If you’ve searched pregnancy or postpartum fitness to any degree, you’ve probably come across plenty of fears surrounding coning, ab separation, and Diastasis Recti. Let’s break down the facts on Diastasis Recti, including exercises that can improve it.

What is Diastasis Recti?

A Diastasis is a naturally occurring separation of the left and right side of the abdominal wall at the midline (the linea alba). The tissue of the linea alba is designed to stretch during pregnancy and sometimes it just stays a little more stretched out postpartum.

When looking at Diastasis, you test for both the width and tension of the linea alba. Anything up to 2 fingers wide with good tension is considered normal. If you have a slightly wider gap but are able to generate tension in the tissue, that’s not likely an area of concern from a functional standpoint.

But what if you want to close the gap? Keep reading to see what options you have to help improve your diastasis.

Is surgery needed to help repair ab separation?

While surgery can be an option to help bring together the rectus muscles, it’s not the only option nor does it address underlying strength or pressure management concerns.

If you struggle with pressure management and core strength prior to surgery, you’re likely to continue those struggles after surgical intervention. It’s important to progressively build core strength in all ranges of motion as well as learn to manage intra abdominal pressure in order to help improve your diastasis recti symptoms.

If you are opting for surgical correction of the abdominal wall, it is highly recommended that you visit a pelvic floor professional both prior to and after your procedure.

Can Diastasis Recti be corrected with exercise?

Exercise can be an excellent, non-invasive way to help manage and even improve Diastasis Recti.

To help improve your Diastasis Recti, you will want to focus on progressively building strength within the entire core to help strengthen the abdominal wall and approximate the rectus, including, but definitely not limited to, your deep core muscles, the transverse abdominis and obliques.

Pressure management is also very important when considering Diastasis Recti improvement. Excess pressure on the abdominal wall can lead to an increase in stretching and weakening of the linea alba.

What exercises should I avoid with diastasis recti?

There is no do or don’t do list when it comes to exercises to avoid with Diastasis Recti. Sit-ups, leg lifts, and heavy lifting could all be considered safe for someone with Diastasis Recti.

Instead of marking certain exercises as automatically off limits, we look at how you’re performing the exercise, if you’ve properly progressed to the exercise, and how you’re managing load and pressure within the exercise.

When we talk about Diastasis Recti, we often discuss coning as a sign or symptom. Coning is a term used to describe an increase in pressure and extension of the abdomen at the linea alba.

If you see coning present and the coning is soft to the touch, that may not be as much of a concern. If the area of coning is more firm to the touch, that may indicate excess pressure being pushed into the midline which warrants adjustments in your exercises.

How do I stop coning with exercise?

Sometimes we can help to manage the excess pressure associated with coning with form shifts, breathing pattern changes, or by activating the deep core muscles.

For example, if you have excess pressure into the midline with overhead movements such as snatch, pull up, or overhead press, are you able to bring your ribcage down a bit and not thrust out? This helps to better engage the core and help to lessen the pressure into the abdomen.

Adjusting your breathing patterns can also help to reduce pressure out into the abdomen. We do this by timing the exhale with the exertion phase of an exercise. With a sit-up, for example, you could exhale through the entire movement from start to finish. With a pull-up, you may want to exhale as you pull yourself up and inhale as you lower.

An intentional activation of the deep core muscles, the transverse abdominis, is another strategy that can help to increase core stability and reduce tension into the linea alba. For exercises like a plank or push-up, engage and contracting the deep core muscles can decrease the width of the linea alba and reduce pressure on the midline, alleviating the coning. We’re not looking for a strong contraction here. Think 10-15% engagement. 

3 exercises to help you improve your Diastasis Recti

As mentioned, while there aren’t any exercises inherently off- limits for someone with Diastasis Recti, there are movement patterns that you can be performing to help improve your diastasis and overall core strength.

Listed below are three exercises that take you through rotation, anti-rotation, and flexion movement patterns to help you progressively build strength within your entire core.

1. Half Kneeling Band Rotations

The addition of a band provides extra tension to help you engage those deep core muscles. You can also sub a light dumbbell, cable machine, or landmine here.

2. Bird Dog

The bird dog is an excellent anti-rotational exercise for both pregnant and postpartum people. The goal here is as little movement within the trunk as possible which not only helps to strengthen the abdomen, but also helps to improve pelvic floor strength.

3. Banded Pull Downs

While sit-ups can be safe for diastasis recti, they may not be appropriate for you for now depending on your level of strength and ability to manage pressure. Let’s work up to sit-ups with a flexion exercise like this banded pull down.

