Category Archives: Exercise

Is it Worth it?

I treat a lot of women with diastasis recti (DRA) one of the most common questions I get asked is:  I want to have another baby is it worth all this effort if it’s just going to separate again? Well, the simple answer is YES!!!

Here’s why:

All the work you do now to close the separation, prior to getting pregnant will pay off now, during the pregnancy, during the delivery and after when you need strength to look after your new bundle of joy, and want your tummy flat again.

 Now

DRA is the separation of the rectus abdominis muscle. It happens during pregnancy or repetitive strain on the abs (like doing crunches). DRA causes muscle weakness and imbalance throughout the core. A weakened core puts you at risk for injuries to your back, neck and pelvic floor (incontinence, and prolapse among others). Doing appropriate DRA exercises will help restore the proper neuromuscular patterning of the core. When your muscles work properly, everything falls into place (including that flat tummy)

During pregnancy

Yes, with every pregnancy you increase your risk of developing a DRA. However, doing appropriate exercises during your pregnancy will help keep you strong, especially if you have a toddler or two at home to keep up with. It will also help decrease the severity of the separation. Strong muscles will also help maintain your posture as the baby grows. Proper posture is critical for preventing injuries to your back and neck. It will also encourage proper patterning of your pelvic floor helping to avoid incontinence. There is also strong evidence that appropriate exercises during pregnancy has health benefits for your baby.

During delivery

Having control of your pelvic floor muscles (PFM) and your transversis abdominis will be beneficial during the pushing stage, easing delivery and recovery and decreasing complications. Learning how to contract and more importantly relax the pelvic floor muscles is critical. If you are able to relax the PFM the baby can descend more easily through the birthing canal.

After

Muscles have memory. The more frequently an exercise was done before, the easier it is to pattern after. It’s like riding a bike. An exercised muscle also has more blood flow to it so it repairs faster (think elite athlete vs couch potato). It’s much easier to start an exercise you’ve done before than to learn one on little sleep. The core breath can be done immediately after delivery and used as a foundation for the rest of the core program. Basically, learning the exercises prior to delivery will increase their efficacy after delivery.

Now if you didn’t start before, don’t worry, it’s never too late. I have had women in their twenties, thirties, forties, fifties, and yes even in their sixties feel better and close their separation. Stay tuned for a later blog post that will talk about the proper exercises we should all be doing!

So, are you convinced? Is it worth it?

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Physio After Pregnancy. When to Start?

New moms ask me this all the time, so I thought it would make a great blog post!

Q: How quickly after giving birth can I begin post-natal diastasis physio?

A:The sooner you begin the better.

My preference is to start during the pregnancy, as soon as the diastasis is noticed, presumed or diagnosed. This way we can start patterning your muscles to work together, in synergy. When you are more aware of how your core abdominals work it patterns your neurological system and that’s really half the battle. It also helps bring more blood flow to these muscles, and that translates to quicker healing times. Also if I get to see you before the baby does, I can show you exactly what you need to do immediately post delivery, I’m talking minutes, ok let’s be more realistic, hours, after delivery.

If you have already delivered your baby I can see you now. In my program, the first step is education. The beginning exercises to close the diastasis deal with the synergy between the diaphragm, pelvic floor, transverses abdominis and multifidis. They are 100% safe post natally as there is no resistance involved, just posture, breathing and patterning. We then build this into your everyday patterns of movement (ADLs). Once you are cleared by your midwife or physician, we start to add resistance and peak engagement exercises.

Splinting is often recommended, depending on the size of your diastasis and integrity of the connective tissue (that linea alba between the two recti). Most of the healing happens in your first 6 weeks, so doing the right thing from the start is the most effective way to resolve a DRA.

It is truly never too late to start either. It’s just more work the later you start, and the results can take longer to achieve.

Do you have a DRA? If so, when did you get diagnosed? Have you started treatment?

Top 10 ways to stay safe while biking!

Do you know the most common cause of bike vs. car accident?

I have been commuting to work on my bike for more than 10 years. The last 6 years include bringing my kids where they need to go (daycare, school, play dates, shopping). They have logged about 50% of my miles. I thought I had seen it all: cyclists smoking, toddlers eating choking hazards in bike seats, flips, falls and collisions. This week I saw the ultimate: texting while biking on College Street in Toronto. He was two bikes ahead of me and weaving in and out of our lane. He nearly took out one cyclist as she attempted to pass him, and countless cars nearly hit him, yet he remained oblivious to the honks and dangers. I decided we needed a top 10 list of how to stay safe on your bike in Toronto.

