Ab Rehab

Use these non-traditional core rehabilitation moves

to slim the waistline and create a healthy core

Megan Hoover, DPT Lindsay Brin, B.S.E

Ab Rehab moms into
fitness

Congratulations – you’ve had a baby, or six! Maybe your first was born several years ago, or maybe it was more
recently. After all systems return to “normal” following pregnancy, you’ve discovered that you are left with loose
skin, slack muscles and, sometimes, cellulite residing in places it’s never been before.

And, whether it’s been 8 years or 8 weeks, the good news is, you can tighten up the loose skin, tone up your
muscles and reduce the cellulite. But, before you dive in, I want you to know that, while it is important to
concentrate on these key core exercises, it’s also equally important to use them in addition to a well-rounded
fitness program. We can’t lose weight and trim our thighs simply by crunching ... we have to exercise our
entire bodies.

Did you know that 90% of us do a crunch the wrong way? Instead of engaging the inner core muscles and
flattening the belly, we tend to “pooch” the belly out as we crunch up. Why? Well, it takes less work to fill up
the belly than to flatten those muscles, and by default, our bodies take the easy route! The truth is you could do
crunches until you are blue in the face, but until you initiate the movement from the innermost core muscles, y ou
will not see a change.

There is also something else to consider. Maybe you have an abdominal separation – which was once thoughtto
disappear after the baby was born. This is not the case. Did you know that some exercises can make itworse?

Stick with me ... I know you are anxious to get started! But, first you need to know the how and the why of the
movements. You need to know how to turn these muscles on before you can properly train them. And, you n  eed
to know how to cue the most important muscle – the Transverse Abdominis (or TA) – in your quest to fl atten your
tummy!It’s not a fad. It’s not a trend. Over the last decade, activating the ‘inner core’ during exercise, as well as
much of daily living, has increased in popularity due to oodles of research. And, it’s not your fault if you don’t know
how to turn on your TA. It has always been under cued and underused in fitness. And maybe for you, the t hought
didn’t even cross your mind until you had a baby and were left with a weak core or a belly you didn’tlike.

In the last 10 years, I’ve seen thousands of moms change their bodies, decrease low back pain, and flatten
bellies by learning how to properly cue and use their innermost core muscles. But, if I just told you all of my
anecdotal stories, I would be doing you a disservice. So, myself and Megan (a dear friend and Physical T herapist
who I sought out when writing my Prenatal & Postnatal Instructor Course) teamed up and dedicated ourselves
to discovering a way to pair fitness with physical therapy research and practices. Megan’s v ast knowledge of the
core and simple, easy-to-follow cues will have your core serving your body 100% of the t ime in no time at all.

Lindsay
1
Ab Rehab moms into
fitness

Table of Contents
Why are the Transverse Abdominis and the Pelvic Floor s o important? . . . . . . . . . . 3

How do I engage my Transverse Abdominis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Running and Your Pelvic Floor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

The Mom’s Guide to Diastasis Recti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

How do I know if I should see a physical therapist? . . . . . . . . . . . . . . . . . . . . . . . . . 12

Running and Diastasis Recti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Hip and knee stability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Lower Back Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Keeping your posture in check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

C-Section and Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

C-Section and scar rehab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

2
Ab Rehab moms into
fitness

Why are the Transverse Abdominis and the Pelvic Floor

so important?
When performing a crunch the usual focus is on the rectus abdominis, which is great, but it will not help your
core aesthetics or create a healthy core. The transverse abdominis (TA or TVA) will create healthy core
stabilization, in turn helping create a flatter belly. Together the TA, rectus, obliques, back muscles, diaphragm
and pelvic floor (PF) need to work together. After being pregnant you probably know exactly where your pelvic
floor muscles reside ... they helped support your baby for 9 months.

We hear all this talk about the TA and the PF ... So, what’s the big deal with these muscles? They are some of the
essential building blocks of the core. Study after study show that not engaging this key core muscle can leave
you with chronic pelvic, and back pain, and open to injury.

