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Ask The Two Hundred Dollar an Hour Tacoma Personal Trainer On Abdominal Diastasis
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A few years ago I used to write the “Ask the over 100 dollar an hour Tacoma Personal Trainer” articles. It’s been a few years later and I have greatly expanded my skills and the rate has increased accordingly to match the value. With the demand of the skills came less time to write, I took some time out today to answer a question about a splitting of the abdominal wall.

Here’s a question that client asked me following the birth of her first child. Let’s start with her question:

isaac

“For weeks I was wondering why in the world my stomach still looks like I am pregnant. At first I was thinking it was not a big deal until I noticed that working out and eating well did not make one change in my stomach area when that is actually the first place that goes…

After speanding hours of research and feeling just weak in the mid-section I noticed a gap….a pretty large one to be honest which in turn lead to more research. I did a few test and low and behold I have Diastasis Recti/Abdominus.  A diastasis recti is a separation of your outer most abdominal muscles. The job of these muscles (called rectus abdominis), is to support your back and your organs.The cause of a diastasis is from continuous stretching of, and intra-abdominal force and pressure on, this connective tissue that joins your outer most abdominal muscles. Which because I had such a LARGE pregnancy I think it damaged it. Right smack in the middle of this connective tissue is your belly button which is a weak spot. That is why when the connective tissue stretches sideways your belly button will become an “outie”.  Pregnancy and doing crunches are examples of intra-abdominal “force” on the connective tissue. Wearing a front loading baby carrier or being in a hands and knees position are examples of “pressure” on the connective tissue.  Movements where you arch your back will flare your ribs (which I do already because of my scoliosis) This flaring will stretch your connective tissue. 

 Back pain, poor posture, pelvic floor problems (which I have had since pregnancy), gastro- intestinal disturbances like constipation and bloating are all symptoms that occur when the support system for the back and organs is the weak connective tissue instead of the muscles.Most women who have had a baby have a diastasis recti, and this usually gets worse with each pregnancy.Abdominal trauma with a diastasis can cause the connective tissue to tear away from the abdominal wall causing a ventral hernia. This requires surgery to repair.. So given ALL of this.  I can’t do many moves at Befit for Bootcamp.  The best move is hip bridges…is there any other moves that I can do that will work my diastsis?”

An Example Of A Distasis Belly. Note the anterior to posterior size of the Belly because of the lack of support to keep the organs inside.


What Is Going ON?
The first thing to understand is what happens in an abdominal diastasis. Your “six pack” muscles are one nice group of muscles known as the “rectus abdominus” most people hire a personal trainer because they want more visibility of those muscles once they lose the fat surrounding them. The center of the six pack has a thick “fascia” bunching known as your “linea alba” this is the part that most commonly separates during an abdominal diastasis.

Your six pack looks pretty but it actually helps keep your organs from pushing out against your abdominal wall. In the event of a separation like this one you lose the support of your abs to keep your organs from pooching out.

You Can See How THICK the Linea Alba Is.

 What Do I DO?

The immediate concern is to restore the form of the structure as soon as possible, minimize the current damage and work on supporting the structure. The good news is abdominal diastasis is generally non hamrful in terms of organ health. A bigger problem that people encounter is how do they get their old belly button and flat stomach back.

The key lies in “core training” but not any core training. Most people don’t break core training down into as many segments as they need to. In core training we have many planes of movement and we have different ways to train the core for example if I hold a plank compared to do something popular like a crunch.

With a diastasis you want to train the muscles to become stronger an support the linea alba but without stretching the muscles or tearing them.
Most muscle tearing is done on an eccentric or lowering phase of an exercise so crunches and situps are not going to be ideal for this.

The two biggest concerns are bringing the ribs or the pelvis away from the attachments of these two points like if you were to lean back to press a weight overhead instead of bracing your core giving up your back and stretching your abs this would be terrible for your linea alba.

This is what you DON”T want to do when you have abdominal diastasis.

Lifting heavy weights that usually require a brace aren’t ideal at this time either because they require you to PUSH out against a force which if your abs don’t have good structure could increase the amount of stretch.

Exercises where you don’t move as much but rather pull in and stabilize your spine are ideal exercises for this. Let me give you an example of how we would treat this abdominal diastasis.