Diastasis recti doesn’t have to limit you inside or outside the gym. By learning strategies to manage pressure and rebuilding strength in your entire core, you can help to improve your ab separation from Diastasis Recti.

If you’re ready for strategic, relatable programming that bridges the gap between core and pelvic floor rehab and the fitness you want to do, join the thousands of other athletes rebuilding core strength inside the 8-Week Postpartum Athlete Training Program.

Casey Thomas-Hardesty, MS

Casey is a P&PA coach and owner of Two Peas Wellness. She specializes in core and pelvic floor health as well as returning to fitness after pregnancy loss.

Read More: 3 Tips to Exercise

We understand that postpartum is a time of recovery and rebuilding strength. But when you’ve experienced pregnancy loss, postpartum may not feel like it fits the season that you find yourself in at this moment, let alone returning to exercise after miscarriage or infant loss.

While you may not need or want to dial your fitness all the way back, being intentional in your return to exercise can help your body recover and help you maintain your long term fitness goals.

No matter whether you’ve experienced an early miscarriage, a stillbirth, or infant loss, your loss and your ability to get the recovery support you need matters.

Do you need to rehab your core and pelvic floor after a miscarriage or stillbirth?

Yes. If you’ve experienced a pregnancy, even if the pregnancy ended in loss, core and pelvic floor connection and a progressive return to fitness can help your body recover and help you maintain your long term fitness goals.

With pregnancy comes changes in the body, including hormones, postural adjustments, size of the uterus, constipation, etc. These changes can lead to an increase in pressure on the pelvic floor.

This increased pelvic floor pressure from pregnancy, even if only for a brief time period, can lead to an increased risk of core and pelvic floor disorders such as incontinence, pelvic pain, pelvic organ prolapse, or diastasis recti.

How to return to exercise after miscarriage vs a stillbirth?

There are more considerations for returning to fitness after pregnancy loss than simply knowing what trimester you were in when the loss happened.

Other things that can impact your recovery and return to fitness:

• What surgical interventions (if any) did you have? Ex: D&C, episiotomy, c-section, etc
• Did you have any complications? Ex: excess bleeding, high blood pressure, pelvic floor concerns
• Support and mental health. Ex: are you getting a decent amount of sleep, able to fuel your body with food, staying hydrated.

It’s not as simple as first, second, or third trimester. So how do you know what’s ok to do and what’s moving too fast? You can listen to your body, but when you don’t know what signs or symptoms to listen for or if you feel like your body betrayed you, that can be a difficult place to start.

Here’s a simple breakdown of common factors that you can take into consideration to figure out where you should start with your recovery and return to fitness.

• If your loss occurred during the first trimester, you had no medical complications, AND you had no medical intervention (outside of medication) – you can return to fitness close to where you left off. You may want to slow things down a tad, reduce the weights slightly, and add in some supportive core and pelvic floor work for best results.
  
• If your loss occurred during the second trimester, you had no medical complications, AND you had no medical intervention (outside of medication) – This is a time to take a slight step back. You can lift, but maybe you should try tempo and lighter weights instead of high intensity, high reps, and high load. Your body would likely benefit from mobility, core, and pelvic floor routines.
  
• If your loss occurred during the third trimester or later, OR you had medical complications, OR you needed surgical intervention – your return to fitness is going to look similar to a traditional postpartum path. Connecting to your core and pelvic floor, working on breath, balance, and a slow progressive return to strength will be key to helping your body through recovery.

Returning to exercise after miscarriage or infant loss isn’t a black and white event. You can speed things up or slow them down based on how you’re feeling in the moment and what you need in your recovery.

While you may not feel like you’re currently in a state of postpartum, being intentional in your return to exercise after pregnancy or infant loss can help your body recover and help reduce your risk of core and pelvic floor disorders and help you to maintain a lifetime of athleticism..

If you’ve experienced a pregnancy or infant loss, or are a coach helping your athlete through their loss, we’re here for you. You don’t have to go through your recovery on your own.

For more on how to support yourself or loved ones through pregnancy or infant loss, take a listen to Episode 12 of the Practice Brave Podcast where Brianna Battles and Casey Thomas-Hardesty discuss the spectrum of pregnancy loss and how to best support one another during this time.

Read More: Core and Pelvic Floor Basics

We often have a skewed idea of how long the body takes to heal postpartum. Even in the absence of core or pelvic floor symptoms the body does not “bounce back” in a handful of weeks. Even someone with a routine vaginal delivery with no interventions or complications, your body will still be recovering for months, not weeks. So how do we return to exercise postpartum? Read on to learn.

Do you have to wait until 6 weeks postpartum to start exercising?