Your rectus abdominis, otherwise known as the “six-pack” muscle, along with your internal/external obliques
layer over the TA. The TA runs horizontally across of the abdomen and acts like a corset. The main job of the TA
is to stabilize the spine and pelvis before you move your arms or legs. These guys need to work all day, every
day. Every time you take a step, climb a stair, reach overhead, cough or laugh so hard you cry, these lovely little
muscles are kicking in. The problem is that we are not taught how to correctly and selectively strengthen the TA.
I love when Diane Lee said, “you cannot strengthen a muscle your brain does not know it has.” Because the TA is
known as the corset muscle, it is the one we want to hit up to get those pre-mommy tummies back.

How do I engage my Transverse Abdominis?

You must know how to turn these muscles on before you can train them. Watch this Ab Rehab video to start
retraining these muscles.

A lot of times the rectus abdominis and back muscles take over and create a “bread loaf” effect when you do
core exercise. Notice in the video mentioned above we cued the TA to get you out of this habit. As you become
more mindful of actively engaging the TA, your core will become stronger, eventually creating a new habit.
You’ll know you’re doing it right when you feel the ole fashioned burn when performing the 4 exercises in the
Ab Rehab video. As with most things, consistency is key.

3
Ab Rehab moms into
fitness

Next in…your pelvic floor (PF)

Any weight bearing activity (walking, running, jumping ...) increases the strain through the PF. Weakness and
dysfunction in the pelvic floor can cause incontinence and pain. Way too often I hear ladies say, “I’ve had babies,
so peeing my pants is just part of life.” Let me tell you, my friends, this is not true. You can selectively retrain
the pelvic floor to do its job. Now, to be fair I will say, there are times when these muscles and the bladder get
damaged or injured and require more invasive intervention including surgery.

The pelvic floor is a group of muscles that act as a sling to the bottom of your core, from pubic bone to tailbone.
The pelvic floor muscles stabilize the joints around the pelvis. Pregnancy, childbirth and decreasing estrogen
weaken these muscles. But these muscle fibers can be trained! Like any muscle group, you have to specifically
target these muscles.

You wouldn’t swim to train for a marathon right? So let’s find the correct muscles to train. For the pelvic floor we
will be stimulating muscles you don’t necessarily feel all the time. Sometimes it can take several tries for the brain
to communicate with the pelvic floor. These moves are less intense and obvious.

The Kegel is a simple exercise that can be done while sitting, standing or getting ready for bed. And nobody will
even notice you’re “exercising” the pelvic floor. The pelvic floor is not meant to be “turned on” all day.

There are 2 types of pelvic floor exercises that can prevent and treat urinary incontinence during pregnancy and
postpartum:

Hold ‘Ems on a chair or Swiss ball

• Squeeze and lift the pelvic floor muscles by thinking of pulling on both ends of a hammock. You can also
think about using the muscles that you use to stop the flow of urine or hold in gas.
• Hold for 5-10 seconds (you should be able to talk while you do these so you don’t hold your breath). And
relax for 10 seconds. It is just as important to learn how to relax these muscles as it is to turn them on, so don’t
skip that step!
• Do 10 contractions. Try to get in about 3-4 sessions a day.

4
Ab Rehab moms into
fitness

Quick Squeeze ‘Ems

• Now contract those same muscles quickly 5 times. Don’t hold. We’re training motor control here ... fancy
term for retraining that brain to turn them on/off quickly. Relax for 10 seconds after your 5th quick contract.
• Repeat 10 times.

Is there a program that concentrates on these key core muscles?

It’s important to strengthen your deep core muscles through a variety of abdominal exercises specifically
targeting your transverse abdominis (TA) and pelvic floor. It’s equally as important to incorporate safe strength
training into your exercise routine. Healthy (from toning) and supple (from stretching) muscles will treat you well!
Moms Into Fitness has excellent programs and resources to keep you on track.

For exercises that help stabilize a weak core by concentrating on these key core muscles, follow our 30 Day
Restore program. If you’ve had a baby within the last year, follow our Postnatal Program. These programs break it
down to the basic foundation (working your TA and PF). Then build on this foundation, adding layers of difficulty
with each phase.

