Hey Cross Fit moms, happy 18.1! Here are some modifications and considerations you might find helpful for the first workout of the open. If you are early postpartum, I would highly suggest focusing your training on core and pelvic stability and strength before progressing to weighted dynamic movements, impact, or high rep/fast cycling style workouts. Spending more time early postpartum focusing on strength, stability, and form will likely get you back in the game faster with less risk for set backs. The Toes to Bar are the main culprit in this workout for mamas. If they pose more of a risk, consider whether 18.1 unmodified is worth the setback. With that, here are some modifications!
As I learn more about coaching pregnant and postpartum women in Brianna Battles’ coaching course (seriously, it’s rich with practical scientific content), I have practiced teaching the piston breath to lots of people. And I know I need to polish my presentation because some people just look at me like “What’s the big deal? Breathing and kegels are not new.” So let me try to explain better why this is different and has been such a game changer in female biology.
The Piston Breath is a concept I learned from Julie Wiebe. I hit a plateau in my recovery about 9 months ago. I just wasn’t seeing any positive changes in my abdomen, pelvic floor, or my athletic capacity. Then I learned about the piston breath and neutral alignment. Slowly I began to implement the strategy, and after about 8 months of practice, my diastasis reduced by about 50% in most locations, I leak less, my guts feel less sloshy, and I can now run short distances without peeing myself. I’ve been breathing and kegel-ing for most of my adult life. Piston breathing is a game changer and a much more complete strategy.
When you take a breath, your diaphragm moves down. Your pelvic floor and deep core muscles should relax to allow your guts to come down in response to the downward push of the diaphragm. But if your pelvic floor has a vice grip hold on your vag/anus and you’re constantly trying to maintain a rock-hard abdominal contraction, your guts will get squeezed with every single breath all day long. This is one reason that leaks may occur (squeezing the bladder) and a diastasis won’t heal (too much pressure on the weakest part of the abdominal wall). Piston breathing coordinates the pelvic floor and deep core muscles (transverse abdominis) to relax in response to the diaphragm moving down and to contract in response to the diaphragm moving back up. The pelvic floor and transverse abdominis work in conjunction with the diaphragm so that pressure in the core is managed well.
The kegel is an important tool for strengthening the pelvic floor. I needed it and some folks need it to remedy weak pelvic floor muscles. For many folks, however, the problem isn’t weakness. Think about the number of Cross Fit competitors at the games who’ve never had children and are rippling with muscles and they are peeing all over boxes during workouts. Is it likely that their pelvic floors are weak? Possibly, but not likely. It’s more likely that their pelvic floors are too tight or uncoordinated.
The piston breath, unlike the kegel, is about coordinating a system of muscles–not strengthening them. Static holds of a small set of isolated muscles (kegels) can’t possibly allow optimal results for dynamic movements, yet many women hold a constant kegel throughout the day, throughout an entire run, or throughout an entire workout in order to feel secure. This will take its toll on pelvic health, often yield no relief from symptoms like leaking, and stifle athletic improvement.
Automaticity and specificity of coordinated movements is a better goal. This takes practice. Lots of practice. And then it becomes automatic. So try for a few minutes a day to lay or sit or stand in neutral alignment (check out my post Easter Egg Alignment) and focus on piston breathing. Inhale and relax the abdomen and pelvic floor. Exhale contract abdomen and pelvic floor. Try this throughout the day and then integrate it into your larger movements and workouts. In the video below, I demonstrate how to do both the foundational piston breath (aka blow before you go) and the more dynamic piston breath.
Once you have the hang of piston breathing, try to make each contraction “task specific” as Julie Wiebe says. Meaning rather than contracting with the force equal to a bear trap with every exhale, match the contraction strength to the current task. Are you picking a toy up off the floor? Only a subtle, gentle contraction is necessary . Are you attempting a 1RM deadlift? You’ll need a bit more contracting power.
I have a bladder prolapse, a rather troublesome diastasis recti, and umbilical hernia. Piston breathing has not only allowed me to continue in training, but has transformed my training into a mechanism that has helped heal me instead of injuring me further. I have been doing weightlifting, power lifting, some impact work, modified gymnastics, and substantial conditioning. Piston breathing integrated into training has improved my pelvic and abdominal health.