No. While the 6 week postpartum visit with your medical provider isn’t a green light to return to exercise as you were pre-baby, it’s also later than ideal to begin exercises for your core and pelvic floor recovery.

Exercises You Can Do Early Postpartum

The early postpartum period is a time to rest, recover, and rehab. During this phase you’ll want to focus on connecting to your core and pelvic floor through breathwork, gentle core contractions, and pelvic floor lifts. You can also use this time to gradually increase your walking distance and non-exercise daily activity.

Some exercises we love for early postpartum:

• Prone breathing
• Glute bridge
• Rocking

Learn more with the free e-book: 6 Exercises for the First 6 Weeks Postpartum:

Vaginal Birth vs Cesarean Section

While recovery for a vaginal birth and a cesarean section are the same in many ways, there are a few differences.

A c-section cuts through multiple layers of muscle and tissue. You’ll need to allow time for the scar to heal before increasing the intensity or load of your workouts. Once the scar is healed, you may also find scar massage beneficial to improve the look and feel of your scar.

Even though you may not have given birth vaginally, that doesn’t exempt you from the need for pelvic floor recovery with a c-section. Pregnancy itself still puts excess pressure onto your pelvic floor. You’ll want to take the time to rehab your core and pelvic floor to help reduce your risk of complications and improve your long term athleticism.

Postpartum core and pelvic floor disorders

While incontinence, pelvic organ prolapse, and diastasis recti are not specifically pregnancy or postpartum disorders, having a baby does put you at a higher risk for those core and pelvic floor issues. As you reintroduce movements postpartum, it’s important to note if any core or pelvic floor symptoms appear and adjust your exercise accordingly.

Since how you do an exercise typically matters more than which exercises you do, there’s not an easy safe vs unsafe list of exercises when it comes to core and pelvic floor health. Instead, we look at symptoms and if you can adjust your movement strategies to help you reduce your symptoms. Some strategies may include breathing patterns, alignment, and tension management.

When to return to lifting postpartum

No matter how much you lifted prior to or during pregnancy, you aren’t exempt from a low and slow return to lifting postpartum. You’ll need to progress not only in weight but also in exercise selection, intensity, and endurance as well.

Starting around 6-8 weeks postpartum, you can begin to add light load to your workouts. Since this is a vulnerable time in your healing, it’s not recommended to add high volume, high intensity, or high load training at this time.

Before increasing the intensity of your workouts, it’s important to first master bodyweight movements, breathing strategies, and learn to reduce tension to ensure you’re not sending excess pressure down into your pelvic floor or out into your midline.

When to return to impact exercise after pregnancy

A return to impact exercises like running or jumping is not recommended prior to 12 weeks postpartum. Before you start adding impact, it’s important to focus on rebuilding core and pelvic floor connection, balance, and single leg strength.

Once you are ready to add impact, you’ll want to begin by introducing impact drills to help your pelvic floor train coordination. If you’re able to progress through impact drills without symptoms, the next step is moving on to interval training and speed work before working to build endurance.

While it may seem like a slow jog would be a better reintroduction to running, interval speed work is actually less impact on the pelvic floor. With the slower jog, you’re more likely to strike the ground harder and more often with your feet leading to more pressure on the pelvic floor.

Postpartum exercise does not have to be boring, but it’s important to respect the changes your body has experienced, and begin your return to exercise with self awareness and a strategic recovery plan. Your body has changed, your lifestyle has changed and what you do now can help set you up for a LIFETIME of athleticism, allowing you to continue to do the activities you love for years to come.

If you’re ready for strategic, relatable programming that bridges the gap between core and pelvic floor rehab and the fitness you want to do, join the thousands of other athletes inside The 8-Week Postpartum Athlete Training Program.

Rehab your core and pelvic floor, rebuild your strength, and return to the fitness you love.

Outside of specific medical conditions where your provider may deem restrictions necessary, exercising during pregnancy is not only safe, but beneficial for both you and your baby. What about CrossFit in pregnancy? Is it still safe? Let’s take a look.

Can you do CrossFit while pregnant?

Yes! One of the great things about CrossFit is that it is infinitely scalable, making it easy to adjust to the needs of your changing body during pregnancy.

Most CrossFit WODs offer an Rx and a scaled option, but the scaled option doesn’t necessarily mean that it is scaled appropriately for pregnancy. During pregnancy, it typically matters more HOW you do the exercise rather than what exercise you do. However, there are certain exercises, symptoms, and modifications that you will need to make throughout your pregnancy in order to protect not only your baby but also reduce the risk of complications that would affect your long term athleticism.

What exercises should you avoid during pregnancy?

