RECORE and maintaining my Core

Big image.JPG

ReCORE

My consistent and deliberate work on my DR began in 2016 when I met Celeste Goodson. Celeste has a BS in Fitness and Wellness and 15+ years experience in health and fitness from working in physical therapy clinics to cardiac rehab, aquatic therapy, and numerous fitness facilities. Celeste has been certified through ACE as Medical Exercise Specialist since 2005, certified to train those with musculosketal, neuromuscular, and metabolic conditions cleared by physicians. After her own personal struggles postpartum with her third child (mild prolapse, Diastasis, stress incontinence, and struggles returning to running), she started ReCORE in 2011 and felt the need to focus on helping postpartum women properly re-activate and re-strengthen their inner/outer core progressively before returning to typical exercise. Even those that don’t deal with DR still have core and pelvic floor weakness, and activation/stability issues postpartum. Celeste is an avid runner and marathon junkie.

When we first met she took me through some tests, measurements, and gave me my homework for ReCORE:

1ST VISIT- Aug 8, 2016

-Tested inner core coordination (breathing, pelvic floor activation with with ab sets, maintaining neutral spine)

-Discussed Intra Abdominal Pressure and the importance of breathing and lifting pelvic floor during the hard part of any exercise

-Tested inner core strength with Drop Test

-Discussed splinting

-Measured DR – did passive measurements with DR, but primarily looked at the active measurement (measure when abs FIRST start to activate) since that is measuring functional DR

The focus in the beginning was:

1. Making sure inner core coordination becomes a habit (lift pelvic floor when engaging, relax pelvic floor when relaxing abs) and not involving the glutes when lifting pelvic floor

2. Keeping neutral spine and not shifting pelvis

3. Adding inner core coordination and strength progressively with larger muscle groups –  add glutes, abductors, and quads to help improve core stability and hip drop and working with Hypo2 all this time has been a huge help.

We did more advanced core strength/coordination testing with me (Pistol and Star Test) because I did pretty well on the initial Ab Set and Ab Set Ha’Ha exercises and had decent strength/inner core coordination on the Drop Test. Celeste doesn’t typically do the Pistol or Star Test with recently postpartum clients.

PISTOL TEST – left side more unstable than right (work on inner core coordination with quad, abductor and glute strength)

DROP TEST –

1st visit – just struggled on the last 20 degrees of the leg drop.

2nd visit – ace’d the drop test 

3rd visit – just re-assessed DR and pistol test

Celeste has been gracious enough to offer a discount for 10% off the FITsplint or downloadable ReCORE program. You can use my name: Steph10 at checkout. If you are a pro athlete or someone who has certain goals/circumstances, I would recommend looking into one-on-one training with Celeste (via online) to customize the progression. She is a wonderful person and resource to work through all of this with.

DR in my experience can’t ever be fully healed, but if you can restore strength and stability and muscle coordination you’re basically where you want to be. I still have saggy skin, and I will forever for a few reasons. Because I run on average 90-115 mile weeks I lose most of my body fat all over, but the excess skin from my stomach stretching will always be there. I have accepted that. I don’t want surgery, I don’t feel its necessary but I understand some women do so that’s your choice. Just know I don’t believe the surgery will actually correct the muscle instability and weakness but just fix the cosmetic issue. That’s a debate with some doctors I know. After doing ReCore for about 3 months and continuing to do maintenance exercises all the time for the last 18 months no longer have pelvis pain, prolapse, back pain, and my ab muscles are about as good as I’d like to see them. I believe the goal for you women who have this condition should be to get out of pain, build strength, maintain that strength, and then build confidence in your physical appearance. In that order. I do suffer occasional weaknesses and injuries will pop up for me, but I’m also pushing my body more than the average person but have loads of time for recovery, a team of support, and it’s my job. Things I avoided in the beginning phases were planks, push ups, sits up (always) and basically anything you did that created a bulge in your tummy. If you bulge, back up, that’s too aggressive for where you are at. I lift very heavy weight now (3 years PP) performing squats, doing plyometrics, and just about all core exercises. Don’t rush, work from the inside out, and you’ll get there. Rock your imperfect tummies, start the conversations in coffee shops, and let’s get doctors and therapists to address. I don’t believe there’s a too late. I think you can always begin working on your core, whether your child is 6 months or 6 years old.