If you’re struggling to figure out how to implement these strategies, find a pelvic floor physical therapist who works with athletes, a coach who has been educated about postpartum issues, or better yet, find both.
Here’s Julie explaining this concept with more eloquence if you need further convincing from a brilliant, experienced, athletic, professional scientist lady.
I’ve mentioned the Transverse Abdominis in some of my other posts, but I want to emphasize how important this muscle is to the abdomen, especially for postpartum women and still more important for postpartum women with Diastasis Recti. The Transverse abdominis or TrA from now on, gets little love and attention from the fitness industry. Most folks want to work the outer, more visible 6 pack abs and obliques and rarely end up working the muscles of the “deep core” –the TrA. Not working the TrA is especially problematic for women with Diastasis Recti who essentially have a malfunctioning layer of outer muscle because the linea alba is too stretched to anchor the muscles in place so they can do their job as designed.
To understand why the TrA is so stinking important, we’re going to have an anatomy lesson.
First, a piece of vocabulary: Fascia. For our purposes, fascia is the tissue that connects muscles to other muscles or muscles to bone. It is not muscular tissue.
Here is the TrA. It is the deepest abdominal layer closest to your guts. As you can see, it’s like a corset attaching your ribs to your pelvic bones in the front and all the way around
back. It’s a stabilizer muscle meant to keep you upright. Notice the muscular tissue does not extend all the way to your midline. Instead, the muscle becomes fascia across the midline.
The next layer on the outside of your TrA is shared by the rectus abdominis muscles (6 pack) along the midline and the internal obliques further away from your midline. It is important you know that these muscles are connected together in the same layer with facia, so remember it for later. This layer is the most problematic one for those with Diastasis Recti. The problem lies in the linea alba, the fascia that connects the left and right recti sides in the middle. The linea alba is too stretched out to hold the recti close together. What’s more frustrating, tissues of the rectus abdominus run up and down–not side to side. So no amount of working these muscles will pull them back together toward your midline.
The outermost layer is the external obliques. They attach across the middle, again, with fascia.
Here’s where the anatomy gets a little complicated. Somewhere just below your belly button there’s this area called the arcuate line where these 3 layers of fascia holding these muscles together switch their arrangement. And it matters if you have Diastasis Recti, so stay with me.
Below the arcuate line, notice that the fascia (or sheath) that holds the sides of the deep TrA together connects over/outside the rectus abdominis? This means, if you contract the TrA, it physically hugs the rectus abdominis together and in. This is fantastically helpful for the rectus abdominis and the stretched linea alba. Here it is quite literally a natural corset that squeezes your recti into you. Yay!
Above the arcuate line, notice that the fascia of the TrA no longer goes directly over/outside the rectus abdominis anymore. Instead, its fascia connects underneath the rectus abdominis. So the TrA and its fascia can no longer physically hug these muscles in. However, contracting the TrA still holds back all the contents of the guts behind it, relieving that next layer of rectus abdominis and injured linea alba of some of the work its not currently capable of doing.
So remember that the internal obliques share fascia in the same layer as the rectus abdominis? Take a look at the cross section above the arcurate line. This is how most of your abdomen is organized. See how the fascia of the internal obliques wrap around the rectus abdominis? If you contract the internal obliques heavily or if you work them to the point that their resting tension is super tight, it actually pulls the left and right recti apart, which will further widen the damaged linea alba that we want to come back together. The recti can’t fight this tension because they don’t have fibers that run left and right–only up and down. So they can’t contract and pull against this tension. Does this mean you shouldn’t ever work these muscles? No. That’s impossible. You need to use these muscles, but you shouldn’t be focused on them in your exercise routine or you will likely make your Diastasis worse. (This is why most people with Diastasis Recti are told to avoid sit ups, crunches, V-ups, Russian Twists, etc.) Also, if you are doing any kind of abdominal work whether in daily activities or working out, the focus should be on engaging your TrA.
So the take away message here: It is absolutely vital for the health of your abdomen to engage your TrA while doing abdominal activities. I hope you can quite literally see why now.
Ok, so it’s important. Now what?
