregnant and postnatal clients and Pilates forms the basis of a lot of my education, training and background.
The slight issue I have nowadays with Pilates is the pre-teaching of the ‘core’ engagement stuff that I’m no longer down with.
It took a lot of resistance for me to stop saying ‘now draw your tummy in’ or ‘engage your core’ in my classes.
Way back when I first started teaching exercise to pregnant and postnatal women I had no idea what I was doing.
When YOU first started out your career working with this niche population, did you have any clue either?
Fortunately, by the time I had this photo taken with me and a group of my pregnant ‘bumps’ I did though. Don’t they look great?
Ok, ok, so we get the basic qualification, we educate ourselves, we read research articles here and there, buy a few books/DVDs to get some ideas, go on training courses, attend conferences, trial and test out some stuff we absorb and just get stuck in, don’t we?
When training your pre/postnatal clients in quadruped position (hands and knees/all fours), do you sometimes struggle getting them to keep their pelvis stable?
When you prompt them to ‘lift their right leg behind them’, do you find their pelvis automatically shifts over to the left to compensate?
Do you have to get ‘hands-on’ quite frequently to ‘hold’ their pelvis in place?
Often notice how their pelvis shifts to the right or the left, and no matter how many times you ‘coach’ and ‘cue’ them to NOT do this, it still happens?
I have a great little strategy to help you to get your clients to take ownership of their own pelvis! Sounds interesting, doesn’t it?
I’ve welcomed over 1,000 pregnant and postnatal women into my pre/postnatal fitness and Pilates classes.
When I did my Level 3 Pre/Postnatal certificate (like a hundred years ago!) there really wasn’t a lot of emphasis on the exercise element of the qualification.
Yes, there were exercises demonstrated and listed in the written manual for sure.
I vividly remember walking away with a grand total of 3 safe abdominal exercises for pregnant women…
…and, the postnatal section of my instructor booklet consisted of 3 x A4 pages which consistenly stated ‘no adaptations / same as for pregnancy’ (can you believe it?!).
One observation was, there was certainly a lot more emphasis on learning the theory, than perfecting the practical and performing (which is sort of important for your confidence if nothing else, huh?).
I can remember spending hours putting a lesson plan together that ‘ticked all the boxes’ so to speak to pass the assessment, but when it came to the real wide world of teaching pre/postnatal – I really didn’t have a lot to go on.
Unless you’ve had your head in the sand, you’ll have noticed that there’s been a shift towards ‘functional’ training over the past few years.
Nothing new there.
So today I’m going to give you the tools to enable you to freshen up your standing exercises safely and effectively for your pre/postnatal clients.