Give the exercises in the links above a shot to get those deeper core muscles activating accurately and safely!
With that being said ... core stability and strength take time and consistency. It takes about 4-6 weeks of
performing these exercises about 4 times/week to see a measurable change.

If you are not seeing a significant improvement after consistently doing the exercises, please get in touch with a
Women’s Health physical therapist. Your core may not be firing correctly. A Women’s Health PT will be able to
get your brain re-connected to the rest of you!

5
Ab Rehab moms into
fitness

Running and Your Pelvic Floor

Next in ... your pelvic floor and running. Your core/trunk is a transfer station for everything that goes on in the body.
Running dramatically increases the amount of force through the core, pelvic floor and legs.
Start super slow, and not before two months postpartum UNLESS you have been super consistent with activating
your TA and PF. If you are a hard core runner you have a little more grace in that you can start running 6 weeks post a
vaginal delivery (given your doctor agrees).

Starting running too soon can wreak havoc on your pelvic floor. Its primary job is to keep that baby in and then
afterwards to keep your insides ... well ... in. Think of it as a hammock that holds your bladder and reproductive
organs in and attaches to the front and back of your pelvis. These muscles work all day long. 24/7. They work in
conjunction with the TA to stabilize the core. Any insufficiencies in these muscles can cause pain, incontinence and
altered movement. A study by Poswiata in 2014, found that 45.54% of the 112 elite female endurance athletes
(runners and cross-country skiers) polled, suffered from incontinence. It is so common ladies! You are not alone!

You never want to subtract to add i.e. don’t put your pelvic floor at risk to start adding miles. If you have good core
strength and stabilization you can progress through the following recommendation more rapidly, otherwise spend
2-3 weeks at each stage. Make sure you properly warm up (walking) and cool (walking and stretching).

A few considerations before beginning:

• Are you able to stabilize your core? All of the internal muscles we’ve talked about, they help stabilize your core.
• Have you integrated full body strength training? Specifically exercises that take you into different planes of
motion. We spend a lot of time in one pattern while running, we need to strengthen all those stabilizing muscles
in different planes
• And stretching? Always an important part of any exercise routine. Did you know tight chest muscles can move
down the kinetic chain and cause knee/hip pain while running?

• Timed I: aim for 20 minutes of run 1 minute/walk 1 minute, repeat

• Timed II: aim for 20 minutes of run 2 minutes/walk 1 minute, repeat
• Timed III: aim for 20 minutes of run 3 minutes/walk 1 minute, repeat
• Mileage I: aim for 2-3 miles of run 3 minutes/walk 1 minute, repeat
• Mileage II: aim for running 1 mile, walk 2-3 minutes, aim for running 1-2 more miles
• Mileage III: aim for running 2 miles, walk 2-3 minutes, aim for running 1-2 more miles

Incorporate daily PF exercises. You will find these pelvic floor exercises on page 4. As always, it’s important to
incorporate strength and flexibility into any running routine.

If you are 5+ months postpartum, I recommend pairing your running routine with our Running Supplement
workouts. The perfect combination of cross-training and firing up the inner core muscles.

6
Ab Rehab moms into
fitness

The Mom’s Guide to Diastasis Recti

Many moms experience postpartum body changes. One of these is an incredibly common condition called
diastasis recti, which affects up to 45% of women six months postpartum. Diastasis recti abdominis is the separation
of your abdominal muscles; it commonly occurs during pregnancy to make room for your growing baby.
Diastasis Recti occurs in 33-60% of pregnant women. Recent research suggests even more than this concrete
statistic, suggesting most pregnant women will have some form of diastasis in the late stages of pregnancy.

Research shows about 45% of women still have this condition 6 months postpartum. You are more prone to this
abdominal gap if you have a weaker abdominal wall, if you are carrying a large baby, if you are carrying more than
one baby, if you have a narrow pelvis, if you have more than one child, if had them close together, or if you’re
over 35 when you get pregnant.

After that long list of predisposing factors, you can see why diastasis recti is common. That said our bodies are
made to bear children and are also resilient in getting back to their prior self!

