Setting realistic training goals and using the right tools for recovery
Having a healthy pregnancy is widely encouraged. There’s protocol for nutrition, fitness, strength, and cardiovascular training recommendations and parameters. Doctors, midwives and doulas encourage women to continue exercising and maintain a healthy lifestyle through their pregnancy (given no complications). Research supports consistent exercise through pregnancy. The exercise spectrum varies considerably for having a fit pregnancy ranging from walking a few times per week, to Olympic lifting, Crossfit, and running up until 40 weeks into the pregnancy. Social media indicates there is a trend toward tracking a fit pregnancy, documenting different activities and workouts that are done with a baby bump. Birthfit is an example of an organization that promotes and celebrates having fit pregnancy and lifestyle. Birthfit is an educational resource for active women who choose to maintain their lifestyle as their body progresses through pregnancy. Pregnant women receive a great deal of attention and education concerning physical training and proper progressions. However, once these women have their baby, everything they once knew about their body, particularly their pregnant body, has once again changed. A healing process begins to take place but must be facilitated in the correct way to ensure proper recovery and maintenance of optimum fitness levels. Program design and awareness of postpartum needs is equally important as is program design for pregnant women. The postpartum woman is typically motivated to “lose the baby weight,” and this motivation can lead to injury and negative long term affects if not done properly and under proper supervision.
As fitness professionals, we must understand the postpartum population as well as their specific needs. Recovery and timeline of program design is a necessity. Over 4 million babies are born in the United States every year. Many trainers work with new mothers, all at different stages of postpartum life. While the emphasis of this guideline is for women to exercise their first year or two postpartum, it is important to identify what implications may exist among women who trained poorly during pregnancy, not at all, immediate postpartum and how it could be affecting them currently.
Although this is based on research, I can personally attest to the implications of pregnancy and postpartum training as I am a mother, fitness professional, and athlete having trained through my entire pregnancy. I had goals early on postpartum and did not take the right steps to recovery, even though my intentions were good. As a professional, shouldn’t I have known better? Perhaps, however, I believed I had been “cleared” which, to me, indicated I had the go ahead to reintroduce movements and be an athlete again. What I didn’t know was that some of the exercises that were normal to the “pre-pregnancy me” were detrimental to” postpartum me”. Various movement (lifting, crunches, etc.), all of which felt fine when I “listened to my body,” were damaging my undiagnosed Diastasis Recti and ultimately ended up causing an umbilical hernia requiring surgery a year postpartum. Listening to your body doesn’t always provide enough feedback. My Doctor and coaches did not know how to help a postpartum woman like myself. I’ve learned through trial and error and plenty of research all of which is facilitating my continued learning about how to coach a postpartum woman.
A woman’s body is designed for pregnancy and childbirth. It adapts as the months go on, leading up until the moment the baby is ready to arrive. Although pregnancy and childbirth are common and natural, complications do exist and, according to the CDC, the rate of caesarian section in America is above 30%. This percentage has increased dramatically over the past several years. It is vital fitness professionals be aware of the implications related to this surgery and how it affects recovery and reintegration into training for their clients. A caesarian section is major abdominal surgery and requires time to heal appropriately. Childbirth, regardless of vaginal or caesarian, affects the muscles, tendons and ligaments of the abdomen and pelvic floor. Learning how to strengthen and heal the core and overall body structure of the postpartum woman is crucial for sustaining fitness levels and avoiding potential injury.
A common condition among postpartum women is Diastasis Recti (DR). Diastasis Recti is the separation of the abdominal wall. This causes stretching of the mid line fascia and linea alba. This tissue connects the abdominal muscles downward through the center of the abdomen and can stretch through pregnancy due to poor posture, inter-abdominal pressure, genetics, a caesarian section, larger than average baby, a uterus pushing against the tissue, and/or doing any type of crunching motion during pregnancy. About two-thirds of postpartum women have this condition and, in my experience coaching women, I have yet to meet a new mother who does not have separation typically near and around the belly button. Separation can vary anywhere from 1-2 fingers width to 8 inches or more. Severity is dependent upon the individual. Pregnancy places substantial pressure on the belly affecting the anterior muscles and may alter their shape. When the ab muscles move aside like this, the uterus, bowels, and other organs only have a thin band of connective tissue anteriorly holding them in place. Without the necessary muscle support, a vaginal delivery could be more difficult. The condition may also cause lower back pain, constipation, and urine leaking. This may also make breathing difficult and normal movement impossible. Tissue can tear with organs protruding which is commonly referred to as a hernia (WebMD).If coaches and their clients are unaware of this condition, they may enhance worsening of the DR with exercises that elicit this separation rather than closing it. There are numerous exercises which can be introduced to clients with Diastasis Recti the first year on training postpartum. Identifying which exercises to avoid is necessary during this first year until the separation has closed.
