He Said, She Said: In search of expert advice

Got questions about postpartum fitness? Search ten websites and you may find ten different answers. Then there’s the books, the magazines and the videos – each with its own point of view.  How does a mama know which to trust? When it comes to postpartum fitness advice, who’s the expert?

Needless to say, I’ve spent a lot of time researching postnatal fitness. We could say obsessing, but let’s not. I’ve found a variety of recommendations from trainers and fitness instructors. I’ve also found some conflicting information. What I haven’t found is a definite authority on the matter.

Doctors and midwives are well versed in matters of obstetrics, but don’t necessarily have knowledge of fitness training. Conversely, many fitness experts know about training, but not about postpartum considerations. You can find trainers certified in postpartum fitness, but quite frankly, that piece of paper is about as easy to get as a drivers license. I know. I have both. This is not to say there aren’t experts out there. It’s just tricky to decide who they are and which advice to follow.

My biggest question has been about appropriate abdominal exercises for flattening the tummy. It’s a particularly important question if your abdominal muscles have separated as mine have. (See Dec. 14th Post, “I’ve Come Undone”). If you’re curious too, here are examples of what “they” have to say and offer. You decide who to trust.

BeFit-Mom

BeFit-Mom (befitmom.com)

  • Crunches may do more harm than good in the initial postpartum period
  • The secret to a flat stomach is to rebuild the deepest abdominal muscles, the transverse abdominus
  • Claims it’s a myth that separation requires surgical repair
  • Says “manual splinting of the abdomen may perpetuate muscle weakness”
  • Offers a video on postnatal core conditioning

Makes sense to me. Plus, the website offers detailed information to back up the recommendations.


Tupler

Julie Tupler, RN (maternalfitness.com)

  • According to Dr. Oz, she’s the expert on treating diastasis recti
  • Recommends the “Tupler Technique” for closing diastasis. It includes splinting shown here.
  • To learn the Tupler Technique, buy the book or DVD then sign up for the workshop or private sessions.

Ms. Tupler has a lot of impressive credentials and the price tag to go with them!


Andrea Page, FITMOM

FITMOM (fitmomcanada.com)

  • The “Postnatal Workout” video warns not to do the featured abdominal exercises if experiencing more than 2-3 centimetres of separation
  • Does not provide any alternatives or specific advice for treating diastasis
  • A personal email from Andrea suggests that I could try “a hand on interaction called splinting”

Andrea has the benefit of both personal training and childbirth education qualifications. It’s disappointing that she does not offer more advice since she is really touted as a postnatal fitness expert here in Canada.


Expert Village video

http://www.youtube.com/watch?v=TL0RN_y5M_E

  • This video does a decent job of explaining diastasis and demonstrating how to diagnose it
  • Recommends only pelvic tilts & abdominal contractions if experiencing 2+ finger widths of separation

I don’t know who this woman is but the video is easy to understand


Samara Pole Studio

Samsara Pole Studio (http://www.youtube.com/watch?v=QBJcZpL1MAQ)

  • Suggests considering surgery or pilates, depending on the degree of separation
  • Emphasizes the importance of talking with your caregiver

This pilates instructor gives a long-winded but detailed explanation on how to diagnose diastasis. It amuses me to hear her talk, LOL.


Baby Center

Baby Center (babycenter.com)

From what I can tell, this site offers no advice on dealing with ab separation after pregnancy. Disappointing since they are such a “go-to” site.


Jago Holmes

http://www.greatshapeafterbaby.com

  • Offers a system called the Baby Belly Fat Loss Plan
  • “Tone and flatten your baby belly in just minutes a day”, he says
  • Warns that some exercises should be avoided because they can cause more damage
  • Includes diet as a key factor for losing baby belly

This trainer claims to have postpartum experience. He alludes to the diastasis issue but sheesh, the website is one LONG sales pitch! This is the exact type of resource I’m skeptical about.

What recommendations have you found? Where/Who do you go to for postnatal fitness advice?

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16 Comments

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16 responses to “He Said, She Said: In search of expert advice

  1. Hema

    Lots of info for all the new moms! Julie Tupler’s splinting looks suspiciously like a high waisted girdle. What do I know….I’m not a mom and don’t really know the issues faced after birth.

