By Jenny Burrell BSc (Hons), Founder of Burrell Education, Specialist For Pregnancy and Post Natal Fitness & Therapy, London, UK. www.burrelleducation.com
As a health and fitness professional serving Post Natal clients, there are (in my opinion) 5 major confounding issues that the client presents with when employing the service of a specialist fitpro….in no particular order:
1. A wobbly stomach with stretched skin and poor muscular tension/tone and a general feeling of disconnect to the abdominals.
2. How to get rid of a C-Section tummy that overhangs her scar.
3. A malfunctioning pelvic floor leading to at best urinary leakage, at worst faecal incontinence.
4. A palpable gap at the midline of the abdominals, technical term: Rectus Diastasis or Distension and when/if it will close.
5. How to get rid of ‘baby fat’!
This post relates to a few other factors to bear in mind when a client presents with a Distension (Diastasis) beyond simply measuring the gap and deciding what type of programming is suitable for her present state.
1. How old is the clients’ ‘baby’? – The older the Distension, the less likely that it will close completely ie., a 6 month PN client is in a much likelier position than a 2 year PN client.
2. How old is the client? – A younger mother (under 30) is generally in a better position regarding Collagen and Elastin production compared to an older mom (sorry!).
3. What is the condition of the midline? Papery/slack and offering very little resistance or can gap be felt but midline has good tension that can withstand pressure? – Having a distension (gap between the bellies of the Rectus Abdominis) doesn’t necessarily mean that you are doomed to a life of poor core strength, incontinence and back pain. For example, many fitness professionals who returned to work early to teach classes and exercised inappropriately often have fantastic looking midsections and fully-functioning core’s with a a Distension. Their Rectus bellies can be separated but their midline is strong on palpation and more than able to do its job of withstanding intra-abdominal pressure when required to.
3. If the client had a previous birth, what were the conditions of the abdominals before and after the previous baby? – Previously separated abdominals are less like to return to a fully closed position after a second and third pregnancy and birth.
4. Was there a short space of time between two pregnancies? – Connective tissue needs time to heal, short time-frames between pregnancies is less ideal and mothers with short gaps between pregnancies are more likely to experience poorer tissue resoration post birth compared to those who have had a longer ‘healing period’ between births.
5. What kind of abdominal work/sport has the client been performing post birth and prior to coming to see you the Trainer. What’s her occupation and daily activity levels? – I once assessed a fitness professional with a Distension to find that she taught 2 Spin Classes, 4 Body Pumps and led a running club. She had a two year old distension that probably would remain as her work activities and full schedule did not allow for modification to the quantity of stress placed on her abdominal muscles – incidentally, she had a firm midline and didn’t experience any back pain or incontinence!
6. Does the client experience any back pain or pain during her activities of daily life (ADL’s)? Especially in the case of a longstanding Distension with a firm mid-line, if the client has good continence and no back pain and is happy with her tummy…..who are we try to ‘fix’ her.
Answers to all of the above questions will give you a much fuller picture of your clients’ true core strength and capabilities and help you create a more realistic core strength programme suitable for the demands of her life.
www.burrelleducation.com – Passionate About Pregnancy & Post Natal Health & Fitness Education FOREVER!
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OK ,the gig is finally up on ONLY performing Kegels to re-activate and re-condition the Pelvic Floor! Don’t get me wrong, after giving birth when the musculature, nerve and blood supply, fascia and ligaments of the Pelvic Floor and Pelvic Basin have undergone significant trauma or at the very least, have been stretched by carrying the weight of a growing baby, Kegels are a vital tool. In the every early days after vaginal birthing and C-Section, performing Kegels can provide a lifeline to knowing that you are still in one piece! Also, performing Kegels for both the anterior, mid and posterior muscles of the PF assist with healing, bringing nutrient –rich blood and healing agents to wounded tissue. And still after the acute trauma phase has passed these muscle contractions can still help to recondition the PF and restore function. But there comes a point when Kegels are not really ‘functional’ – ie., preparing the mom for real life, after all…..afterall, who pees themselves when they are stood still? It’s usually during movement and an increase in intra-abdominal pressure that the PF fails and urinary incontinence is experienced. So, introducing MODERN MOVEMENT-BASED PELVIC FLOOR EXERCISE, spearheaded by forward-thinkers such as Eric Franklin and many other specialists in this field across the pond.