In A Perfect World

As a note, the reason you’re seeing my write about this on my blog is because I tend to do more fitness and therapy related personal training, much of this very basic abdominal training is done with a physical therapists while trainer normally push clients through higher level core exercises.  As a trainer I see many back pain patients, moms and clients of all levels so I find the progressions and regressions that work for my clients, not to say that a well qualified therapist wouldn’t be able to do these either. In my session I would address the therapy and then move on to getting my client stronger, fitter and happier so you’ll see my approach is based off that.

1. Measure the Distasis
Without measurement there is no progress. You want to measure your diastasis and take pics of your stomach. Measuring can easily be done with fingers to see the size of the belly in relation to the width an example would be ” two fingers wide on the right, three fingers wide on the left”.

2. Track Pelvic Floor Control.

During birth a pelvic floor gets traumatized which simply means you have a harder time keeping your legs together and also keeping your bladder stable. This is one reason in general I don’t prefer my clients who have had children to lift in a wider stance. Sumo deadlifts are great for people without pelvic floor problems but developing that kind of strength in “abduction” is not a good idea for someone who has problems in “adduction”.

Tracking Pelvic Floor progress is pretty simple, my clients will do a few bounces and pretty soon they will need to use the bathroom, count bounces or pogos. I have a pogo video for you here so you can count reps until your have to use the bathroom.

If Pelvic Floor Control is extremely weak I would address that first as that is probably the most useful thing to keep strong. We address that with some breathing drills, some pelvis repositioning drills ( I especially like the concepts from the Postural Restoration Institute) and focusing on doing lower body training with an emphasis on pinching our knees together.
3. Stick to More Single Leg Work NOT Just A Hip Bridge and Get Moving.

Lunges are a great way to get strength in and the weight front loaded will keep your abs down from tearing.

We avoid lifting max effort training until we see improvements in either measurements or pelvic floor movements. A key note the hip bridge is NOT the best exercise for abdominal diastasis. Because of the lack of abdominal support from the splitting most people get back pain from not being able to support their spine but it doesn’t mean the only exercise you can do is a hip bridge.

An exercise on all four will enable you to feel the contents drop down and then you will “PULL” the abs back, if this is difficult on all fours you can always change your angle to make it easier. This is a much better exercise than your hip bridge, nothing is wrong with the hip bridge it’s just far away from the best pelvic floor exercise or feed back for bracing your abs.

Starting on all fours, practicing “vacuums” and then moving to make the exercise more dynamic while maintaining control of your abs is what we would focus on here.

 4. Get Some Good Manual Work Done To Speed Healing

This post is already almost two thousand words so I’m going to briefly go over this. The scar tissue from the abdominal wall should be worked out for faster healing as well as blood flow, DO NOT work directly on the linea alba as that can encourage it to weaken, if you know how to work past tissues and with each system like the artery specifically the veins there is going to be a lot of dysfunction with this area including the viscera.

Let’s Put Together A Session

The biggest mistake people make when they have a problem is they throw everything out! In reality the only thing you need to do differently if you are one of my personal training clients with abdominal diastasis is measure your diastasis, check your pelvic floor strength and modify your program for less spinal loading. Fitness really isn’t much harder in terms of not being able to workout because you have diastasis you just need to do some extra work at the start of the session, watch your form carefully and maybe do some exercises at home.
Here’s a quick example session of what I would have a personal training client with diastasis do if they were a brand new client.
Warmup
A1- Quadraped Vaccum= 5 second holds- 5 reps
A2- Side Plank- 5-25 second hold 1-5 reps
B1- Anterior Wall Slide with extension control- 8 reps
B2- Hip Bridge w/feet shift and towel squeeze- 10 reps
C1- PRI Mini Band Abduction- 15 reps each Side
C2- Split Stance Neutral Cable Rows- 10 Each Side
X1-2Workout
A1- Front Loaded Step Up- 8 reps
A2- McGill Crunch ( no trunk movement)- 30 sec Hold
A3- TRX Pushup- 8 reps
X3
B1- BB RDL w/ Exhale- 8 reps
B2- Cable Motorcycle Rows- 15 Reps
X4
C1- Half Kneeling Chops- 5 reps each Side
C2- Sled Push- High Bars= 25 seconds
X3

As you can see there is plenty to do here. I don’t have time in this post to explain why I pick all these exercise for this client but I can tell you this is a good workout for strength, stabilization and fat loss at the end.

Any questions email me at befittacoma@gmail.com, if this article helped you please share and like on facebook because, “sharing is carin and likin is excitin!”

BeFit,
Isaac
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