Forget the 6-pack, what you really need is a strong core
A couple of weekends ago I made the trek to Whitby to attend training with the group Bellies Inc.
If you haven’t heard of Bellies Inc. yet, it was created by three Canadian moms who work in pre- and post-natal physiotherapy and fitness. Their mission is to raise the bar on the quality of advice that women receive during the prenatal and postpartum period, and to educate and empower women so they can better prepare for and recover from birth.
Bellies Inc. provides training for health and fitness professionals like physiotherapists, chiropractors, midwives, and fitness instructors. Their courses are unique and are based on the most up-to-date scientific research; they also evolve as studies uncover new information.
I’m incredibly excited to bring my new knowledge about core, pelvic floor, and pre- and postnatal health to Peterborough (I’m the first certified Bellies Inc. trainer in our area!). The course was also an excellent compliment to the PFilates training I did back in the spring (you can read more about that here).
Here are a few key messages that I’d like to pass along to you:
About 50% of postpartum women will experience core dysfunction.
The “core” has become a buzz word in our society, although the true definition of “core” is not widely understood.
Our true core is a team of 4 muscles (the diaphragm, transversus abdominus, pelvic floor and multifidus), which work together to anticipate and support our everyday movements without us even thinking about it.
Before building the outer abdominal muscles (e.g. the rectus abdominus “6 pack muscles” or the obliques), we need to have a strong foundation in our inner core, and make sure that it’s functioning properly.
Some signs that your core may not be functioning properly include peeing a little when you jump, laugh, cough or sneeze, getting up in the middle of the night to pee, injuring yourself doing simple movements such as reaching up to grab something from a shelf, pain in the low back or pelvis, prolapse symptoms, a low belly pooch that won’t disappear, and postpartum abdominal separation that doesn’t heal.
(A note about bladder control – any involuntary loss of urine at anytime of any amount is considered incontinence. Too often we hear from well-meaning friends or doctors that leaking urine is a normal part of becoming a mother. Common yes, but normal, no. Clear scientific evidence shows that urinary incontinence after childbirth is highly responsive to treatment, so if you are leaking urine or are unable to delay the urge to pee, this isn’t something you have to live with! Chat with me for advice on this).
Doing the wrong types of exercises after baby is born can do more harm than good.
Imagine rebuilding an apartment building after an earthquake without first inspecting and repairing the foundation.
There’s no good way to get a baby out – pregnancy and childbirth are going to damage your “foundation” in some way, whether you deliver by c-section or vaginally.
One of the many ways this damage happens: during the second stage of labour, a very important nerve in our pelvic floor (the pudendal nerve) is stretched by 13% to 33% to allow the baby to be delivered. This type of nerve can usually only be stretched up to 15% before damage occurs. When it’s overstretched, communication between our brain and pelvic floor muscles is impaired, and loss of muscle mass (atrophy) happens quickly – within days.
Our first order of business needs to be rebuilding these neurological connections and restoring our core foundation. The core breath is a great place to start – here is a link that teaches you how to do it.
Unfortunately many new moms feel pressured to “get their body back” as soon as possible, often turning to Mommy Bootcamps, high intensity workouts, running and crunches to achieve this.
This return to intense exercise too soon is one of the main causes of core dysfunction and can prolong post-natal recovery.
Science is showing that many of the fitness “cues” and exercises that were popular in the past can contribute to core dysfunction for some people.
Just as sit-ups were replaced by crunches, crunches are now becoming antiquated and are seen as a big no-no for the postpartum body (and if you’ve ever had a baby, your body is considered postpartum, even if your kids are 20 years old).
Another example – the cue in yoga to “draw your navel/belly to spine” is outdated and can contribute to core dysfunction for some people. Hollowing the abdomen tends to encourage those superficial abdominal muscles to dominate, often at the expense of our deep core muscles turning on at all. It can also put downward pressure on the pelvic floor and weaken connective tissues.
If your yoga instructor gives you this cue, think about drawing your low belly upwards and inwards instead, like you are zipping up a pair of jeans that are two sizes too small.
Simple tweaks to our posture and habits can have a huge impact on preventing or treating core dysfunction.
The way we get into and out of bed, our bathroom habits, the way we breathe, and our posture can all contribute to (or prevent!) core dysfunction.
It is interesting to note that women who have had a c-section often do more damage to their bodies after the baby is born, just by the way they get up from laying, nursing, or sitting.
We need to start treating the postpartum period as a rehabilitation phase.
I’ve already alluded to some of the trauma that the body goes through during childbirth. The pelvic floor alone needs a minimum of 4 to 6 months to fully heal after pregnancy.
If you were to injure your ACL and require knee surgery, your surgeon would likely lose their license if they didn’t prescribe some sort of physiotherapy or rehabilitation after the procedure. You also wouldn’t think of returning to intense activities such as bootcamps or running two weeks later.
In our society however, women are often sent on their way after childbirth, possibly told to “do their Kegels”, with no instruction on how to do this, and little regard for rehabilitating damaged muscles or connective tissues.
We need to take that time to retrain, essentially resetting the foundation for proper alignment, biomechanics and movement.
Pelvic floor physiotherapy is critical for new moms.
It’s highly recommended that women see a physiotherapist who specializes in the pelvic floor as early as two weeks postpartum and definitely by six weeks postpartum to assess and help restore proper core function.
If you had your baby in a hospital, your pelvic floor physiotherapy appointment may be covered by OHIP. It is often covered by private health insurance as well. We have a great pelvic floor physiotherapist in Lakefield who I have gone to myself – her name is Kim Payne. More information about her clinic is here. You can also find a pelvic floor physiotherapist who has been trained in the Bellies Inc. methods here.
Even if you haven’t had a baby, many people can benefit from a tweak to the way that they use their core muscles.
In fact, high impact athletes have some of the highest rates of core dysfunction – 85% of trampolinists (who have not had babies), and 67% of gymnasts experience urinary incontinence. It is also possible to have 6-pack abs layered on top of a dysfunctional core.
At this point you may be thinking “childbirth is a natural process – women have been doing this for millennia. Why over-complicate things?”
Modern day humans don’t move the way we used to – we sit in the car, at work, in front of the TV, often with poor alignment and posture. This leaves critical muscle groups underused, and us more vulnerable to core dysfunction.
We also don’t deliver our babies the way we used to – nowadays we are typically on our backs, which puts the pelvis into non-ideal alignment and greatly increases our chance of pelvic floor damage and tearing. (Try delivering on your side – it’s supposed to be one of the best positions).
Modern day babies are also larger, due to better prenatal care and nutrition.
All of this combined results in way more trauma to our bodies than our ancestors experienced.
Join us for our next Pelvic Floor Fitness Workshop – click here for details.