Symptoms of Diastasis Recti

The symptoms of this condition can vary from woman to woman, so it’s important to understand what to look for
if you have recently given birth.

The most obvious symptom is a postpartum pooch around your ab muscles. However, that doesn’t always mean
you have diastasis recti. It could indicate a weak transverse abdominis or weak core.

You might also think you have diastasis if your belly has a “bread loaf” or ridge or it cones as you roll to sit up.

The following are also symptoms of diastasis recti: pelvic floor dysfunction, feeling of flabby abs, incontinence,
pelvic pain, back pain, poor posture or an umbilical hernia.

7
Ab Rehab moms into
fitness

How to Tell If You Have Diastasis Recti

You can do a self-check exercise at home after you’ve given birth to determine if you have diastasis recti. After
performing the self-test you can determine if you should speak with your doctor about this condition.
Click the image or click here to watch the video.

If you feel a separation of two finger widths (finger placement is horizontal), you likely have a mild case of diastasis
recti. Separation of three to four finger widths indicate a moderate case, while four or more finger widths point to
a severe case.

Talk to your doctor or a physical therapist to get a definitive measurement/diagnosis, particularly if signs point to
having a moderate to severe case.

Why do we use the crunch for the self-test?

*an excerpt from our Prenatal & Postnatal Exercise Instructor Course
We use the crunch because it fires rectus abdominis, which tensions up and pulls on the the linea alba. When
the linea alba is healthy it can fire the rectus and withstand this pull and there is the normal <1 cm all along the
linea alba. However, when the diastasis is present, the tissue can’t hold up under stress and separates. Along
those lines, that is why we can do crunches later on when we effectively fire the TA because it bridges that
fascia and reinforces the linea alba allowing us to do that crunch position without the separation. This is why
strengthening the TA is so important … because it runs horizontally and gives that stability to our structure vs.
the rectus that runs vertically and adds stress to the linea alba.

8
Prenatal Exercise Guidelines moms into
fitness

How do I exercise with Diastasis Recti?

There are a number of exercises you can do to strengthen your core. But because we spend so much time sitting,
standing, walking, etc. it’s key that you train your TA to activate throughout the day.

As you move daily – in exercise and in daily activity – you will want to work “functionally” with your diastasis recti.
Anytime you bend, lift, twist, etc. think about tightening your TA. This will reduce the strain on the linea alba
where the separation occurs. It will also reduce pelvic pain and back pain! When rising from bed or the floor,
roll over and do a side sit up (instead of sitting up straining the belly muscles). Think about making a few postural
adjustments and activating the transverse abdominis every time you pick up your toddler or car seat.

We teach you safe exercise techniques and mofified exercises in our Diastasis Recti Program. But there are a few
things you can do while reading to help you better this condition.

• Correct your posture

It sounds simple, but years of habit can take a bit to correct. In fact some studies show it takes thousands of
repetitions to correct bad habits.We spend 12 hours a day upright, this is key time to keep your abdominal
wall from being overstretched. With your feet parallel, stack your hip bone over your ankle bones. Stack your
rib cage over your pelvis, careful not to flare the ribs. Breathe normally.

Don’t stand with a swayback and open rib cage, “no rib flaring”. This exacerbates the issue. The smallest of
changes – closing the ribs and stacking the hip bones over the feet – takes pressure off the linea alba (where
the recti separation occurs).

• Daily Functional TA patterns

It’s not just the 30 minutes of exercise that matters, it’s what you do the other 23.5 hours a day. Every time you
lift a car seat, pick up a toddler, sit in a chair, walk, stand (you get the gist;) activate that TA! In our Diastasis
Recti Program we teach you these cues, how to use them within exercise, plus how to use them in everyday
function!

• Avoid heavy lifting

While you want to engage your core throughout exercise, excessive heavy lifting can lead to added abdominal
pressure and separation. If you have older children who want to be carried or your job requires heavy lifting,
squat and engage your leg muscles. Wearing a support belt can also take pressure off your abdomen.

9
Ab Rehab moms into
fitness
• New Mom Note!
It cannot be assumed you have diastasis recti if your belly isn’t flattening after birth or a C-section. Sometimes
a distended belly is due to an under cued transverse abdominis or deep core musculature.