Any Pre/Post Health & Fitness Specialist worth his/her salt now knows that the PF muscles respond much more to a host of functional movements such as squatting, lunging, hopping, moving in multiple planes, gravity and vibration. Here are some tested functional movements and the microvolt reading (electrical potential of the PF muscles as contraction occurs) versus Kegels. (These were measured using a vaginal probe). I think you’ll find them pretty impressive! NB these exercises were performed without adding either conscious TVA activation or a Kegel contraction!
Kegel vs Movement – EMG Testing Summary
Exercise Name
Maximum uV
Kegel
75.1
Wide squat
168.1
Transverse step into squat off a low platform
180.2
Low Level Jumping
117.6
Supine bridge with resisted abduction (resistance band around knees)
169.2
Wide stance sumo deadlifts with resistance band
107.5
Table 1: (Reproduced with Permission) : Kegels vs Functional Exercise EMG Study – Jenny Burrell, Louise Dear, Stephen Powell, Phil Nourse, 2011.
So, in short, the Pelvic Floor LOVES MOVEMENT! When the time is right and your mommy is out of her acute phase (and been given the goahead by her HCP to exercise – she must have had her 6 week check!) You need to get her squatting, lunging and moving in multiple planes – where appropriate. You need to get her working her PF against gravity (start with mini hops on an empty bladder), introduce her to vibration (Power Plate or Flexi-Bars are both awesome tools for whole body vibration that includes the Pelvic Floor) and give simple adduction, abduction and pelvic tilting exercises as homework (great for when watching her favourite soap).
So Trainers!!!! Let’s get those mommies moving for real-life solution to a real-life problem. They’ll thank you forever. Remember, it’s all about more laughs and less leaks! Incidentally if your client base includes the post menopausal woman, this information is just as applicable!
Remember, keep it passionate, mediocrity is a sin!
Want to find out more about MODERN MOVEMENT BASED PELVIC FLOOR EXERCISE, attend the Burrell Education Modern Post Natal Assessment and Exercise Prescription Course –
worth 16 REPs CPD points
By Jenny Burrell BSc (Hons) – Founder of Burrell Education (www.burrelleducation.com) Specialist Pregnancy and Post Natal Fitness & Therapy Education
For rationale on grading the PN client as Level 1 to 4, please see blog article entitled: ‘5 VITAL Steps to Post Natal Fitness Programming’ – Posted in January 2012.
1. Kneeling Scapular Retraction & Abdominal Scooping – Looks simple but there’s a lot’s going on here. This exercise is great for activating the lumbar and thoracic musculature/fascia. Holding the kneeling hip flexion position ‘turns’ on this musculature and fascia whilst simultaneously performing scapular retraction by pulling the band wide activates deconditioned thoracic musculature. TVA/PF activation occurs as the client aims to withstand the pull of gravity on her abdominals by activating TVA and its synergist PF. Suitable for Levels 3 & 4 clients. If the client is unable to activate TVA and keep her abs pulled in as she works, this position is too advanced for her. You can regress this exercise by performing it in a standing position (still with hip flexion) to reduce the effect of gravity on still weakened abdominal muscles.
2. Assisted Heel Drops – One for the Pilates massive! – I teach this in the ‘flat back’ or ‘imprint’ lumbar position for the PN client to off-set and de-train her anterior tilted pelvis and to assist in lengthening shortened lumbar musculature and fascia. The flat back also ensures that the lengthened abdominals are being re-strengthened in a shortened position. An early PN exercise (Level 2 onwards). Client gently holds here knees as she works, ensuring the at TVA activation and the lumbar position is maintained throughout. As the client progresses, the hands can be placed on the floor as she works. You might find that early returning C-Section clients might first need to be regressed to HEEL SLIDES before progressing onto these ASSISTED HEEL DROPS.
