April Knowledge Drop
Each month for our newsletter, the Lady Blurb, we'll share answers to some pelvic health questions you've submitted. The questions below were taken directly from you! To submit a question for next month, comment below or email us at contact@ladybirdpt.com.
**The answers to these questions are not meant to be used as medical advice. These answers are not meant to take the place of a skilled physical therapist or discussion with your medical provider. If you are experiencing concerning symptoms, please contact your physician.**
This month, we’re answering:
If I don’t have a diastasis, when can I start doing planks postpartum?
I was told that I couldn’t do core exercises during pregnancy. True or false?
Kegel trainers.. Yay or nay?
1. If I don’t have a diastasis recti, when can I start doing planks postpartum?
This is a hard question to answer with specific timelines because it really depends (shocker!) but here are a few things to keep in mind:
The majority of people do have some kind of separation in their abdominals postpartum, with studies citing that 30-68% of people have some degree of diastasis recti after childbirth. It’s advised that you check your own diastasis recti if you know how, or have a trained professional assess the depth, width and associated tissue health prior to progressing to higher level core strengthening like planks. The more you know about your body, the better!
Planks are a HARD core exercise and it’s probably not where you want to start. Early postpartum, exercises that used to be easy may feel challenging and it’s important to give your brain and body a chance to recalibrate. There are so many other abdominal exercises to do first in order to work up to planks. Check out our 6 week postpartum recovery program to guide your return to exercise and core workouts.
Three, it is very important to strengthen your deep abdominal muscles to help heal your core after childbirth. A physical therapist can help you identify how to engage these muscles optimally and provide you with exercises to strengthen your core based on your current level of strength and endurance.
The earliest I typically see people return to planking is 8-10 weeks. Usually these patients have started strengthening their deep core muscles at 3 weeks postpartum and worked up to be able to do planks at that time. No matter how far postpartum you are, it’s a good idea to still start with the basics. But remember, everyone is different and personalized advice when accessible is your best option. Message us here to set up an appointment today.
2. I was told that I couldn’t do core exercises during pregnancy. True or false?
I hear this all the time and its one of the biggest myths about pregnancy. (Give me a soap box, I will be here all day).
YOU ABSOLUTELY SHOULD STRENGTHEN YOUR DEEP CORE MUSCLES DURING PREGNANCY. That’s it really. It's the truth.
Where things get tricky is that as a pregnant person, you will likely have to modify the core exercises you are doing throughout pregnancy because of doming and coning. Doming and coning of the abdominal muscles is when you see tenting of the middle of your abdomen which means that your linea alba, a line of fascia connecting your rectus abdominis, is being stretched. It doesn’t necessarily mean you have a diastasis, but it is something you may want to limit depending on your strength and control. While it’s not black and white, excessive stretching to the linea alba may contribute to a diastasis recti postpartum. If you are seeing doming/coning with day to day activities or exercise, see a physical therapist to help appopriately modify your programming.
Here are 5 tips for core strengthening during pregnancy.
3. Kegel trainers.. Yay or nay?
My answer is “mehh..” They aren’t the best for everyone, but some people use them, like them and benefit from them.
Who benefits from them? People who need to strengthen their pelvic floor, have great pelvic floor coordination and like to gamify their home exercise program.
Kegel trainers usually involve you putting a sensor inside your vagina and using an app on your phone to see if you’re contracting and relaxing your pelvic floor. So you can do holds, quick flicks or work on relaxing your pelvic floor muscles. This can help create accountability for the pelvic floor strengthening part of your exercises.
Why a kegel training isn’t the BEST use of time or at least shouldn’t be your entire home exercise program? Because the pelvic floor shouldn’t be strengthened in isolation... or at least not for very long.
Your pelvic floor works with your glutes, core and hip rotators. If you’re pelvic floor needs strengthening, these are muscles probably do, too. But you can’t use a kegel trainer with exercises that strengthen these muscles (like squats, lunges or single leg exercises) because the sensor picks up noise from these muscles and confuses the results.
Another problem is that not everyone needs pelvic floor strengthening. Some people have too much tension in their pelvic floor and they actually needs to learn to relax their muscles. If someone with a tense pelvic floor does a bunch of kegels while playing with a kegel trainer, it can make their symptoms worse!
The best way to use a kegel trainer is in conjunction with the advice of a pelvic floor physical therapist. The reason as a physical therapist I don't recommend this very often is because you can strengthen your pelvic floor and glutes/hips at the same time once you make sure your pelvic floor is activating properly. So you are not only killing two birds with one stone, but you don’t need to stick anything inside your vagina to do so. Win win.
Working with a pelvic floor physical therapist can help address sexual dysfunction, bowel and bladder concerns and help you prepare for pregnancy, birth and postpartum recovery. Contact us here to learn more about setting up an appointment with us, today!
By Dr. Jessica Chastka, PT, DPT, WCS
Jessica (she/her) earned her Bachelor’s in Exercise Science from the University of Louisiana at Monroe, while playing softball. She received a Doctorate in Physical Therapy from University of Texas Medical Branch in Galveston in August 2015. In 2019 she became Board Certified in Women’s Health, through the American Board of Physical Therapy Specialists.
For the last five years she has been working as a pelvic floor physical therapist, treating people who have pelvic pain, leakage, urgency, frequency and constipation. This includes the pregnant and postpartum population as well as people with chronic pain. She is passionate about making her patients feel heard and seen, validating those who feel that their problems are not worth mentioning because everyone has them or because embarrassed to talk about them.