Note: if you’ve had a baby within the last 6 months or are currently breastfeeding, download our Postnatal
Exercise Guidelines. The hormones in your body make the tissues more lax, even after the relaxin leaves your
system (sometimes a few months later). It can contribute to diastasis recti. This is also why a postnatal workout
is so important, specifically for the pelvic floor and midsection!

• Stretch and Strengthen

It kind of goes without saying, but if we take care of our body it will more than likely take care of us. It’s
important to incorporate safe strength training into your exercise routine. The Moms Into Fitness diastasis
recti workouts have all been modified to be safe for those with diastasis recti, including flexibility, cardio, and
strength training. Healthy (from toning) and supple (from stretching) muscles will treat you well!

• Try ab-safe core moves

As we mentioned, traditional moves like planks won’t work. Instead you need to strengthen your inner core
muscles to help approximate the recti bellies, decreasing the gap. Exercises like these are found in our
diastasis recti program:
- Diaphragmatic Breathing
- Side-Lying Bracing
- Bent Knee Fallouts
- Modified Cat
- Transverse Marching
- Rolling Bridge
- Clam Shell

10
Ab Rehab moms into
fitness
• Avoid some types of Exercise
If you are following our programs, all workouts are already modified for you!

There is no universal list of don’ts in the diastasis recti world. But because it is usually the intra- abdominal
pressure that causes the recti muscles to have a bigger gap between them, our direction is to stay away from
applying extra intra-abdominal pressure. Traditional exercises can put too much strain on the belly tissues.

You should refrain from most (not all) twisting and spinal flexion (crunches). We also recommend you don’t
do planks, push ups, quadruped positions, and most traditional abdominal exercises, at least until your TA
can stabilize your torso and your muscles are firing effectively. Be mindful any time you are hinged at the hips
– support your torso.

When can I progress to more traditional exercise?

The short answer is when you can appropriately fire the TA so there isn’t any tension on the linea alba. That means
you shouldn’t see/feel any pull/tension along your diastasis recti. You would see either a “caving in” or “bread
loaf” effect. Until then you need to stick to exercises you are able to be very conscious of your form and posture.
In our diastasis recti program we do just that between phase 1, 2, 3 and plus+.

Diastasis Phase 1: A series of core-specific workouts will help you train your core from the inside out by
strengthening the transverse abdominis (or TA). This series will teach you how to use your inner core muscles,
create core stability, how to do arm and leg exercises while keeping the belly tissues safe and slowly add new
exercises as the condition gets better.

Diastasis Phase 2 - After building core stabilization in diastasis recti phase 1, we add layers of difficulty while
maintaining safe positions and exercises. As I always say you never subtract form to add intensity. With over 20
workouts in phase 2 you can decide what’s best for your core.

Diastasis Phase 3 – Your core is more stable so we start to add functional moves like twisting, the diastasis
crunch and wall/modified planks. Each workout is full of cues to brace your core before adding a layer of
difficulty.

Diastasis Plus+ - After completing diastasis recti phases 1, 2 and 3 you are ready for diastasis plus+. Includes
a collection of workouts offering modifications for diastasis recti, so you can decide what your body is ready for
before moving into our “traditional” exercise programs.

11
Ab Rehab moms into
fitness

How do I know if I should see a physical therapist?

If you were to ask me, every woman who has had a baby should see a physical therapist (PT) or physiotherapist.
Then use MIF as a teammate in rehabbing your core.

1) PT’s specialize in the musculoskeletal system and how it has to ALL work together for efficient and pain
free motion. Our bodies are REALLY good at compensating, and it is so helpful to have someone who is
skilled in finding those compensations, correcting them and showing you how to keep them from coming
back! Not only that, underlying problems such as a hernia, disc issues, neural tension and other conditions
can affect the body’s ability to perform exercises and activities.