While most exercises can be made appropriate during pregnancy, there are some activities generally considered unsafe to perform during pregnancy. This includes, but is not limited to:

• Activities with an increased risk of falling (rope climbs, bar muscle ups, etc)
• Contact sports
• Activities that may raise your core body temperature

If you’re doing CrossFit in pregnancy in the heat of the summer, make sure to take precautions to hydrate and stay cool as needed.

What symptoms are red flags during pregnancy?

While you may have been used to listening to your body before, training while pregnant can present an entirely new and complex set of symptoms that you may find hard to tell if they are normal or not in your new body. The following are lists of symptoms of varying degrees that are considered abnormal during your pregnancy.

Please note that due to the nature of pregnancy, these lists are not all encompassing of every symptom that could arise. If you are concerned at any time, please contact your medical provider.

When to stop exercise and call your provider:

• Vaginal bleeding
• Chest pain
• Dizziness
• Headache
• Increase shortness of breath
• Painful uterine contractions
• Fluid leaking or gushing from your vagina
• Calf swelling

Your core, pelvic floor, and CrossFit

You can’t 100% prevent core and pelvic floor disorders like diastasis recti, incontinence, and pelvic organ prolapse, but you can make changes in your exercise selection and your intention with each exercise in order to reduce your risk of complications and help to set yourself up for a strong return to exercise postpartum.

When it comes to your core and pelvic floor during pregnancy, you’re looking to reduce pressure into the linea alba (the tissue that separates your rectus “six pack ab muscles”) and down into the pelvic floor. You may notice excess pressure in terms of symptoms such as leaking any amount of urine, gas, or stool, pelvic pain, increased pelvic pressure (feeling like you have a tampon falling out), or coning along the middle of your abdomen.

How to Reduce Intra-abdominal Pressure

We reduce intra-abdominal pressure and help to reduce the risk to your core and pelvic floor through breathing pattern changes, exercise selection, and small adjustments to form.

For breathing and bracing, pregnancy is a time to ditch the weight belt, reduce effort in your lifts, and opt for diaphragmatic breathing instead of the valsalva maneuver. With diaphragmatic breathing, you can help to spread pressure evenly across your core while exhaling either through the entire movement or during exertion to help reduce pressure even further and reduce your risk of bearing down into your pelvic floor.

Exercise selection also plays an important role in your core and pelvic floor health during pregnancy. For example, burpees, box jumps, and kipping pull ups could be performed during pregnancy, but we don’t recommend them. Those movements place too much pressure on an already strained core and pelvic floor system. Instead, opt for modifications like pregnant burpees, step-ups, and ring rows. You’ll be able to get the desired intent of each exercise while helping to support your core and pelvic floor.

With small adjustments to form, you may be able to continue performing an exercise that was once making you symptomatic. For example, a popular pregnancy substitution for running in WODs is rowing. If you notice your stomach coning as you lean back in the rower, first play around with your breathing patterns to help reduce pressure. Second, don’t lean back so far. Sitting a bit more upright in the rower and finishing your pull short is going to allow you to have less tension and pressure on your core while still getting excellent cardio benefits.

Modifying other CrossFit exercises during pregnancy

When to Ditch the Barbell

Exercises like deadlifts and squats may be able to be performed throughout your entire pregnancy depending on your comfort level, but Olympic lifts like the clean and the snatch should be switched to dumbbells as soon as your belly is showing, typically in the 2nd trimester. While there isn’t as much of a risk of you hitting your bump with the barbell, the concern comes with altering your bar path. You will naturally move the barbell further away from your body in these lifts to avoid hitting your belly. That can take a long time postpartum to relearn.

Eliminate Inverted Movements

During the second trimester, you’re going to want to eliminate inverted movements such as handstand walks and handstand pushups. Not only do these movements have an increased risk of falling, but they also put a lot of excess strain on your core. Try dumbbell overhead presses instead. 

Core Exercises During Pregnancy

You want to keep training your core during pregnancy, but you’ll probably want to ditch the sit-ups at the start of the second trimester. When doing sit-ups during pregnancy, it can be difficult to maintain proper tension in your core and pelvic floor leading to coning in the abdomen and bearing down into the pelvic floor. Try pallof presses, bird dogs, or elevated planks instead. 

Impact Exercises

Pregnancy itself places added pressure on the pelvic floor. You’ll likely want to modify impact exercises like double unders and running during your second trimester as well in order to reduce further pressure and impact on your pelvic floor. Try substituting rowing or sled pushes instead.

Overhead or Hanging Exercises

Overhead presses, kettlebell swings, and pull-ups can be continued throughout your pregnancy as long as they remain comfortable, but pay attention to excess pressure in your core. Because of changes in posture due to your expanding bump, overhead exercises can have an increased risk of coning which can increase your risk of diastasis recti postpartum. Try switching to Russian kettlebell swings in the second trimester and single arm dumbbell presses and straight arm banded pull downs in the third trimester.