Focus on strengthening your TrA for the activities that you want to participate in. If you’re reading this blog, I hope you’ve already taken my advice to go see a women’s health physical therapist (and if you are any sort of athlete who wants to pursue athletics, preferably you’ll see a therapist who has experience with athletes). So I’m assuming you’ve done some rehabilitative exercises under the care of a physical therapist. After doing quite possibly a trillion heel slides, marches, and toe taps lying on my back over the course of a year, my core was much stronger, but I was crazy bored and on a plateau of strength gains. I was sick of doing an hour of rehab work then having to do my workout later because there was no full body challenge or real energy system challenge. Let me be clear, rehab exercises are vital and make a huge difference. I was just ready for more. I needed to see how my rehab was directly linked to the physical activities I want to pursue. The blow-before-you-go method helped me make rehab super applicable to my favorite movements. Here’s a video I’ve already done to demonstrate how to engage the TrA before movement.
This blow-before-you-go method should be used before any movement if you want to locate and strengthen your TrA, even picking up baby, hauling in groceries, or getting something heavy off a high shelf. There are some movements, however, that engage the TrA more than others. These movements aren’t typically considered abdominal focused, but can really emphasize the TrA a workout when you focus on engaging it. Learning to engage and strengthen the TrA might slow you down at first, but will likely lead to future strength gains in a variety of movements. Some of my favorite movements to engage and strengthen the TrA are deadlift, sled pushes, uphill sled pushes, bench press, single arm (alternate your arms!) farmer’s carry, breaststroke in the pool, and ski erg or skiing-fashion pull downs from a cable machine. The video below shows my current focus on strengthening the TrA enough to do a pull up safely.
And if you just want to focus on TrA strength with some supplemental movements (that are not heel slides or marches), here are 2 of the exercises I do on the regular now.
- Bridge plus double clam shell.I got this from Ashley at www.getmomstrong.com. It ends up getting the TrA, hips, pelvic floor, and more. Lay on your back with your feet elevated (start at lower elevation to make easier). Exhale while pulling belly button to spine and pulling your pelvic floor muscles up and in. Then start your bridge. When you reach full height, push knees out. As the knees go out, try to maintain the intensity of your pelvic floor contraction. Knees go back together, lower yourself down. Rest. Do your reps slowly–there’s much to focus on in just one rep. I started without a band and since have graduated to one of the lighter circular bands in my set. If you notice the linea alba bulging, your TrA is probably not ready for this one. Work on bridges from the ground and clam shells separately.
2. TrA balance. It doesn’t look like much, but it is. Anchor a band on something and then back up. The tighter the band becomes, the harder this is. Engage the TrA. Hold on to the band keeping a 90 degree angle at the elbow and keep elbows tightly at your sides Heels come off the ground as you shift your weight toward the balls of your feet. Think about hovering your chest over the balls of your feet. Do not hinge at the waist, but notice the bum does stick out a little bit. Now hover in this position and focus on making your TrA keep you upright. My glutes, quads, and hamstrings often want to take over the stabilizing work, so I have to purposefully relax them to force the TrA to do the majority of the work.
One of the most helpful tools for TrA engagement is a mirror. Complete these movements in front of a mirror, especially when starting the blow-before-you-go method. Sometimes it’s hard to tell from feel if the TrA is fully engaged, but I can always tell when I see my abdomen. If your gym doesn’t have mirrors, go buy a cheap full-length mirror, store it in the restroom, and use it during workouts.
Alright, now go make your TrA totally B.A.
After seeing Diana Fasset at Success Physical Therapy, I was directed to Ashley’s resources at www.getmomstrong.com. One post that caught my eye was about pull ups. I often feel bored and frustrated with my movement restrictions, so I was very interested in working toward getting my pull ups back safely. I also suspect that there are some postpartum ladies out there who need to ensure that they are doing pull ups in a way that is safe for their abdomen. Knowing that Ashley struggled with Diastasis Recti after her twins, I was excited to see what she had to teach with our physical therapist. Check out the video.
After receiving some supervised practice from Diana, I was given the ok to start this progression, and I thought it might be helpful to see what it looks like a beginner with a noticeable gap tries this safely. So here I am.