2) Women’s pelvises like to move. Yep...while moving to help with child birth is so helpful (and essential),
the continued movement of the pelvis after we’re done having those amazing little kiddos, is not. Not only
does altered mechanics of the pelvis cause pain (think leg length issues, sciatic symptoms, knee pain, back
pain...), it also affects the way our muscles fire. For example, a rotation of one side of the pelvis (super duper
common) can shut off the glutes and the quadratus lumborum on that same side. All those amazing hip hikes
we are doing... when those guys aren’t firing right... causes all our hard work to go no where. So frustrating!
A PT can use our own muscles to correct that alignment so the muscles can fire the way they were designed
to function, and now our hard work gets to pay off!

3) PT’s are there to help make sure you are doing all those great DR exercises correctly and teaching you
how to treat yourself. Seriously... that is the whole goal. We want my patients to get to the point where they
don’t need me anymore and know tips on what to do if they start having similar issues in the future. No one
wants to live in a PT clinic!

TIP : If you’ve recently had a baby, the postpartum period is the best time to get in! Usually you’ve met your
insurance deductible and insurance will cover your visits.

12
Ab Rehab moms into
fitness

Running and Diastasis Recti

“Should I run with diastasis recti?” This is a question I often get asked by ladies after having their babies. In an
idealistic physical therapy world, the answer would be no. Now, before you completely write me off ... please
keep reading. W  hile my easy answer is no, I understand that runners are a unique and wonderful group and are
very driven to return to their sport. I also know that most runners are going to return to running regardless. Trust
me, I know ... I am one of you. My hope is that we can help you run with less impact on your DR (diastasis recti)
and help you understandwhy running may slow your progress of reducing your diastasis and can impact your
pelvic floor. Regardless of if you had your baby/babies via vaginal delivery or C-section, your pelvic floor was
impacted.

For 10 months (seriously ... whoever said pregnancy was 9 months obviously never was pregnant), your pelvic
floor kept that baby in and supported you both ... That is a ton of work. Taking time to re-educate and strengthen
your pelvic floor before you return to running and while you are running is so very important. It is not normal for
you to pee every time you laugh, cough, sneeze, jump ... Moms, you are incredibly selfless and put your kiddos’
needs before your own! Please do not put your pelvic floor and core in the back seat, mommas! You do not
haveto put up with pelvic pain and incontinence.

As we discussed earlier, diastasis recti abdominis (DR) is a condition in which the rectus abdominis muscle
separates or thins along the middle of the muscle at the linea alba. It can be mild to severe. DR dramatically
impacts the stability and integrity of your core muscles.

Let’s talk about the deeper abdominals or the Transverse Abdominis (TA). Pay attention my running mommas. T his
is where we talk about you successfully returning to running without making your DR worse. On either sideof your
floppy bridge are winches, otherwise known as your TA. Your TA fibers run horizontally and act as thecorset of
your core. As your TA gets stronger, those winches crank on your bridge and you get that tensionback.

Your core/trunk is a transfer station for everything that goes on in the body. Running dramatically increases
the amount of force through the core, pelvic floor and legs. If you have DR, your structural integrity is already
compromised. When running with DR, you are likely compensating, which can lead to other structural issues
including, knee pain, IT band pain, plantar fasciitis, low back pain and hip flexor issues, just to name a few. Notto
mention increased strain through your pelvic floor. We need to address your compensations to ensure youcan
run with proper alignment, so you can successfully return to one of your loves. It can be very difficult toknow how
you are compensating.

Please also avoid sprinting. When you sprint, you increase the force and rotation through your trunk muscles,
which can really strain the linea alba and surrounding muscles and fascia.

If you are not seeing a significant improvement in your DR after consistently doing the exercises we’ve talked
about, please get in touch with a Women’s Health physical therapist. Your core may not be firing correctly.
Make sure you are using the PF exercises on page 4, these are safe for Diastasis Recti.

13
Ab Rehab moms into
fitness

Hip and knee stability

I get lots of questions on how to treat knee pain. My answer: get your hips and ankles more stable. Your knees
move, for the most part, in one dimension of motion they flex (bend) and extend (straighten). Unfortunately, your
poor knee is stuck between a hip and ankle that move in all directions. Any weakness in the hip and ankle will
affect the knee. Limited stability and strength with force the knee to try to control motion and increase side to
side forces in that joint that is going to cause pain, altered mechanics and will over time, wear it out. 