    Question: As a new mom, what sites do you go to for parenting advice? If you are Googling (or any other search) what do you search? Full disclosure: this is work related research.

    • Debbie King

      LOL, yes, it essentially looks to be a new-fashioned girdle.

      I don’t visit specific sites (other than babycenter) but rather Google topics of interest. For instance, “3 Month Old Development”; “Breastfeeding & Aspartame”; or “How often do 3 month olds eat?” Hope that helps.

  2. I have also found it really hard to get sound post natal fitness advice. It’s so easy to get caught up in the heresay( “I lost all my weight in 2 weeks!” or “I have never lost mine and my kid is 5 years old-just live with it!”) I’ve kind of given up and decided that all I can do is be the best mom I can while always remembering to be good to myself and take time to do what makes my body feel good. I think the number one rule is: BE PATIENT.

  3. FYI, the woman in the photo demonstrating how to test for abdominal separation (diastasis recti) has her hand/fingers placed incorrectly.

    The fingers should be held parallel to the waist, not vertically along the mid line. The width of the mid line is measured by how many fingers can fit across the gap.

    Women should test above, below, and at the belly button, and to get an accurate reading, make sure that their ribs move closer to their hips.

    • Debbie King

      Thanks so much for your response, Helene.

      As founder of BeFit-Mom, I’m curious to know how you qualify somebody as an expert in postnatal fitness.

      I’m also curious about your core conditioning DVD. I’ll be checking that out soon 🙂

  4. Angel

    Hey Deb

    The best advice is to know your body. Every woman recovers differently from childbirth. Both emotionally and physically.

    It’s not just your muscles that you need to be concerned about. Our organs spend 10 months readjusting themselves to accomodate our beautiful offspring and are then thrust into yet another new postion post partum.

    From my own experiece having 3 babies in completely differing situations (2 when I was young, within 13 months of each other and on my back and the last in my 30’s, lots of recovery time between births and standing up) it still took over a year for my body to feel like me and not a life vessel.

    Emotional well being, hormonal changes, sleep deprivation, spousal/family support, the seasons, the difference between dealing with 1 baby, 2 babies or 3 childen and a baby can all make a significant difference in how you work your way back.

    Sadly, getting your mojo and your body back is as different for every woman as there are books, articles, doctor’s opinions, blogs and friends with amusing stories. The biggest thing, if it hurts differently than it did before your pregnancy, back off a bit and take it a bit slower. It took 10 months to grow a fully functioning human being – why do we expect it to take 2 weeks to heal?

    • Debbie King

      Well said and so true. Our bodies definitely speak to us during and after pregnancy. I know at 5 months pregnant mine told me to slow down and enjoy some root beer 🙂

      I do think however, that many women are unaware of the abdominal separation that can occur with pregnancy. This is one particular area where we could listen to some expert advice as well as our own bodies, in order to avoid problems (like herniation) down the road.

  5. interiorfitness

    Hi Debbie,
    Really appreciate your honest, and earnest pursuit of this. Your struggle is universal as women try to sort thru the changes that occured in pregnancy (but the changes came w/o a new owners manual). I am a sports med/women’s health physio in the GTA (was excited that you were in TO) who specializes in pregnancy recovery, Core restoration (including the elusive pelvic floor-which is a secret weapon in the battle of flat bellies), and returning women to fitness. Wanted to share one word of caution on your diastasis, great job avoiding crunches, but planks can contribute to separation as well. All the abdominal muscles attach to the that center line (linea alba), so the abdominal activation required by a plank can pull against the linea alba and open the separation. Also, in my experience most women who have a diastasis, also have postural issues (leftover from pregnancy positioning/habits and muscles that got tight) that keep the diastasis open throughout the day.

    All the best in your pursuit, let me know if you have any questions. Julie Wiebe, PT http://bit.ly/7pl30H
    http://interiorfitness.wordpress.com/

    • Debbie King

      Thanks for the view and reply Julie. No planks either, huh? I really thought isometric exercises were okay.

      Many of my blog readers are members of my prenatal class (now my mom’s group). It would be great to have you speak to us on core conditioning and dispel some of the myths. Perhaps we can talk about this offline. I would even love to do a follow-up post after meeting with you.