The safest way to do this is under the supervision of a physical therapist. My body doesn’t look or operate exactly like yours. And to reiterate, if your ribs flare, your back arches, or your linea alba bulges, stop! You can injure your linea alba further. I like to work with a mirror in front of me almost always to ensure what I’m doing is not provoking a bulge. Sometimes it’s hard to be aware of the bulge, especially if you’re not familiar with what your abdomen should look and feel like when safely engaged. Go get a mirror or train a gym buddy to check you properly during movements.
So while my Transversus abdominus tries to catch up with the strength of the rest of my body, one thing I don’t want to loose is Latissimus dorsi strength. One of the exercises I use to engage my TA and Lats are pull downs using a band. Hopping on a SkiErg or cable machine would give about the same stimulation. This is also a great exercise to practice the blow-before-you-go method. If you missed that post, it’s right here.
I’ve also done a lot of freestyle in the pool with a buoy between my legs (often available at pools). I don’t kick during laps to put all the work of propulsion on my upper body. It’s quite a Lat blaster. Be careful to keep your TA engaged (especially as you exhale under water) and prevent your back from arching.
I like these 2 exercises because unlike ring rows, they involve an overhead (or nearly overhead) pull without unhealthy stress to the abdominal wall. If I’m attempting a CrossFit workout that prescribes pull ups, I often sub a mixture of ring rows and pull downs to keep my Lats in the game until I get my pull up back.
Good luck mamas!
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.
Hey mamas, here’s Mama Castro’s last video of the season.
And here are the workout standards for 17.5.
In case you missed the announcement, here it is.
17.4 Has been announced! I’d like to list some pointers and scaling options for each movement.
Make sure your TA is engaged while deadlifting.Here’s a video I made on how to engage the TA before a DL. If you’re having trouble with the scaled weight, drop some weight or slow down a bit.
Don’t “bottom out” during the squat portion of the wall-ball shot. It’s really hard on the pregnant and postpartum pelvis and pelvic floor and promotes a lack of control for those who are hypermobile. If your body wants to bottom out every rep, place another wall ball or stack of plates under your butt to stop you before you drop too far. If you can’t stabilize your hips, reduce the ROM by not squatting as far. You can also consider reducing the target height, reducing weight, or switching to light dumbbell thrusters.
At the end of each pull while rowing, make sure that your linea alba is not bulging or doming. If it is, end your pull without leaning your torso back as far as the athlete in the picture. Another option is to substitute an Assault bike (or something similar). I’m sure Castro wanted this pull in there for a reason, but rowing was probably included more as a tool to get athletes breathing. So switch to a bike if the rower is not working for your abdomen.
Ensure that your TA is engaged during the movement. If any bulging or doming occur, scale the push ups by doing them from your knees or at an incline (hands on stairs, box, wall).
Here’s 17.4 from the website.
Go get it mamas!
I’m a little late with this and I have a cough. Here’s some 17.3 modifications.
Here’s the announcement:
I was very excited to see that Cross Fit HQ came out with an article earlier this month that provided some strategies for coaching pregnant women. The article gave much attention to diastasis recti, an issue that I believe more coaches should be educated on. It even provided helpful guide for scaling as a free download. Please take some time to read the article and the free guide, especially if you’re unfamiliar with scaling methods and you have pregnant and postpartum CrossFitters in your care.
There are a number of issues that concern me, however, about the coaching and care of pregnant and postpartum women that still need to be addressed. First is the categorization of pregnancy with typical injuries. In the article, Nicole Christensen writes,
“Over the years, countless women have contacted me to inquire how they should train while pregnant. They often explain that their coaches can’t guide them because they’ve never been pregnant and don’t know how to scale for pregnancy. I’ve never broken a foot, had shoulder surgery, recovered from cancer, lost a lung in an accident, had a vasectomy, herniated a disc or cracked a rib, but I’ve coached people who have. You don’t have to experience pregnancy to scale for it; you just have to apply sound CrossFit principles: Work within pain-free range of motion to preserve the intended stimulus and movement patterns whenever you can.”