While you can’t control everything with pregnancy and delivery, control what you can. Genetics and delivery may be out of your control, but the way you exercise and the way you approach scaling isn’t. Pregnancy is a short and temporary phase in your training journey, adjust now to be able to train the way you want later.Want more detailed info on modifying by trimester PLUS exercise substitution ideas? Download our free E-Book: How to Adjust Exercise During Pregnancy.

While we often think of the core and pelvic floor in terms of pregnancy and early postpartum, your core and pelvic floor are so much more. Understanding your core and pelvic floor basics, your tendencies, and how to counter those tendencies can help you reduce symptoms, minimize risk of complications, and have a positive impact on your athletic performance.

What is your core?

Your core is more than your rectus (or 6 pack abs). Rather, your core is a system of muscles that work together for optimal function. Think of your core as a canister, including:

• Diaphragm – syncing and managing pressure from the top
• Transverse abdominis – deep corset muscles
• Pelvic floor – supporting your pelvic organs (uterus, bladder, and bowel)

When you inhale, your diaphragm naturally contracts allowing your lungs to fill with air. At the same time, your pelvic floor lowers or lengthens, and your belly relaxes.

On exhale, your diaphragm relaxes, pushing the air out of your lungs. In other parts of your core, your transverse abdominis contracts and your pelvic floor contracts and lifts. These are super gentle contractions that you may not even feel happening, but the system is important to be aware of when it comes to counter any tendencies that you may have and decrease symptoms in your athletic endeavors.

It looks like this:

Core, Pelvic Floor, and Athletic Performance

Maintaining an appropriate level of tension in the pelvic floor allows you to have the strength necessary to hold the pelvic organs in place while also allowing the relaxation necessary for urination and bowel movements.

That’s important both inside and outside of the gym.

While it may seem that you want a strong pelvic floor, it’s more important to have a coordinated system, one that’s responsive to the task at hand. Ex: deadlift, sneeze, or run. Too little strength, too much tension, or too much pressure generated in one area can lead to potential issues like incontinence, pelvic organ prolapse, or diastasis.

A Coordinated Pelvic Floor

You want awareness, not hyper awareness of your pelvic floor. When you’re hyper aware of your pelvic floor, as often happens after a prolapse diagnosis, with leaking, or during pregnancy, you’re more likely to try to hold everything tight, ending up with excess pelvic floor tension. Your pelvic floor can’t hold that much tension, especially when adding impact or load, likely leading to an increase in symptoms.

Once you have awareness of your system and tendencies, you can translate that into your lifts. 

Using Exercise to Help Your Core and Pelvic Floor Symptoms

Breath holding

Are you someone that holds their breath all the time, bearing down, or sending pressure to the midline? If so, how can we redistribute that pressure using your breath so it’s not concentrating in one spot?

Try breathing into your lats. That’s a cue that works well with athletes to get you to have full ribcage expansion at the start of your exercise which helps to prevent you from collapsing at the top of your core and bearing down into your pelvic floor.

Click here to watch this video.

You can also play around with exhaling either through the whole exercise or through the portion of exertion in a lift. By timing this exhale, you’re allowing your body’s natural system to take place where the pelvic floor slightly lifts on exhale. You’re not looking to have to do this with every rep of every exercise. The goal is to make it automatic so you’re not thinking about it forever.

Tension

Do you have a tendency to constantly suck in your abs, grip your glutes, or clench your jaw?  Tension isn’t isolated. Holding tension in your core, glutes, and jaw means tension in your pelvic floor too.

You’ll want to downtrain and lengthen the system in that case. That may look like reducing tension in your workout by not squeezing your glutes when you squat or at the top of a deadlift, not doing a kegel while you’re jump roping, or relaxing the belly in a run. 

What about coning and diastasis?

Coning along the midline of your belly doesn’t automatically mean diastasis.

A diastasis is a naturally occurring separation of the left and right side of the abdominal wall at the midline, linea alba. The tissue of the linea alba is designed to stretch during pregnancy. Sometimes it just stays a little more stretched out postpartum.

When looking at diastasis, you test for both the width and tension of the linea alba. If you have a slightly wider gap but are able to generate tension in the tissue, that’s not likely an area of concern. Likewise, if you see coning present and the coning is soft to the touch, that may not be as much of a concern.