IMG_2154.JPG

If peeing your pants is cool consider me Myles Davis- Billy Madison

Dream Big

Steph

DR In My Own Experience

DSC_0634.jpg

What’s the deal with DR anyway? I don’t really know if Diastasis Recti is supposed to be abbreviated to DR but it makes me feel fonder of the condition I have. Like, “Hey you have DR, too? Cool, let’s go grab coffee and then activate our inner core muscles.” These are the conversations I wish existed in the halls of Labor and Delivery in hospitals, or whenever another woman runs by you with her shirt off and yells, “DR got you too, high five!” But the truth is it doesn’t. It’s a very quiet and almost taboo topic for women to discuss in the public forum, let alone show their ghastly condition.

I’ve worked with a lot of great therapists, doctors, and chiros after giving birth to my two boys. I’m fortunate with running being my profession that I have access to some of the most knowledgable and thorough specialists in the area of postpartum care, pelvic floor specialty, and strength and conditioning, all while being a woman and an athlete. I’d like to take a few moments to thank Renee Cinco, Celeste Goodson, Wes Gregg, Shea Tinder, my friend Sara Tanza and John Ball for their extensive work and patience with me over the last few years.

According to my research and what I have learned from the therapists mentioned above, here’s what I’ve come up with to explain my experience and knowledge with DR. Diastasis rectus occurs in 50-80% of women during pregnancy and into the postpartum period. DR occurs when the fascia between the two sides of the rectus abdominus muscle in the center of the body gives way to accommodate the growing baby. There is always a fascial line between the muscles, but separation occurs when this line stretches wider and/or the tissue integrity is compromised, leading to not only a greater width along the line but a softening and increase in depth. Recovery rates are not well known/studied, so we don’t have good evidence on how long it will take, what the best exercises are, and what outcomes we can expect at given points in time postpartum. Women with DR are more likely to have other pelvic issues such as pelvic organ prolapse and urinary and fecal incontinence, and are more likely to have difficulty with lower back pain affecting their daily activities.

Because we don’t have good data on the best exercise protocol to use, the best way for women to get help postpartum is to work with a health care provider that has training and experience with pregnancy and postpartum/pelvic health issues. They can learn exercises that work for them without further stressing the diastasis and that help approximate the two sides of the rectus abdominus muscles. While they can complete most of the exercises at home, they should be monitored while first doing the exercises to make sure the right activity is happening in the muscles and then monitored as they progress their exercise program. Some women will benefit from other PT techniques such as taping to approximate the muscle during exercise and daily activities, or use of postpartum supports, manual therapy techniques to release adhesions on the lateral borders of the rectus abdominus muscle and encourage the approximation of the muscle. There needs to be more research/funding to guide how we help women recover in the postpartum period. Most if not all women will benefit from a consultation with a PT who specializes in pelvic health before they begin to exercise postpartum, and women with larger diastasis and more loss of pelvic floor function will benefit from ongoing follow up, yet this is not routinely provided as standard care in the US as it is in other countries.

What’s involved with Diastasis recti?

The linea alba, that nice line down the middle of our abs that we notice more pronounced during pregnancy, is fairly resistant to horizontal pull.

Having children and giving birth is considered the most natural act a woman can go through. It’s evolution, it’s history, it’s our world. My experience, however, was a bit farther from natural than I could have imagined. The human body is an amazing specimen with it’s ability to grow a human and stretch it’s tissue and muscles to make room for a baby. These steps do happen naturally. But then the baby grows bigger as we approach our due date and the skin stretches more. Depending on your body size, height, and weight the distribution of the extra force can be separate the muscles and stretch the skin so much that there becomes a “hole” in the middle of your stomach.