I do believe with the correct education and support, any coach who has not been pregnant can safely coach pregnant and postpartum women. However, there is a lack of knowledge on the part of coaches about how to consider pregnancy and how to coach clients through it. Pregnancy is different than an injury. It is a whole body change that adjusts hormones, circulation, digestion, weight, heart-rate, center of gravity, balance, connective tissue quality, shape of the musculoskeletal system, and much more. I can’t think of a common injury that affects that many body systems. And furthermore, the sound Cross Fit principal of working “within pain-free range of motion to preserve the intended stimulus and movement patterns whenever you can” isn’t actually all that helpful. For example, when I was pregnant, there were many safe and non-harmful things I needed to do to survive (like pooping, standing, getting up, walking, etc.) that now felt weird and painful. And there were many very unsafe things that I did that have contributed to lasting physical harm (like kipping and double-unders) that were not painful at all during my pregnancy.
Second, there is an assumption on the part of coaches that pregnant women are receiving quality practical education from the medical community on what they should and should not be doing while pregnant or postpartum. From my experience and from the experience of many moms I know, this is not the case. The general information given to many women including myself is the following: 1. Anything you were doing consistently before pregnancy is ok to do while pregnant. 2. If it hurts, stop it. 3. Listen to your body. Postpartum, I heard similar things plus: 4. If it makes you pee or bulge, stop it. While there is a purpose for standard advice, it doesn’t really help practically or restore folks to their lifestyle or sport. Seriously, if I hear one more person say “listen to your body,” I might lose my shit. What does that mean exactly? Are there going to be bodily alarms that go off every time I do something that’s bad for me? There were many things that I continued to do throughout most of my pregnancy (like pull ups and double-unders) that likely contributed to my DR and pelvic issues, but it never felt wrong to me while pregnant. As I mentioned before, there were other normal daily activities that felt so very wrong because in the third trimester, everything feels awful. Moms need visible or tactile, measurable, individualized indicators to have the safest and fittest pregnancy and postpartum experience. Please no more of this “listen to your body” crap.
Third, many modifications that were suggested in my experience were to protect the baby and not me. I was told over and over by well-meaning folks including PA friends and some coaches that if I did X, it would hurt the baby. I don’t remember any suggested modifications for my own sake. My kid came out strong and kicking like a mini warrior ninja princess and I was the one who was trying to stuff my guts back into my broken body. There aren’t many folks out there coming up with lists of postpartum scaling guidelines either, because once the baby is out, who cares? Far less craps are given about mom than baby. I’m not suggesting that coaches, doctors, and physical therapist should not address concerns for baby; however, baby’s thriving is dependent on the mothership’s wellbeing inside and outside the womb. If you take care of mama, you’re taking care of baby.
Fourth, postpartum care–in general–is crap. I was in labor for over 33 hours with nurses yelling at me for sneaking in food (did you study nutrition in nursing school?), pushed for over 3 hours, tore terribly, and nearly passed out multiple times before my baby was delivered with the help of forceps (think salad tongs in the vagina to pull baby’s head). I received no special instructions or descriptions of what I should expect my recovery to be like. They just sent me home bleeding, incontinent, still looking pregnant and repeatedly told me that everything I’d experienced during labor and postpartum was normal. I had to bother the crap out of my doctors just to get someone to both acknowledge and provide care for my abdomen and pelvic floor. I am not the only one with this experience. Most women go to a doctor or midwife after about a month and a half and are “cleared” for working out. And that’s it. Doctors don’t assess pelvic strength, analyze alignment, check hip stability, or even conduct observations of patients doing the typical movements they want to return to. They simply aren’t trained to do that. So why are doctors clearing mom’s for fitness?