Diastasis affects the integrity and function of the abdomen, causing difficulty for previously athletic women to train safely and with the progression they expect. For example, a female who recently had a baby wants to resume heavy lifting to enhance her quest to lose body fat. She wants to squat again using the barbell. This does not present a problem until she reaches a weight that requires her to use the Valsalva maneuver. The Valsalva Maneuver increases intra-abdominal pressure providing additional back support during heavy lifting (Sports and Physical Therapy). This is done by not allowing air to escape from the lungs. The more inter-abdominal pressure she creates, the more her diastasis will separate. Being aware of how much she strains while lifting is an important factor for the coach and the woman to be extremely cautious of when reintroducing this kind of movement.
There is an aesthetic component of Diastasis as well. Many postpartum women complain about the “pooch” that never goes away after having a baby despite eating well and exercising. They do hundreds of crunches in hopes of obtaining a flat stomach or assisting in the process of fat loss. However, often times this “pooch” is caused by the separation of the linea alba. The muscles of the abdominal wall are literally open. A solid foundation across the core simply does not exist and creates the “mummy tummy.” Very few women are aware of this. They obsess over their pooch, mommy belly or “fat.” Detecting DR in your clients is fairly simple. It can be tested by having your client lay on her back, knees bent, elevate her head and shoulders off the ground (a slight crunch), and place her fingers so they are pointed down toward her pubis. Have her begin pressing right under her sternum and continue tracing her linea alba until she may (or may not) feel a “hole” in her stomach. The largest separation is typically under the belly button.
The best way to assist in the healing of DR is to incorporate exercises that properly engage the transverse abdominal muscles. The deepest layer of the abdominal wall, and the most important in postpartum workouts, is the transverse abdominis. It’s fibers run across the abdomen and performs abdominal compression, which draws the belly inward, and narrows the waist. This muscle acts as the body’s "internal girdle.” Interestingly, unlike most skeletal muscles, the transverse abdominis does not move bone and does not create a lot of inter-abdominal pressure toward the linea alba. Contraction of the transverse abdominis acts like an internal splint, helping to close abdominal separation from the inside. It is the body’s most important core stabilizer and is responsible for re-flattening the abdominal wall after pregnancy (Be Fit Mom).
The Birthfit team recommends the following guidelines to assist in developing the transverse abdominals facilitating closure of the DR. It is important to note these recommendations can be applied during pregnancy as well to avoid DR.
- Avoid any “Crunch Type” motion. Any kind of sit ups, V ups, kipping pull ups, toe to bar, etc., should be avoided. Exercises that flex the upper spine in particular should not be encouraged during and after pregnancy as this can create DR, or further the distance of separation.
- Engage your entire core. This is an absolute necessity in strength training and daily activity. Mindfulness of body alignment, correct breathing, and focusing on correct movement patterns will have an effect on interabdominal pressure essential for increasing strength and recovery. This translates into simply standing, sitting, nursing or holding a baby.
- Incorporate your breath during all movements. Most people, including postpartum women, breathe at the incorrect time when lifting. Being cognitive of when to breathe while under a load (even if it’s simply body weight or light resistant training) is important for coaches to properly cue. Remember, inhale during eccentric motion, exhale on concentric movement. Many women are never cued properly and this is fundamental for core rehab and building a new foundation of strength.
- Goblet squats, overhead squats, and front squats with PVC pipe or empty barbell. This allows for coaches to align their client in a way to best facilitate excellent movement pattern and stabilization of the core. Avoiding forward lean (weight on toes) or leaning back (weight on heels) helps clients to feel engagement of the transverse abdominals. Be aware of the belly relaxing- have her push up into the bar which will allow for her trunk to tighten and remain stable.
- Strict pull-ups with or without bands. It is important to be aware of spinal flexion. When pull ups become challenging, even with a band, it’s instinctual to use hip drive and “kipping” to assist the ascent. Focusing on a slow concentric movement and a controlled (not jolting) eccentric movement helps build strength and improves the quality and engagement of the TVA.
- Hip Thrusts/Glute Bridges. Instructing a woman on how to properly engage her glutes assists in pelvic floor activation and stability of the entire core. This exercise also relieves pressure and loading on the spine and may alleviate back pain.