So what was my experience. I had 2 pregnancies very close together, 15 months apart, not on purpose. My stomach grew very large and very out. My babies were also on the bigger side, 8 and 9 lbs. So what did I do? After I gave birth to my first son Riley, I was a mess. I had a very aggressive delivery and a grade 4 tear with an episiotomoy. My first run was seven weeks postpartum and my uterus just about fell out of me during that three minute jog. The next run, I shit my pants. I laughed and I shit my pants. This is shit (ha ha!) you can’t make up and you can’t talk about in most settings, but it’s a shame because it’s real life. It’s not gross and shouldn’t be kept in the constraints of hospital walls and OBGYN appointments. There should be more discussion from women, with women, and even with men about this. Truthfully, I didn’t really know what I was doing coming back from giving birth. I knew how to get fit, get back in shape, and get strong because I’ve been a professional runner for almost a decade. But I didn’t know how to face the problems that my new body were now presenting me with: Incontinence, pain in my pelvis and lower back, prolapse, and lack of muscle coordination. I didn’t feel like I was rushing back after my first son was born, but then I really didn’t have much time because I got a little surprise six months postpartum and found out I was pregnant with our second. Since my sons were born 15 months apart, I’m not entirely certain as to whether that’s a factor in why my DR was so pronounced, coupled with the fact that my babies were big, or that my torso is small in relation to my height, or that my abs were strong before I had children. This is the journey I’ve been on to discover what factors contribute to certain women having DR and if it’s preventable. I thank all of you who have reached out to me and shared your story in hopes that I can offer some insight into this condition.

Inspiration

Much of my motivation and inspiration to bring this topic to light and further explore and research is the women that I have met or who have reached out to me over the last 4 years. Whether I respond to you or not, please note that I read all of your comments wherever you leave them, and they encourage me to keep sharing. Below are just a handful of emails from some brave women who emailed me. I’ve left out their names for privacy but I hope I have helped or answered some of your questions and provided a resource for you.

Dream Big

Steph

I just found your blog and I love it!  I am a mom and a runner and I have enjoyed following your Instagram and your journey.  It’s great to be able to see that everyone has a human journey and that it isn’t just six packs and racing briefs.  It sure is inspiring to me as a middle of the pack runner momma.

Anyway,I thought I would give you my dr info for your research.  I have four kids and have had dr since the first.  It hasn’t gotten bigger/ worse (always about 3-4imches) and my youngest is now 2 years old. I have a long torso and grew big babies (8.1-8.9lbs).  My abs were not in great shape before each pregnancy but I was a runner and did core work a couple of times a week.  I did some abdominal conditioning during each pregnancy.
Our family is now complete and I am committed to strengthening my pelvic floor and core muscles.  It’s been much harder than I thought.  I think I am making progress though as I can now visit the trampoline park with my children with out an adult diaper in place ha ha ha :).
I’m going to try some of the ab work you posted.  Thanks so much for putting your life out there for others to follow.
With admiration,

I found you online and would love to ask you how you were able to close your diastsis.  I’ve been told not to do any push ups or sit ups and it appears you are able to do those?

Came across your blog and love how you speak about DR.

I discovered I had it after my second child. I had it repaired after my third. I had a total DR with complete ventral hernia. I’m now held together with fishing line and thank God for it every day. Before the operation I couldn’t stand straight by the time 5pm came around and when I woke in the morning my hips and feet were so sore I hobbled down the hall. Very tough with 3 girls in 3 years. Now I can run half marathons!Not sure how much information you are looking for but thought I’d briefly share my experience.Keep keeping it real!

The sheer exhaustion that comes with caring  and pumping for quads. Not to mention how long I had been with not exercise. Some days- I get sad. I worked so hard to get in such great shape- and pregnancy took that from me. Don’t get me wrong- I absolutely feel incredibly grateful at the wonderful blessing I have— and I miss my body.
I work out weekly with other moms In a stroller group. They have their cute bodies. Their bob stroller. 1-2 kids. They have time to devote to exercise.
I don’t have a cute body. My stroller seats four, doesn’t off-road well, weighs over 80 pounds. And I struggle to find time to workout. And I long to be able to run and bike like I did as I try to modify the push ups, planks, and other exercises that the moms master.
Your blog brings me much hope and motivation. Thank you. Thank you for showing your belly and keeping it real. Thank you for setting the bar high and also letting us know when to fall. Thank you for being honest. Thank you for breastfeeding while you run. Thank you. Thank you.