3. Kneeling Straight Arm Press Downs with NEUTRAL PELVIS! – A great way to strengthen the abdominals without creating the usual intra-abdominal pressure associated with crunches. Emphasize NEUTRAL PELVIS and TVA activation at all times to ensure the abdominals are not strengthened in a lengthened position and the Pelvic Floor muscles are in the perfect position to be activated. Start and finish positions are shown. Suitable for Levels, 2,3 and 4 clients. In forder to ensure total core activation, cue the client to exhale as she simultaneously presses her arms downwards and draws her belly-button towards the spine. This will have a synergistic benefit to the pelvic floor muscles and muscles and fascia of the lumbar region.
Caveat: This information is intended for use by Certified Specialist Professional seeking inspiration when programming for the Post Natal client. If you are a mom looking for suitable exercises after your baby, please seek professional help/advice before commencing any exercise programme.
Need to modernize your exercise prescription for your Post Natal clients?
The next Burrell Education ‘Modern Post Natal Exercise & Exercise Prescription’ REPs Endorsed CPD Course in London, UK.
Friday 15th June, 2012 – SOLD OUT!
New ‘Overflow Date’ – FRIDAY 22ND JUNE – BOOK EARLY! This WILL sell out!
By Jenny Burrell BSc (Hons), Founder of Burrell Education, Specialist REPs Endorsed Pregnancy and Post Natal Fitness& Therapy Education, London, UK. http://www.burrelleducation.com
What do women want on their return to exercise after having their babies?
Fatloss?
Energy?
A better looking & functioning belly?
A non-leaky pelvic floor?
Rest?
With over a decade of experience working with this client population, the tools and strategies to tackle all of these areas have never been more effective, plentiful and easy to implement.
1. Let’s start with post baby fat loss. A bit of a tricky subject if you’re not able to get with the science. There are a few key factors why post baby clients hold fat:
The heightened Cortisol during pregnancy, remains high after birth and this situation is not helped by the added stressors of the early post birth period, poor sleep patterns and for some, the hormonal influence on fat stores perpetuated by on-going breast feeding. It’s a complexed subject but here Jade Teta of the Metabolic effect succinctly explains one of the mysteries of why many women DO NOT lose fat when they breastfeed unless perhaps you are Victoria Beckham or Abbey Clancey :-)!
The next key area of the post baby fat loss conundrum is EXERCISE INTENSITY. I could write forever on this but basically, the magic bullet for blitzing fat stores is INTENSITY NOT TIME! Unfortunately, most people don’t like to get uncomfortable (literally and metaphorically) so rarely go there! Unfortunately, discomfort is a vital key to effective exercising in shorter sessions that have huge fat burning/hormonal shifting potential for HOURS AFTER YOUR ACTUAL EXERCISE SESSION! Here are the generally accepted key elements of a metabolism boosting, fat busting session:
a) It’s short 20-30 mins maximum
b) Contains compound, integrated, functional movement – no individual ‘body-part’ exercising here! OK, may just bi’s and tri’s 😉 firm arms mean the world to us girls!