- Strict presses with Kettlebells, Dumbbells, Barbell, or PVC. A cue a coach can use for a postpartum woman learning to reactive her transverse abdominals is to keep her ribs over her hips when she presses any weight overhead. Keeping a natural curvature of the spine and activated TVA prevents the hips and lower back from swaying forward.
- Regular plank/side planks/Bird Dog. Planking is one of the greatest exercises a postpartum woman can do, but only if it’s done properly. Controversy with planking is based on women and coaches who do not maintain alignment and proper weight displacement. The core should be engaged and the hips should not drop to the ground. A coaching cue that can be used is to bring the belly button up toward the spine. This forces the TVA to contract and maintain alignment and correct weight displacement.
- Overhead walking lunges with plate. Lunges require balance, coordination and proprioception. Adding a weight overhead allows for the core and shoulder girdle to contract for maintaining balance. Please note the external line (white arrow) of force is through the hip (glute) at this position as well as the small orange line to the hip. This indicates the load is very much on the quad however, the load will shift accordingly to the posterior muscles upon moving forward making this exercise a quad and glute dominant exercise. The torso should remain rigid and controlled throughout the movement.
- Farmer Carries or Suitcase carries. This movement can be intimidating for many women. Build confidence by using light weights and focus on keeping the torso upright. Introduce suitcase caries and have them watch in a mirror what happens to their torso when they carry a an object in one hand, so they can see how easy it is to get out of alignment and force inappropriate torque on the core. This is a great way to help women learn how to carry their child/diaper bag/etc., in a way that won’t hurt their posture or rehabilitation of their abdomen. Awareness is the foundation for long term wellness!
These exercises stabilize the entire core, from chest to pubis. When the core is engaged and aligned properly, the transverse abdominals and pelvic floor work in conjunction, which is an ideal scenario for any postpartum woman looking to get stronger and rehabilitate any repercussions of pregnancy and childbirth. Stabilization of the core and alignment of the spine allows for diaphragm breathing. Conscious, controlled breathing allows for the diaphragm to relax and engage all components of the pelvic floor. A coach should explain how to engage the core, assisting their client in coaching cues to properly contract and relax the abdominal muscles, ensuring that the TVA are being contracted, vs applying interabdominal pressure at the center of the abdomen. The more aware the client is naturally, the better she will reintegrate herself into exercise and avoid making her DR any worse.
Our job as fitness professionals and educators is to know better, do better and assist people in creating not just a foundation, but a progression toward optimal strength and recovery. Each person is different and will have a different path postpartum. A conservative approach is key because regardless of how easy or hard pregnancy/childbirth/weight loss is, the body still underwent a huge transformation and takes a long time to heal and recovery internally, even for the fittest of women. As coaches, we must have a basic understanding of how to assist in this new transformation that may be different than how their body was prior to pregnancy. We must help to adjust the mindset of our culture, encourage women that it’s not “normal” to simply bounce back without physical, mental, internal or emotional scars of pregnancy and motherhood. As advocates for fitness and wellness, we must empower these women to prioritize their training, recovery and promote what it does for their mental health and role as a mother. A healthy mother is better able to care for her child in terms of energy and self-esteem. If we can assist in the process by promoting healing, strengthening, educating and empowering, we are doing our job as fitness
About the Author
Brianna has worked in the strength, conditioning and wellness industry for years and coached at various levels. She has experience coaching Division 1 collegiate athletes, corporate wellness management, personal training and specializes in women’s health and fitness. She works as a Women’s Strength and Conditioning Coach, provides personal training, small group classes and remote coaching. Brianna is also a Birthfit coach and the only one in the Conejo Valley and surrounding area that specializes in pregnancy and postpartum training and recovery. She believes in all encompassing lifestyle wellness and advocates for women to find strength through self empowerment and health. Brianna is a mother of a wild toddler and she completely understands the challenges of balancing motherhood, work, health and daily responsibilities!
Brianna has her Master’s Degree in Coaching and Athletic Administration and her Bachelor’s degree in Kinesiology. She is an active member of the NSCA where she is a Certified Strength and Conditioning Specialist (CSCS), USA Weightlifting (USAW) as Sports Performance Coach and is a certified Wellness Coach. She is a former Division 1 collegiate athlete and has competed in triathlons, powerlifting, Crossfit and Olympic lifting.
Brianna Battles, MS, CSCS
Strength, Conditioning and Wellness Coach