There is a difference between strength and stability. When I say stability, I mean the joint being able to move ap-
propriately in speed, direction and smoothness of motion. The nerves, muscle and brain have to all work togeth-
er to successfully control that joint. Strength is important, but stability is more important. Stability is also more
functional. Our joints have to move continually through space throughout the day. If they cannot move appropri-
ately with good mechanics, we end up with pain.

Gluteus medius strength has been a hot topic recently and for good reason. It is a major stabilizer in the hip.
However, it is not an isolated muscle and must work with the other glutes as well as the deep rotators of the hip
to stabilize the hip and the pelvis. These have to work in turn with the TA, obliques and back muscles to stabilize
the top h  alf of the pelvis and the spine. Muscles need to be trained functionally. You can train individual muscles
for specific weakness, but make sure you put it all together. For example, clamshells are a fantastic exercise.
Do them! But then g  et up and work on your curtsy lunges or single leg squats (all these exercises are in the MIF
workouts ... so don’t worry, we got ya). Get those muscles all working together. Do exercises in closed chain
positions (i.e.: get your feet on the ground). The nice thing about getting those feet on the ground, you get
those ankles firing as well.

14
Ab Rehab moms into
fitness

Lower Back Pain

I’m going to disappoint most of you and start out by saying there is absolutely no one exercise you can do to cure
low back pain. There, I have said it. Gosh I wish I had a magic wand to bibidi-bobidi-boo back pain away. There
is a reason b
 ack pain costs BILLIONS of dollars to treat each year. Back pain can be complicated and down right
yucky (highly educated description).

However, if you are consistent with retraining your core muscles and practice good posture and body
mechanics, you can dramatically decrease your back pain and can even go a long way to preventing back pain.
Start out by getting the TA and PF firing and then add in exercises to strengthen you back, deep hip rotators
and glutes. Moms Into Fitness is an excellent resource and the core videos are great at incorporating key muscle
groups. If you do have back pain and are finding that consistency with your core program is not getting rid of
the pain, please get in t ouch with a physical therapist. You are probably getting tired of me recommending this,
but physical therapists are movement specialists and can help determine the exact cause/driver of your back
pain. Often back pain is just a sympton of a deeper issue. As I’ve said before, a P.T. can help you get to the root
of the problem.

Keeping your posture in check

We spend 12 hours a day upright, much more time than we spend working out. Your posture is an important part
of the equation! With your feet parallel, stack your hip bone over your ankle bones. Stack your rib cage over your
pelvis, careful not to flare the ribs. Breathe normally.
• Lengthen your spine
• Relax your shoulders
• Slightly engage your core so your ribs don’t flare
• Stack your rib cage over your hip bones
• Stack yourhip bones over your knees
• Soft knees

15
Ab Rehab moms into
fitness

C-Section and Exercise

Many women spend most of their pregnancies assuming that they will be giving birth vaginally. But sometimes,
surgery is necessary to give you and your baby the procedure that is the most efficient and safe for your situation.
You might d  eliberately choose a C-section, or be surprised by the need for one.About 1/3 of the pregnancies in
the United States are delivered by C-section (cesarean section).

A C-section is a surgical procedure, but unlike what most women think, your doctor will not be cutting through
muscle with the exception of the uterus. When a C-section is performed the fascia is cut horizontally, this is a layer
of soft, flexible connective tissue that acts as a sheath over these muscles. Then the abdominal rectus muscles are
separated from one another and moved to the side. These muscles are very rarely cut, and if they are they are
usually put back together.

Exercising after a C-section should be done with caution. As long as your doctor is okay with it, you should be
able to perform pelvic floor exercises – See Hold ‘Ems and Quick Squeeze ‘Ems. After your doctor releases you
to exercise around the 6-8 week postpartum mark, you can start the TA Foundation exercises. They should be
done pain free. If this is not the case you need to back off. The bridge and clamshell foundation exercises are
really important for C-section mamas ... these create stability to take the strain away from the incision area.