      Readers, stay tuned…

      • Hi Debbie,

        Planks require lots of ab work. The loss of the Core during pregnancy tends to cause an overuse of the superficial abdominals for tough tasks like that, and will pull on the separation. Once your diastasis is 2cm or less, and you are properly engaging your Core as a team again (this includes your diaphragm, and pelvic floor) then planks are a great way to get back to the belly you love!

        Would love to schedule a seminar! Spreading the word to moms that there is help and hope to be had in recovering from pregnancy is one of my favorite things to do! Will respond to coordinate a date offline. Thanks for the invite.

        Julie

  6. Hiya Debbie,

    Thanks so much for this discussion. When I mentioned this to my midwife at 2 months pregnant, she had no clue what I was talking about. I then brought in a diagram and she just shrugged. I was quite surprised that they are not equipped to support pregnant women in exercise.

    After that disappointment, my only knowledge has come from some of the videos you’ve outlined above, and a few specific exercise DVDs I bought postpartum. Most of what I found talked about sticking to pelvic tilts, scissor kicks and similar to start regaining abdominal strength. What I have been trying to find out (which none of my sources mention) is how long do you stick with pelvic tilts and abdominal contractions only. If you have only slight separation, how long do you wait before you take up a full ab workout once again.

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  8. Just want to say what a great blog you got here!
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  9. Having worked with Martin Haines (biomechanist) for over 7yrs. I felt this might be helpful.

    Diastasis recti is a separation between the left and right side of the rectus abdominus muscle, which covers the front surface of the belly area. Another name for the more commonly described separated rectus abdominus, it is usually caused by pregnancy and the rectus muscle being stretched by the baby in the uterus. This condition is most common in the later trimesters and more so with multiple births or repeated pregnancies.

    A diastasis recti looks like a ridge that runs down the middle of the abdominals. It stretches from the sternum to the navel and increases with abdominal muscle contraction. In the later part of pregnancy and in extreme cases, the top of the pregnant uterus can be seen bulging out of the abdominal wall when the rectus is engaged. Post natally, to check if your client has diastasis recti, have her lie supine with knees bent and ask her to raise her head. You commonly see a central ridge protrude in the centre of rectus abdominus, and if you carefully palpate above the navel, you should feel a soft gap between two hard muscles. Measure the space of the gap using your fingers (this is called a rec check). If the gap is greater than two finger-widths, your client may be suffering from separated muscles.

    No treatment as such will help pregnant women with this condition, although exercise may help, but there is limited evidence that exercise will resolve the problem. However, post natally, conventional wisdom suggests that after any discomfort has settled, it is reasonable to start some light abdominal work, focusing on the core.

    Understanding their origin and insertions reveal any oblique contraction will most likely exaggerate the split of rectus. We have performed ultrasound scans on this population and have found that engaging these muscles actually increases the separation.

    Until more work has been done on this, we recommend starting with pelvic floor work and stabilizing work with the pelvis in as close to the correct position as you can, while engaging rectus abdominus to minimise the degree of separation. Please note that the production of relaxin (a hormone that is secreted in abundance in pregnancy) affects the collagen make up in the linae alba (the central tendon in rectus abdominus) and may be a cause of the diastasis. As soon as the placenta is delivered, the increased secretion of relaxin reduces to normal. At this point another hormone called prolactin is secreted, it has the same effect as relaxin and they can last for up to five months. Breastfeeding will keep it higher than normal until your client has stopped. This may affect how quickly the diastasis recti will reduce.

    Please also be careful while working the transverse abdominus. While conventional wisdom is sometimes right, it sometimes isn’t. Let’s challenge it now. If you look at the origin and insertion of the transverse abdominus and consider its function, logically when it contracts it will pull the rectus apart further, much the same as contracting the obliques would. There is no evidence to suggest that doing trans abs work is the right thing to do. It’s just something that we all do without, it seems, much thought as to why. Just think, if the trans abs inserts into the aponeurosis of rectus (anteriorly below the navel and posteriorly above the navel), any trans abs contraction should pull the rectus apart further.

    So why do we work trans abs initially with a diastasis recti?

    Are we suggesting going back to the days of doing sit ups? Probably not, but more work needs to be done before we know working trans abs is right for these ladies in the early stages.

    If you have any thoughts or opinions that would be great..

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