If the area of coning is more firm to the touch, that may indicate excess pressure being pushed into the midline. Sometimes we can help to manage that pressure with form shifts or breathing pattern changes. Ex: if you have excess pressure into the midline with snatch, pullup, or overhead press, what happens if you bring your ribcage down a bit and not thrust out? The pressure is still there but it’s likely less.

This is also an area that you may need to play around with either more or less core engagement. That doesn’t mean an all out contraction. Instead, look for gentle 2/10 effort.

Your core and pelvic floor play an important functional role within your body. Understanding the core and pelvic floor basics and becoming aware of these tendencies, as well as learning how to manipulate pressure and tension, will help you be able to use this system for positive impacts in your athletic performance.

Want to learn more beyond core and pelvic floor basics? Join us for the FREE Workshop below to learn the strategies you need to prioritize your safety + performance while being mindful of your core + pelvic floor system.

More and more pregnant women are choosing to continue their athletic endeavors in the gym. These athletes deserve quality coaching and better guidance than the all or nothing approach that has permeated the prenatal fitness space of days past. As a coach, learning the how to of training pregnant women effectively is important in order to be able to help them navigate through this phase of their athleticism and help to set them up for a better return to fitness postpartum. 

1. “Listen to your body” isn’t the best advice.

Pregnancy can be such a confusing time for an athlete. You come from a place of understanding and knowing your body to one where your body is rapidly changing in ways that you may or may not have ever experienced before. When it comes to training pregnant women, telling them to just “listen to your body” can be hard for them to interpret.

Is it normal to have pain in a particular lift, leaking when running, and why does their pelvis feel like it’s on fire when they lunge? These are common concerns that your pregnant athletes may face. Instead of limiting them in their movements or giving generic “do what feels good” advice, you should be able to give your athlete modifications for load, volume, and exercise selection based on their needs and refer out to the appropriate professionals when needed. 

This free e-book covers the adjustments you can make in each trimester of pregnancy:

2. You can build muscle during pregnancy, but that’s not the goal.

PRs are possible during pregnancy, but you shouldn’t be chasing them. Just because something isn’t “heavy” for your athlete doesn’t mean it’s not heavy for their pelvic floor. For training pregnant women, it’s important to take the natural increased load and pressure on their pelvic floor into consideration when making weight and exercise selections.

Instead of trying to build strength or train for birth, pregnancy should be a time for maintaining strength and preparing your athlete for a better return to exercise postpartum. Pregnancy is also an ideal time to work on technique which can help make for better athletic performance. Working on mobility, accessory drills, unilateral training, and slowing down the tempo can all help to maintain strength during pregnancy and improve your technique for postpartum.

3. Know your pregnant athlete’s tendencies for their core and pelvic floor

You know the importance of form and movement for the knees, hips, and shoulders, but do you know about the importance of the core and pelvic floor for your pregnant athlete?

During pregnancy, it’s not just about modifying ab or impact exercises, although that’s a great start. How your athlete is moving is oftentimes more important than what movement they’re choosing to do. In order to understand how your athlete is moving, you need to assess your athlete’s tendencies for tension, pressure, and position within movement. 

You need to understand how much tension your athlete generates normally, plus how much they generate in their lifts. Ex: Do they constantly grip their glutes, clench their jaw, or suck in their abs throughout the day? Do they then squeeze their glutes at the top of a deadlift or maintain a kegel while jumping?

How your athlete manages intra abdominal pressure is also important. Are they breath holding, pushing out into their midline, or bearing down into their pelvic floor? By paying attention to these tendencies, you can give your athlete alternate strategies to help them reduce pressure. One of the easiest ways to help reduce intra abdominal pressure is through breathing strategies like “breathing into your lats” or “exhaling through the movement or on exertion.”

Proper breathing and bracing, pressure reduction, small form shifts, and reducing tension on the midline and pelvic floor will have the greatest impact on your athlete’s core and pelvic floor and help them to reduce their risk of incontinence, pelvic organ prolapse, and diastasis recti.

Watch this video on bracing here.

4. Weighing risk vs reward for the developing fetus isn’t enough. We need to think long term for the pregnant athlete as well.

Whether you realize it or not, you’re weighing risk vs reward on a regular basis. This is especially true in regards to training during pregnancy. Many guidelines weigh the risk of the developing fetus vs the training methods, which is absolutely important but not the only thing you should consider.

Your pregnant athlete is important too. Their core and pelvic floor, their ability to reduce their risk for disorders, and their long term athleticism and training goals are also very important factors to consider when weighing risk.

In order to appropriately weigh risk vs reward with movement, your athlete first needs to be educated on potential impacts in an informative, not judgemental, way. Only then can they decide if a movement or training method is worth it for them to continue during their pregnancy or if a pause for a few months might be more beneficial long term.