I had three babies, with about 3 years between each of them. I was/am over weight currently 215lbs, but have been all the way up to 260 (with first pregnancy). I actually weighed less each one after, yay for that. I am 5′ 8″. I don’t have a short torso, but my 2nd baby liked sticking out like a torpedo (it was crazy!). Actually I remember with him I had this burning sensation right at the top of my baby bump and it hurt to laugh, he was stretching out new spaces and it didn’t feel good. I’ve never been big on exercising, it has always been a struggle to get motivated for me. I did however start working out with Beachbody workouts prior to my last baby and was doing well with weight loss. So in the question of having a weak core, that would be me. 

I want to thank you for sharing your realness. I’ve thought “wow if I had just done this or that prior and during then this wouldn’t have happened”. Maybe it wouldn’t have, but seeing that it also happens for someone who is so fit makes me think that I should give myself a break and not beat myself up over it. 

Either way it’s done and I have the beautiful babes. <3

I had my child 16 years ago, but no one addressed my concern. My abdomen was like a triangle that popped out. I could stick my hand inside. I was very afraid because I had never heard of anything like this before. Although I mentioned it to my now exhusband and my doctors, everyone ignored me. Years later, it has mostly closed. I still feel the ridge in my abdomen and a separation around my bellybutton. Prior to pregnancy, I was very fit and lean. I am also petite, 5ft 100lbs.  I ran and also did a lot of yoga. I have since stopped running due to other medical issues. It is interesting to know why this occurs. Would love to continue the conversation.

I saw a post on my fb feed today (Today parenting?), and I just had to contact you, since I also have severe DR, having had 3 c-sections (my last one, 5 years ago). If you are considering a study or other workout advice, I’d be thrilled to be involved. I have tried PT to work on the transverse muscles, and to be honest, I’m not the greatest with exercise, but it’s frustrating to feel like no matter what I do, the gap can’t be closed. Also, when I would go work out (the YMCA), I never knew what exercises would be more harmful to my disastrous core. I’d try subbing side-planks, thinking regular planks were pretty bad for someone with DR, etc. I’m trying to stick with jogging, although my knees don’t love it
Anyway, just thought I’d send a message to say “thank you” for bringing awareness to this condition and for trying to help women going through it.

Finally I see a mom who has a stomach who looks like mine!!!!!  Since I found out 3-4 years ago that I had DR, I’ve done some reading on it because as many women do, I want my pre-baby body back, and finding out I had DR and it wasn’t going to happen without surgery put that flame out fast.  No more visible flat lower abs, just a lot of “zebra stripes” (as my cousin’s daughter once called them) and looking “saggy like an elephant’s butt” (as my daughter described).  

I’ve thought and read about DR quite a bit, and enjoying research as I do I’ve gathered my own stats about DR.  Most of the people have some common denominators. Many of the girls I know who have DR are naturally thinner, or smaller in stature, and quite a number of them had their children less than 18 months apart.  I think that may be because the female body doesn’t truly return to “normal” until 9 months postpartum, so if they become pregnant shortly after birth they haven’t had a chance for their innards to go back from whence they came.   I had my two 12 months and 29 days apart, and both my kids were larger than anticipated.  

And just because I get a kick out of the 7 degrees of separation…  My future sister-in-law got super excited when she saw me post about you because apparently one of her buddies from college (track or cross country, I’m not sure which) trains with you.  Small, small world.

Hope you have a great weekend, and thanks for posting those pictures!  It really helps moms like me who have the sag but are in shape to feel normal and begin to accept and flaunt our “battle scars” instead of feeling inadequate or imperfect seeing pictures of perfectly sculpted postpartum bodies.   Best of luck in your training!

I have a three year old son and an 8 month old daughter. After delivering my daughter, I struggled with a lot of pelvic and abdominal pain. I tried to return to running and exercising but the pain was horrible. My OBGYN ran all kinds of tests and couldn’t find what was wrong with me. He sent me to a pain management specialist and they couldn’t find what was wrong with me either so they decided they should give me nerve block shots. The Dr said he didn’t know if they’d work but it was worth a try. I decline and he said that I may never find what was wrong with me and may never feel better. I thanked him and left. I went to see my family doctor and she (from conversing with me about my symptoms) told me that my muscles were probably torn and that I should probably take it easy on the exercising until my daughter turned 1. I immediately went home and did some research and found that individuals with diastasis recti were experiencing every single symptom I was experiencing. Sadly I’m still struggling with it. But today I found new hope after reading your blog. I have high hopes that maybe some day I will be able to run again without pain. Thank you.