c) The exercise makes you sweat
d) The exercise makes your muscles burn
e) You get out of breath
f) You get hot
g) You push yourself ie., get a little uncomfortable
h) You don’t over-rest within the training period
The third component of successful post baby fat loss is Optimum Re-Nutrition. Pregnancy, birthing through to the early post birth period is a time of depletion for the mother. When the dust has settled, a key consideration is to re-nourish the body, replenishing depleted stores of essential vitamins and minerals that ensure her system regains balance and functions optimally. Many clients have no idea of the positive nutritional potency of many everyday foodstuffs and conversely how harmful to health many foods in their current diet are too – mainly those that come in packets! These days it really seems that we’ve finally nailed it! We have a long-term formula that actually works in terms of health, wellbeing, offsetting later life disease and helping us to consistently shed and keep fat off. Basically it boils down to: Get rid of, or at the very least CONSISTENTLY LIMIT the C.R.A.P in our diets– starchy carbohydrates and grains, refined foods and to be honest any sugar, alcohol and processed/packaged foods. Following these protocols will have a transformational effect on your clients’ energy, wellbeing and fat loss potential. Insulin is the master hormone for fat loss and once you get out of the sugar-trap, the results are amazing but for a lot of people a diet consisting mainly of restricted quantities of carbohydrates, protein, vegetables and selected fruit is challenging….that is, until they see the fat falling away. Based on my own personal and client experience, I created a cut and paste Post Baby Fat Loss manual that you can plug into your business almost automatically to establish your own system for POST BABY FAT LOSS THROUGH OPTIMUM NUTRTION.
2. Energy – Short, energising exercise session, a great diet, some key supplementation (high quality multivit, essential fats), good hydration and a dedicated strategy for resting as much as possible and not trying to be superwoman during this challenging life phase will go a long way to ensuring that your mommy has hugely improved energy levels. Top tip: If funds permit, suggest to clients that they find someone to help with the big cleaning jobs a few hours a week can be transformational and probably not far off the price of the 2 bottles of wine they won’t be consuming per week anymore.
3. A better looking and functioning belly & core. OK, second only to Pelvic Floor issues ‘OMG, look at my belly!’ is the sentence that I hear uttered the most often. Indeed, after at least 6 months of skin, fascia and muscles being stretched and the curious and annoying development of cellulite on the deflated tummy not to mention the dreaded stretch marks, the return journey back to a flat or at least half decent tummy isn’t always as smooth and rapid as most moms hoped it would be. Also for many, Diastasis (the separation of the two bellies of the rectus abdominis alongside a flaccid and weakened mid-line tissue) adds an extra dimension to a difficult restorative period. The final annoyance comes in the form of C-Section recovery which, I REALLY GET NOW! (I managed to have 2 C-Sections – only 12 months apart!). Not only is C-Section blooming painful in the early days – you are left challenged to perform the simplest of tasks (bending over to put knickers and socks on!!!!) but then when you start to feel stronger after a few months and lift a heavy object , wear high heels or stay on your feet all day, the gift of an achy scar pointedly reminds you that the healing process still has a way to go. Below are 3 core-restore exercises that I used on myself, and in my programmes with clients that I’ve found to be extremely effective and with clients with their core strength assessed to be at Level 2 or above ( Level 2 = 2 finger or under distension with still weakened midline unable to withstand significant intra-abdominal pressure continuously).
Kneeling Scapular Retraction & Abdominal Scooping
Looks simple but there’s a lot’s going on here. This exercise is great for activating the lumbar and thoracic musculature/fascia. Holding the kneeling hip flexion position ‘turns’ on this musculature and fascia from lumbar to the thoracic back, whilst simultaneously performing scapular retraction by pulling the band wide further activates deconditioned thoracic musculature. TVA/PF activation occurs as the client aims to withstand the pull of gravity on her abdominals by activating TVA and its synergist PF. Suitable for Levels 2, 3 & 4 clients. If the client is unable to activate TVA she works, and experiences a bulging of her abdominals, this position is too advanced for her. You can regress this exercise by performing it in a standing position (still with knees bent and in hip flexion) to reduce the effect of gravity on still weakened abdominal muscles and midline. Here this exercise is shown being performed on a Power Plate. The principles of Whole Body Vibration accelerate this brilliant exercise, taking it to another level but is still highly effective when performed on the ground. The settings are 30-30-Low. (Please seek advice from a certified experienced Power Plate Trainer if you are not certified to use this equipment with Post Natal clients).