It’s not always black and white. It’s also not always do or don’t do. There are a vast variety of movement modifications and pressure management strategies you can do to help your athlete reduce their risk without removing a movement completely.

More and more women define themselves as athletes and continue to pursue fitness as they expand their families. There is a huge need for coaches who understand training pregnant women. Learn how to coach your client to maintain strength, protect their core and pelvic floor, and return to exercise postpartum in our FREE mini course – an Introduction to Coaching Pregnant and Postpartum Athletes.

When you’ve been diagnosed with pelvic organ prolapse, it can be so easy to fall down a rabbit hole of worry that you can’t exercise with a prolapse. You may see advice that warns you from squatting, running, or high intensity workouts like CrossFit, but that doesn’t have to be the case.

Just because you’ve been diagnosed with prolapse or are experiencing prolapse symptoms doesn’t mean you can’t return to doing the activities that you once loved. Keep reading below for tips on how to continue exercising with prolapse and how to help reduce symptoms with exercise.

What is pelvic organ prolapse?

Pelvic organ prolapse occurs when one or more of the pelvic organs descends or collapses into the vaginal canal. The type of prolapse is named after the pelvic organ that is descending. The most common types of pelvic organ prolapse are: Cystocele (bladder), Rectocele (rectum), and Uterine (uterus).

The presence of pelvic floor symptoms is not correlated with the severity of the prolapse. You can experience valid symptoms with a grade I pelvic organ prolapse. You can also experience no change or reversal of grade yet experience a relief or reversal of symptoms. 

Is it OK to exercise with a prolapse?

Yes! Exercising is not only safe to do when you have pelvic organ prolapse, but it can also help you in your pelvic floor recovery. While there are no movements inherently off limits when you have prolapse, there are adjustments that you may need to make in order to reduce your risk of increasing your symptoms.

The following 3 tips can help to make your exercises pelvic floor-safe:

1. Avoid straining and bearing down into your pelvic floor.

While some downward pressure into the pelvic floor is normal, excess pressure or bearing down into the pelvic floor muscles can lead to an increase in prolapse symptoms.

One way to help avoid bearing down into your pelvic floor muscles when you lift is to ensure that you are bracing in a way that equally spreads intraabdominal pressure instead of concentrating pressure downward.

Try breathing into your lats. You’re more likely to get a full ribcage expansion at the start of your brace which helps to prevent you from collapsing at the top of your core and bearing down into your pelvic floor.

Not sure if you’re bearing down when you brace? A movement assessment with a coach or an internal pelvic floor assessment with a pelvic floor physical therapist can help you to determine this.

Bonus tip: Make sure you’re being assessed in the lift position (ex: squatting) and not just lying on your back.

Another way to help reduce bearing down into your pelvic floor is through breathing pattern adjustments.

 Try exhaling either through the whole exercise or through the portion of exertion in a lift. By timing this exhale, you’re allowing your body’s natural system to take place where the pelvic floor slightly lifts on exhale.

You don’t have to breathe this way forever. The goal is to practice when needed until your tendency shifts away from bearing down into your pelvic floor.

2. Reduce pelvic floor tension.

When you’re scared that your pelvic floor muscles aren’t supporting you the way they should be, it’s very easy to either consciously or subconsciously want to try to hold everything in by engaging your pelvic floor muscles.

But constantly engaging your pelvic floor muscles, ex: doing a kegel with every rep, holding a kegel while you run, or engaging throughout the day doesn’t allow your pelvic floor to perform optimally. This may actually increase your pelvic floor symptoms.

Your pelvic floor needs both contraction and relaxation. When you’re holding a pelvic floor contraction longer than needed, the pelvic floor muscles tend to become fatigued and unable to rebound as quickly or support with higher loads like they should be.

Instead of holding a pelvic floor contraction, try only contracting when necessary and having the effort of your pelvic floor contraction match the effort of your activity.

For example, carrying your laundry, deadlifting a 35lb kettlebell, and a 250lb barbell deadlift aren’t going to need the same level of bracing or contraction. 

3. Form isn’t everything, but it can matter when you exercise with a prolapse.

You don’t need to try to stay in an “optimal” form pattern with all of your movements. That’s not the way we are made to move through daily life. But if your pelvic organ prolapse symptoms are increasing with certain movements, a form shift may help to reduce your pelvic floor symptoms.

For example, if your lifting form or limitations in ankle or thoracic spine mobility have you leaning more forward in a squat, you may have increased pelvic floor pressure with that movement.

By taking a more stacked position with your ribcage over your pelvis, you’re more likely to reduce downward pressure into your pelvic floor and help to reduce your pelvic organ prolapse symptoms with that movement.