  1.  Do not text and bike. I know it seems obvious, but as noted above, apparently it’s worth mentioning.
  2. Choose routes that have bike lanes or suggested routes, even if it is a little longer. Getting there 5 minutes later is better than not getting there at all.
  3. Make sure your bike fits you.
  4. Keep it tuned (especially your brakes) and your wheels pumped. It’s harder to get a flat on properly inflated tires.
  5. Bike with your kids. It may seem counter intuitive, but cars seem to give you more room and you won’t be as aggressive, keeping you safer.
  6. Bike early in the am: less traffic = less likely to arrive in an accident.
  7. Bike single file. When you are doubled you take up the whole lane.  Faster cyclists can’t get by and cars don’t give much room to the outside cyclist, if they go down so do you.
  8. Accept that you are not the fastest cyclist out there.
  9. Light up your bike like a Christmas tree and wear reflective clothing and ankle bracelets.  Cars have enough trouble seeing us in the daytime hours; dawn and dusk are very difficult. Lights make you more visible, therefore less likely to be hit.
  10. Watch out for streetcar tracks. They are slippery in the rain and lock your front wheel when you get caught in them. I take them at a 30o angle, it seems to work.

But most importantly, PAY ATTENTION!! I’ve treated many cyclists who have been hit by an oncoming car turning left while their lane is stopped in traffic. Be alert to everything around you–you might want to rethink that music player. The most common cause of bike accident in Toronto is getting the door prize. Stay wide and use your bell when passing parked cars. Expect EVERY car door to open so you are not caught by surprise.

Cycling is a great exercise that can be done lifelong. I don’t bike because I am fit; I am fit because I bike. What’s your top tip for staying safe?

Ride safe!

Healthy Snacks for Kids!

For those of you who follow me on twitter: @physioexellence you know how enraged I have been at the boys’ soccer games in regards to the snacks parents are bringing…chocolates, mr. freeze, candy.  I asked Carole Ma, a naturopathic doctor what the best snacks are for kids playing in this heat.
Here is her reply:

 Soccer Snacks for Kids

When kids are running around for hours on the soccer field, their bodies are working hard.   After the game, they need food that will rehydrate, replenish, and repair.  Skip the “treats”, and truly reward them with your enthusiastic support and body building, nutrient-dense snacks!  C’mon, you wouldn’t put sludge in a high performance race care, would you?

Ongoing proper nutrition will keep them feeling energized on and off the field.  And when kids learn and develop the habit of healthy eating, you will have taught them an essential life skill that will benefit them in countless ways, for all the years to come.

Rehydrate:
For every hour of running around, kids need between 600 – 1200 mL of fluids. Ensure kids are well hydrated before and during the game. Dehydration can leave kids feeling fatigued, and also run the risk of heat-induced illnesses. And when sweating, the body is also losing precious electrolytes, so drinking water is not enough. Instead consider orange juice or coconut water, as both are rich in potassium, and other minerals. Coconut water is a popular drink in the warm tropics, and amongst athletes. Avoid drinks with added sugar, as they leave kids still feeling thirsty. Carbonated drinks can cause a stomach upset.

Snack idea:

  • Orange juice
  • Coconut water

Replenish:
With all the activity, the body uses up glucose and glucose stores (glycogen).  When blood glucose levels dip too low, a person can feel quite fatigued and even dizzy.  Replenish these levels with fresh fruit.  Oranges and bananas are especially high in potassium, a salt that is lost in sweat. Be sure to also bring along complex carbohydrates, which the body will convert to glucose in a gradual manner. Foods with added sugars need to be avoided, as they can lead to a quick
rise in blood sugar and then a crash. They can also suppress the appetite, so kids won’t feel like eating their next meal (which of course they need!).

Snack idea:

  • Fruit:  oranges, bananas, watermelon, grapes, berries
  • Complex carbs:  whole grain crackers, brown rice cakes, multigrain bagels, pretzels, popcorn

Repair:
Those muscles, especially in the legs, have had a real work-out.  With strenuous exercise, muscle fibres break down, and then need to be repaired.  This is why protein-rich snacks are so important – they will provide the building blocks for repairing muscles.

Snack idea:

  • Hard-boiled eggs, cheese cubes (salt also helps rehydrate), soy nuts, plain   yogurt (mix in small amount of pure jam), bean dips (served with vegetables  which are also rich in potassium, whole grain crackers)
  • Nuts are usually banned from kids’ events, but they would otherwise make great protein choices.

Enjoy the game!

Learn more about Carole at http://www.carolema.com