Assisted Heel Drops and Heel Slides
One for the Pilates massive! – I teach this in the ‘flat back’ or ‘imprint’ lumbar position for the PN client to off-set and de-train her anterior tilted pelvis and to assist in lengthening shortened lumbar musculature and fascia. The flat back also ensures that the lengthened abdominals are being re-strengthened in a shortened position (the anterior tilted pelvis and Pregnancy has lengthened the muscles and tissues). Client gently holds her knees as she works, ensuring the at TVA activation and the lumbar position is maintained throughout. As the client progresses, the hands can be placed on the floor as she works. NB: You might find that early returning C-Section clients might first need to start with HEEL SLIDES before progressing onto this ASSISTED HEEL DROP as lifting the legs into the start position might be too challenging for them.
Heel Slides (With Glider) With Arm Extensions
Kneeling Straight Arm Press Downs with NEUTRAL PELVIS!
A great way to strengthen the abdominals without creating the usual intra-abdominal pressure associated with crunches against a weakened core. Emphasize NEUTRAL PELVIS and TVA activation at all times to ensure the abdominals are not strengthened in a lengthened position and the Pelvic Floor muscles are in the perfect position to be activated. Start and finish positions are shown. Suitable for Levels, 2,3 and 4 clients. Remember to coach: EXHALE ON EXERTION (ie., when the band is being pulled down).
4. A Non-Leaky Pelvic Floor – Pelvic Floor exercise has come a long, long way since Mr. Kegel and his great revelations BUT there is still a way to go beyond the walls of research and academia. In plain terms….women are still leaking and those sales of Tena Lady are increasing year on year (yes I actually checked!!!). So, a bit controversial here, can I posit the notion that if Kegels are the sole answer to urinary and faecal incontinence (ie., they were easily taught, people understood them and compliance was easy) why does just one half of my local supermarket shelf look like this?
Right now, there is a huge, well researched and vociferous movement towards emphasising the importance of including MOVEMENT to re-train the Pelvic Floor once the client is out of the acute tissue trauma phase post birth. That said, movement won’t necessarily solve the problems of more complicated and critical cases such as prolapse, but in the case of those simply seeking a restorative programme post birth, the principles, practices and rationale of MOVEMENT BASED PELVIC FLOOR EXERCISE really has to be in the kit-bag of any medical and fitness professional who specializes in rehab in this area.
So what does the PF love? Squatting, lunging, lifting, pulling, tilting, multiplanar movement, hopping, and balancing – do these moves sound famililar? THESE ARE ALL FUNCTIONAL MOVEMENTS THAT WE’RE ALREADY PRESCRIBING FOR OUR CLIENTS! All give superior unconscious stimulation to the PF muscles without the aid of performing or cueing Kegels and fit beautifully with modern exercise prescription and preparing the client for her REAL LIFE! Combined with an optimal breathing strategy, basically (exhale on exertion – this puts a ‘lock’ on the Core Cannister and offsets increased intra-abdominal pressure against weakened abdominal tissue) PELVIC FLOOR EXERCISE BECOMES FUNCTIONAL. I’ve summarized the ‘turn-ons and turn-offs’ for the Pelvic Floor in the table below:
Pelvic Floor ‘Turn On’s’/Strengtheners
Pelvic Floor ‘Turn Offs’ / Weakeners
Integrated Whole Body Movement! Think of the effect of immobility on the continence of sedentary elders.
Immobility
Vibration – whole body vibration also involves Pelvic Floor muscles too!
Combative sports or those that involve body blows (consider a parallel bar gymnast).
Instability – the whole core is activated included TVA which is a synergist of PF.
Anterior tilted pelvis (the usual pelvic position of the Pre & Post Natal client).
Adduction –due muscular & fascial links between adductors of the Femur and PF.
Over-active Piriformis – seen by some as part of the Posterior PF. The rear PF gets strong, the front PF gets weak!
Abduction – due muscular & fascial links between the deep lateral rotators of the Femur and the PF.