You don’t have to give up the fitness and active life that you love – you can exercise with a prolapse! By avoiding bearing down into your pelvic floor, reducing tension, and making small form adjustments, you can help to reduce your pelvic organ prolapse symptoms and return to the workouts that you enjoy.

Want to learn more about your pelvic floor symptoms and exercise? Join us for a FREE workshop to learn the strategies you need to prioritize your safety + performance while being mindful of your core + pelvic floor system.

Pelvic floor pain during pregnancy may seem like a normal thing, but there are exercises and lifestyle tips to help you manage that pain. It’s not something you just have to live with!

Let’s take a look at some of the more common types of pelvic floor pain you may experience during pregnancy and what you can do to help manage it.

Is pelvic floor pain normal?

As your pregnancy progresses, pressure from the growing baby and growing belly puts extra strain on the pelvic floor and pubic bone. That extra pressure is a normal part of pregnancy.

However, just because excess pressure on the pelvic floor is normal, doesn’t mean pain needs to be normalized.You can have pressure without pain. You can also find ways to help reduce pressure down into your pelvic floor during your workouts.

If you’re experiencing pelvic pain during pregnancy, the first step is to check in with your medical provider. A pelvic floor physical therapist or occupational therapist is also recommended.

Pelvic floor therapy during pregnancy can help to greatly reduce pain caused by multiple factors as well as help to prepare your pelvic floor for delivery.

What causes pelvic floor pain?

There are numerous possible causes for pelvic floor pain during pregnancy. Let’s look at the 3 most common:

Symphysis Pubis Dysfunction

There’s a space between the right and left side of your pubic bones at the bottom. This is called the pubic symphysis.

During pregnancy, you can sometimes have more than normal movement at this space creating pain with movement, especially single leg movement. Many people describe this pain as a sharp stabbing pain in the crotch earning symphysis pubis dysfunction the nickname “lightning crotch”.

Pelvic Floor Tension

It may seem like you want to maintain a tight pelvic floor, but pelvic floor tension can actually contribute to pelvic floor pain. Instead of doing a high volume of kegels or subconsciously holding tension in your pelvic floor throughout the day, aim for a coordinated pelvic floor – one that contracts when needed and relaxes as well.

Sacroiliac Joint Pain

The sacroiliac joint is where the hip bone meets the sacrum. Pain here can feel like a sharp pain in the back of the pelvis and may or may not travel down the thigh. 

What can I do to help?

Lifestyle Adjustments

Here are simple lifestyle adjustments that you can make to help manage pelvic pain during pregnancy:

• Wear supportive shoes with little to no heal
• Sit down when putting on pants
• Keep both legs together when getting in and out of a car or bed
• Sleep with a pregnancy pillow or a pillow between your knees
• Wear a support belt or undergarments
• Stop sucking in your belly, clenching your glutes, and tensing your pelvic floor throughout the day
• Reduce stress

Exercises to Help Pelvic Floor Pain During Pregnancy

Strengthening your core and glutes and practicing pelvic floor relaxation can be a great place to start to help manage pelvic floor pain in pregnancy.

Glutes

While you may feel more comfortable reducing single leg exercises if you’re experiencing certain types of pelvic pain during pregnancy, you can still strengthen your glutes to help support your pelvis.

• Side Lying Hip Abduction
  Using a ball with this side lying hip abduction helps to give compression around the pelvis while also strengthening through a full range of motion

Core

You want to focus on the deep core muscles when navigating pelvic pain. Try this exercise:

• Kneeling Hip Thrust with Banded Pull Down
  Take a big 360 degree inhale then exhale just before you start to thrust. Continue your exhale as you complete the thrust and band pull. As you exhale, gently contract your transverse abdominis muscles.

Pelvic Floor Relaxation

Visualization can be really helpful when trying to focus on relaxing the pelvic floor. Try this exercise below:

• Supported Child’s Pose
  Take a big diaphragmatic inhale to lengthen the muscles of the pelvic floor. Then slowly exhale as you let some of that tension within your body go.

Note – You’re not bearing down into the pelvic floor here. Instead, you’re allowing your pelvic floor to naturally expand as your diaphragm lowers. Can’t focus on your pelvic floor? Focus on relaxing your glutes here instead.

You don’t have to put up with pelvic pain as a normal part of pregnancy. These lifestyle factors and exercises can help you manage pelvic pain during your pregnancy and beyond.

Want to learn more ways to navigate symptoms that occur during pregnancy?
Learn how to continue the workouts you love during pregnancy while keeping your body and baby safe with our free guide: How to Adjust Exercise in Pregnancy.