You had major surgery. Combine that with a newborn’s sleep schedule and it can create stress. Ease into exercise
and only if it can be done pain free.

16
Ab Rehab moms into
fitness

C-Section and scar rehab

Normal tissue in our bodies is aligned in a nice uniform direction. However, when scar tissue forms it is kind of
like your toddler played pick up sticks and tossed them all over the floor. The tissue is laid down in haphazard
directions. Most C-sections are performed using a horizontal incision or bikini cut over a mom’s lower abdominal.
When the scar heals, just like any other scar, it lays down tissue in every different direction. The scar tissue can
cause adhesions to the abdominals, pelvic floor and surrounding muscles.

This scar tissue can cause many more problems, beyond cosmetic. When the scar tissue impacts the muscles
around it, it can cause issues with the deeper core muscles firing correctly, can cause issues with incontinence,
can lead to back pain and pain with sexual intercourse. So often I find that moms think that once they have a
C-section scar, it is what it is and there is not much they can do about it. There is hope mommas!


Scar tissue responds very well to mobilization. I know ... big words ... sounds fancy but it is quite easy to do on
your own. Now ... I will say, if you have a thick scar that is super tender and angry, or are dealing with issues with
back pain, incontinence, or diastasis recti, please find a physical therapist/physiotherapist who specializes in
Women’s Health. They will be able to address your scar and other issues and get you back to being super mom
much more quickly than if you just do a simple scar tissue mobilization at home.

First, you need to let that scar heal all the way. Do not get over eager too early in the game ... you can pull open
your incision. Wait until your incision is fully healed. Then put your fingers down along the incision and move your
incision/scar in ever difference direction. Start gently. This may be uncomfortable. A little soreness is ok, but do
not torture yourself! It does not matter if your scar is 4 weeks old or 10 years old. I have gotten scars to move that
are decades old. It is never too late to work those scars!

Very often I find that soon after the scar is healed or is healing it can be very sensitive. You might not tolerate
pants w  ith a tighter waistband or even having your shirt brush against it. This is called “hypersensitivity” and is
not normal. Your body is telling your brain that everything is causing damage even though it is not. We need to
retrain your brain and desensitize that scar. You can start with just brushing your fingers over it and gently rubbing
it if you can tolerate it. Then grab a washcloth and get it wet with warm water. Run it over your scar and then
repeat with it cold. Play around with different textures that you can rub over your scar. If you consistently work on
your scar, your sensitivity will improve!

Most scars respond very well to mobilization. If you are still having issues after trying to work on your scar at
home, p lease find a Women’s Health PT. They have so many tricks and tools in their toolboxes and would love to
help youachieve your goals.

17
Ab Rehab moms into
fitness

Lee, D. (2011). Understand your back & pelvic girdle pain.

Lee, D. (Accessed 2017, 2019). Diastasis rectus abdominis and the implications for returning to sport after
pregnancy. Retrieved from https://dianeleephysio.com/education/diastasis-rectus-abdominis-postpartum-
health/

Lee, D. (Accessed 2017, 2019). Core training vs. core strengthening: what is the difference and why does it
matter? Retrieved from https://dianeleephysio.com/education/core-training-vs-strengthening/

Duvall, S. (Accessed 2017, 2019). Can I Run with a Diastasis?

Retrieved from http://www.coreexercisesolutions.com/can-i-run-with-a-diastasis/

Nixon, J., Goom, T. (Accessed 2017, 2019). Running, incontinence and pelvic floor exercises.
http://www.running-physio.com/pelvic-floor/

Poswiata, A., Socha, T., Opara, J.(2014). Prevalence of Stress Urinary Incontinence in Elite Female Endurance
Athletes. Journal of Human Kinetics, 44, 91-96.

Crow, W.T., Willis, D.R. (2009). Estimating Cost of Care for Patients with Acute Low Back Pain: A Retrospective
Review of Patient Records. The Journal of the American Osteopathic Association, 109, 229-233.

Cook, M. (Accessed 2017, 2019). Physical Therapy After C-Section.

Retrieved from http://www.motionmn.com/physical-therapy-after-c-section/

18