If you’re in the process of recovering from Diastasis Recti and any sort of pelvic floor dysfunction, you’re likely doing strengthening exercises like crazy. This is great. Muscle weakness contributes to miserable symptoms like low back pain and incontinence . Many postpartum ladies (myself included) just want someone to hand them a list of 10 exercises that will fix them. And we’ll all do these exercises until the cows come home. Some ladies will be successful, and others like myself will get stronger, but still have a residual abdominal gap, weakness, and instability that refuses to budge.
I’d like to share a piece of mama rehab that you may not have considered. The illustration is my own, but the alignment ideas are from smarter ladies than I who have worked in the fields of sports and women’s health physical therapy for years. So let me hit you with this: Doing rehab exercises for even up to 2 hours/day may not rehab your body if you spend the rest of the 22 hours/day walking, standing, sitting, and breathing in ways that strains your abdominal wall and pelvic floor. Alignment is complicated, especially because bodies are so different in proportion. So what I really hope to do here is give you a brief illustration that encourages you to find a women’s health physical therapist who can help you with your body’s specs.
Imagine your rib cage as the top of an Easter egg and your pelvis as the bottom. The best way to securely contain the most amount of Easter candy (your guts plus occasionally a small person) in an egg (your abdominal cavity) without some squishing out is to place the opening of the top directly over the opening of the bottom. Any hinging of the top (ribs) or bottom (pelvis) forward or backward will release candy (smoosh guts out). If you have not already, please read my post The Abdominal Pressure System. Our abdomen works like a pressure system to support us and help us breathe. Those of us who struggle with DR and Pelvic Floor weakness are really struggling to contain our guts under a healthy pressure. When you then stand, sit, walk, and breath in ways that squish your guts further outside your egg, you strain the very abdominal wall and pelvic floor that you’re trying to rehab–the parts of you that are supposed to contain your guts under pressure. Let me show you some ways that we do this wrong.
The orange egg below is in what I’d like to call the mom slouch. Here’s why it’s a problem. The front of my rib cage is now angled in. This migrates guts that should live happily near the southern border of my ribs further down, making the mom pooch stick out more. This puts more pressure on your abdominal wall than necessary. Guts gotta go somewhere. Also, when your pelvis is tucked like this, your Pelvic Floor and your Transversus Abdominus–the muscle under your 6pack that we desperately need to be firing–doesn’t engage fully. Please stop and take the time to read this article by Julie Wiebe about bum-tucking treachery. As a CrossFitter, I’ve been told to tuck my bum for exercises and athletic posture. As a coach, I’ve told others to do this. It’s a very common cue in CrossFit arenas, and I can’t say that its a bad position for male athletes. But it most certainly is not a beneficial position for pregnant and postpartum women.
And here’s what I’ll call the archy boob salute. This one might be less obvious because I don’t have large breasts to emphasize it. In this position the front of the rib cage is thrusting upward. The back of the rib cage and spine follow forward often encouraging an arched back. A lot of women do this to emphasize breasts and booties. It’s also not a great position for pregnant and postpartum ladies. At it’s bottom, the linea alba attaches to the front of your pelvis; at it’s top, to the front of the ribcage. If you lengthen that distance out constantly by thrusting the front of your ribs up and the front of your pelvis down, you’re not giving the linea alba the position it requires to recoil back to a healthy position after carrying a baby. Now if you add a load to this position like in an overhead squat or kipping pull up, you’re not only stretching the linea alba to the max, you’re adding weight to it in a stretched position. Yikes! Archy boob salute and the mom slouch also do not allow optimal breathing. Check out this video by Julie Wiebe that illustrates how alignment affects breathing.
The green egg below is my attempt to display neutral alignment (it’s not perfect yet). In this position, I’m trying to keep the opening of my ribs hovering over the opening of my pelvis, allowing my guts the most space that I anatomically can give them in order to reduce unnecessary pressure on my abdominal wall and pelvic floor to allow for healing. And according to Julie Wiebe, this puts my pelvic floor in a more ready position, activates the Transversus Abdominus (you can feel the difference), and allows for the most optimal breath. This has been a process. I found it much harder to change my daily alignment than any specific movement modifications I’ve had to make because it’s all. day. long. I have yet to enjoy any really noticeable gains in my linea alba (I’ve been at this for 3ish months), but my breathing is better, and I’m certainly leaking less. I found it helpful to leave reminder notes to cue me throughout my house and show my husband what my alignment should look like so he can cue me when he sees the bum tuck.
We should also strive for neutral alignment while sitting. This is especially important for those of you who have to drive or sit for work everyday. Look what happens to my pooch when I sit with my pelvis tucked and ribs caving in (left pic). Not great news for the linea alba and diaphragm.
One of the ways you can mindlessly cue your pelvis to untuck while sitting is using a rolled up towel on the chairs you sit in at home, work, and in the car. Place it slightly behind your sit bones. This will help your prop your pelvis and prevent that tuck. These positions changes are also valid while you’re pregnant. Many preggers ladies like to throw shoulders back, thrust ribs up, and tuck the bum to cope with the belly. If you’re not at a high risk for Diastasis Recti and you’re not experiencing symptoms like low back pain or leakage, then you can probably get away with this posture. If you are having issues, however, I suggest making a few adjustments to see if you see some improvements.
It may seem that all these changes are overwhelming. I like to think about the impact that it will have if I achieve neutral alignment for even just 50% of the day. I hope this helps. Good luck and may your pants be drier, your abs and pelvic floor safer/stronger, and breaths deeper.