If a mom is lucky, she’ll get to work with a physical therapist, someone who can actually help address muscle weakness, lack of coordination, breathing, and alignment. The problem is, if a mom is lucky enough to have a women’s health physical therapist in her area, it doesn’t mean that the therapist has an extensive sports background. So, she might do some exercises like the heel slide and clams for months and then be released back into CrossFit, running, etc. OR she might be given a standard list of things she should never do again. I’d like to suggest an alternative physical therapy progression for every single mom, especially athletic ones
1. Restorative exercises (clams, heel slides, pelvic tilts, bent knee marching on back)
2. Restorative exercises + drills focused on desired functional movements (breathing and alignment focused training to transition into desired movements)
3. Functional movements with modifications such as restricted ROM, no weight, slow speed (going through movements with focus on correct breathing, alignment, and muscular engagement)
4. Cautious reintegration back into sport pursuing gradual building back up to new postpartum capacity
If moms with extensive postpartum issues are only helped with the first step and not taken through 2-4, she will most definitely experience symptoms when heading back to CrossFit, Zumba, triathlon training, etc. In most cases, there will not be anyone with enough knowledge to help her. For example, let’s say a postpartum mom starts leaking while doing box jumps. She either stops doing them or a coach tells her to stop and switch to step ups. In most cases, that’ll be the end of it. She may have the physical capacity to do a box jump without leaking, but there isn’t someone to figure out what exactly isn’t working for her. Is her transversus abdominus engaged? Does she just need to work on pelvic strength for a few months? Is she coordinating her pelvic floor and diaphragm? Is she holding her breath? Or should she stop impact altogether because her bladder is about to fall out? Telling moms “just don’t do that anymore” is sometimes great advice if the cause of the leakage can’t be fixed by training. But what if she’s leaking because of a coordination issue? That can be safely trained. She might not have to give up something she loves if she just receives some specific coaching. The goal should be to return her safely to all possible movements acknowledging it might not be possible in all cases.
I was given the standard list of things not to do after bladder prolapse. I figured it meant that I shouldn’t do those things until I healed further. I vividly remember the day when after months of physical therapy, I asked my therapist, “When will we start a jumping or running progression?” She gave me a puzzled look and reminded me about the list of restrictions. It took me a second to process that I wasn’t ever supposed to do those movements again. No running, no jumping, no impact, ever. I’m not sure if I thought it or said it outloud, “Then what hell have I been doing here?”
Here’s the problem with postpartum care. Between doctors, physical therapists, and coaches, there are either assumptions that someone else is teaching mamas about that stuff or there are standardized restrictions imposed in order to err on the side of safety because many providers don’t know how to help a postpartum mama back into CrossFit safely. So this puts a mom in a scary world of figuring out for themselves what their doctor, PT, and coach could not figure out OR she’ll say “screw it!” and not comply to the restrictions very possibly injuring herself further. I’m not sure who is responsible for better care. I don’t think it’s quite fair to expect doctors to have physical therapy training, or women’s health physical therapists to have specific sport training, or coaches to know how to help with every postpartum medical issue. However, a good OBGYN better damn well know when to refer patients to PT, and PTs would help clients better if they knew some quality area coaches, and coaches should be able to recognize symptoms indicating clients should go see a physical therapist or doctor.
With all the women flooding into Cross Fit over the past decade, it’s an issue that all Cross Fit gyms need to be aware of and be prepared to address more fully than providing a scaling chart. One possible solution? Mama on-ramp courses. I’ve seen these work. Just to be abundantly clear–I’m not referring to those classes where the “hot mom” by virtue of her 6pack abs leads all the other lazy dopes through tough-ass workouts to whip them “back into shape”, as if the only thing keeping postpartum moms from fitness is their lack of work ethic. Instead, one women’s health conscious coach has a close working relationship with a women’s health physical therapist in the area. Together they design programs to help reintegrate moms safely back into CrossFit classes. Mama on-ramp classes would include general strategies that most moms will find helpful (i.e. how to breathe when lifting weights postpartum) as well as individualized strategies for specific struggles (i.e. “What visible or tactile indicators show me that a movement isn’t safe for me right now?”). If a client presents an issue beyond the coach’s training, clients are referred to the physical therapist. If a gym is rather small, this program could be shared between a few local gyms. Coaches and physical therapists could host classes and seminars at various boxes in an area…I could ramble on and on. I think this is do-able.
These problems won’t go away. CrossFitters will continue to have babies and will want to go back to CrossFit. Keep up CrossFit, PTs, and Docs! Mamas need your help!
Hi mamas, I did 17.2 this afternoon. Rather spicy. Here’s Mama Castro with some modifications to keep you involved even if you’re pregnant or struggling with postpartum recovery.
Here’s the link for the workout description and standards.
And here’s the announcement in case you missed it.