Pregnancy (stretching of the PF muscles by the weight of a growing baby).
Multi-Planar Movement –a combination of stimulation of adductors and the stretch reflex occurring in the PF muscles.
Vaginal birthing especially when assisted (ventous/forceps/episiotomy) – produces varying degrees of soft tissue and nerve trauma that can have a direct impact on the function and connection to the PF muscles post birth.
C-Section –crucial synergistic core ligaments, nerves, skin, blood vessels and fascia are severed and take many, many months and in some cases, years to repair/reconnect
Working against gravity, especially with progressed speed and power.
TVA Activation & Diaphragmatic Breathing – TVA, Diaphragm and PF muscles are synergists.
Persistent coughing without mindful control of the increased intra-abdominal pressure.
Co-Activation of PF through activation of the Muscular Sling and fascial systems ie., full body integrated/compound movements.
Menopause – causes a fall in Oestrogen production which affects connective tissue formation and strength.
Ageing – an ongoing decrease in Collagen and Elastin formation affects connective tissue tension and less resistance to gravity and pressure.
5. Finally, last but most definitely not least – Rest – For too long, meditation and those with a consistent practice have been seen as some sort of secret society but thanks to advances in modern technology the rest of us mortal souls can now enter the loop. The power of meditation is HUGE and it’s a massive asset to health and well-being and FAT LOSS even if you have just a few minutes a day to dedicate to it. Even when night-time sleep is hard to come by using strategies such as ASSISTED MEDITATION wearing a set of headphones listening to an audio recording is a huge asset to redressing the imbalances caused by sleep deprivation. Check out http://www.centerpointe.comand www.blissitations.com. Both of these sites have products that you can purchase and or download that literally give your brain the equivalent of the best massage you’ve EVER had! Utterly blissful and even 10 minutes does you the power of good! Perfect for the time pressed mommy. For more on this, check out my previous blog on Stress, Sleep Deprivation and Fat Loss.
So, in conclusion, fat loss is tricky at the best of times, never mind after the endocrine turbulence associated with pregnancy, birthing and breastfeeding. Helping your clients to understand the facts will help to temper her anxiety that her body has gone to pot FOREVER. Simply helping her to detoxify/clean up her diet and teaching her new ways to rest can be a great way to start on the journey to losing her baby weight in the early days but ultimately, this is one time in most women’s life when they are forced to learn the art of patience, self-acceptance regardless of what size they are wearing and a time for redefining what success means in terms of their diet and fitness. It’s always a little dark before the light :-). With our help, great guidance and empathy they will make it back and be better, stronger and wiser for their ‘down-time!
Til next time! Remember…..Mediocrity is a Sin! Go Bold or Go Home! 😉
I‘ll be presenting at the UK Top Fitness Convention later this month, check out the amazing line-up & my sessions….
I was having a very deep conversation the other day with a good friend about FACEBOOK and it’s potential to bring out the not-so-great co-dependent aspects of one’s personality (should you have any, of course 🙂 ie., ‘OMG they’re doing this and going there and my life’s so dull etc., etc., etc., Essentially comparing other peoples’ ‘outside’ with your’ insides’ with the result that you will always get it wrong – EVERYTIME!
What I know for sure (after a couple of years of ill-health from which I’m now gratefully emerging) is that life is about BEING and not DOING and it’s in the moments when we just BE OUR FUNNY/RANDOM old selves that we experience the most deep joy. Have you noticed how doing whatever we do in those moments (smelling a baby’s head, petting the dog, stretching, meditating, listening to music, arranging flowers, napping, smelling fresh laundry, watching a sunset or an awesome sky) costs us either nothing or very little. So (and I say this to myself too…..) Let’s all spend a whole lot less time ‘comparing and dispairing’ and start living our AUTHENTIC lives on OUR OWN TERMS. Possibly one of the greatest gifts we can give to ourselves EVER!
Burrell Education 