Restore Your Core: Diastasis Recti and Pelvic Floor Talks

Pelvic Floor Stretches

Persistent pelvic floor pain can be difficult to endure. Pelvic floor dysfunction issues can range between hyperactivity to pelvic organ prolapse. The result of both cases can lead to painful and embarrassing symptoms for both men and women. In this article, I will address helpful exercises and stretches that help free you of painful symptoms and aid in restoring pelvic floor and core function. To be clear, stretching is just one type of input into the pelvic floor system and is not the only thing you should do for a tight / tense pelvic floor. Downtraining your pelvic floor will require a variety of loads and inputs, stretching is one important one.

How to Stretch Pelvic Muscles

There are several ways you can properly stretch and engage your pelvic floor in order to reduce pelvic floor tension . One of the most beneficial and important techniques that I teach my clients is 3-D breathing – a pattern of breathing that uses the rib cage expansion rather than belly expansion for an effective and efficient strategy.

One of the key elements in resolving pelvic floor dysfunction and POP is breathing mechanics. In Restore Your Core, I spend a significant amount of time teaching my clients proper breathing mechanics. Often people don’t realize the way they breathe impacts the integrity of their core and pelvic floor. Yet, most of us do not even realize easily we can fall into improper breathing patterns.

Most people are belly breathers. This means that while inhaling, they’re extending their abdomen – focusing the tension in their belly. An Illustration of this would look like filling an oval-shaped balloon with water and squeezing the top creating a bulge. The exact same thing happens when you belly breathe. Bulging your gut strains your core and pelvic floor by increasing intra-abdominal pressure. This tends to cause muscle and organ damage in those regions. Our pelvic floor is not designed to handle a lot of consistent pressure and stress.

I spend a lot of my time with clients training them to 3-D breathe. 3-D breathing trains you to engage your diaphragm and rib cage while breathing. This means that instead of your belly extending as you inhale, your rib cage expands. Breathing in this manner reduces pressure in your core and pelvic region. Additionally, this technique encourages proper core response and engagement in your daily activities. Now that you understand proper breathing mechanics, it is time to learn how to properly stretch and exercise your core and pelvic floor.

Stretches for the Pelvic Floor:

Supine Pelvic Floor Stretch

Lying on your back, keep your knees bent and bring them toward your chest. Slowly extend your knees to the side to stretch the inner groin. Relax your pelvic floor and butt. Remain in this position for 5 to 10 breaths and relax.

Symphysis Pubis Dysfunction (SPD) happens when the ligaments that keep your pubic bone and pelvis stable become overstretched and no longer stabilize your pelvis. Essentially, a structure that is designed to move very little begins to move a lot, and it can be very painful and difficult to move with ease. SPD is a condition that sometimes arises during pregnancy, though it can also first occur during labor and birth or in the postpartum period. Pelvic girdle pain in general is quite common during pregnancy—between 48% and 71% of women report feeling significant pelvic discomfort. About 30% of women report that the area of the pubic symphysis is painful. While SPD does involve the pelvis and the integrity of the pelvic floor muscles, a general pelvic floor dysfunction treatment like kegels is often not the answer to symphysis pubis dysfunction.

Where is the Symphysis Pubis Located?

The pubic symphysis is a cartilage joint that resides in between the pubic bones: above the genitals and in front of the bladder. In most cases, the joint can rotate and move a few millimeters without causing any issues.

What are the Symptoms of Symphysis Pubis?

The symptoms of SPD can vary for different people, both in terms of severity and presentation. The most commonly experienced symptoms are:

The symptoms will vary from person to person – both in severity and in presentation. However, if you’re concerned that you have pubic symphysis dysfunction, these symptoms may be present:

• Pain in the pelvis in general, and specifically in the groin and inner thighs; pain moving around into the buttocks
• Clicking sounds in the pelvis
• Pain while sleeping
• Activities like getting out of bed, in and out of cars, stepping up and down from steep stairs, really, any position that widens the legs can be very painful

What Causes Symphysis Pubis Dysfunction

Symphysis pubis dysfunction is most often pregnancy related. However, the factors that predispose people to SPD are quite varied. The medical literature on symphysis pubis pain seems to agree that the hormone relaxin is not entirely to blame. Factors as different as hypermobility, bearing twins or other multiples, and a history of back pain can play a role in pubic symphysis pain during pregnancy. SPD usually resolves for most pregnant people after delivery, with most returning to normal function by 6-12 months postpartum. Rarely, some people find that SPD becomes a longer-term problem. Most people are able to have a vaginal birth even with symphysis pubis dysfunction—finding pain-free ranges of hip movement prior to labor can be helpful if such a delivery is in your birth plan.

What Causes Symphysis Pubis Pain?

Symphysis pubis dysfunction (SPD) and pelvic girdle pain occurs when the ligaments and joints that help support and align your pelvic bone become overly stretched or relaxed. This often leaves the pelvic joint unstable and can lead to various painful sensations, including pelvic pain. During pregnancy, it is common for these joints and ligaments to become stretched, especially as you are nearing the time for delivery. When the pubis symphysis becomes too loose too early in your pregnancy, you may begin to notice more pain in your pubic region.

Although the most common cause of symphysis pubis dysfunction is pregnancy, SPD is not entirely pregnancy related. In some cases, the cause of SPD is unknown.

It may be common to experience pain during pregnancy or postpartum in these areas:

• hips
• stomach
• pelvic floor
• pelvis

What Does Pubic Symphysis Pain Feel Like?

Discomfort and pelvic pain are usually the most common symptoms of symphysis pubis dysfunction. The pain is generally located in the front of the pelvis, above the genitals and pubic bone. In some cases, people report feeling a clicking or popping sensation as they walk or shift their weight. It is common for many men and women to experience the pain in their lower back, lower abdomen, hips, groin, and legs.

Hernias are relatively common and can affect many men, women, and children at any time in their life. Hernias may arise due to a variety of circumstances. A hernia occurs as a result of a weakening in the abdominal tissues and muscles. This may cause an organ or fatty tissues to slip through the small tear which may result in abdominal pain, other digestive issues, or even be asymptomatic, meaning, not present any symptoms initially.

Often a hernia occurs in between the chest and hips or lower abdomen. However, they may also appear in the upper thigh or even in your groin.

Most hernias are not immediately life-threatening. They typically do not resolve on their own and do require medical attention to diagnose and to treat. Unfortunately, there are times when surgery will be required in order to prevent any life-threatening side-effects.

Symptoms of a Hernia

One of the most common side-effects of a hernia is the presence of a slight lump at the site of pain or in the affected area. For example, inguinal hernias typically present a lump or bulge on either side of the pubic bone at the site where the groin and thigh meet.

It is more common to feel the bulge when you are standing, coughing, or bending over. Often, discomfort and pain will be felt at the site of the hernia. Depending on the type of hernia you have, the symptoms may vary. Some of the most common symptoms include:

• Bulge or lump in the groin, scrotum, or noticeable swelling in the scrotum.
• Pain or discomfort in the groin or abdomen that worsens if you bend over or lift anything
• A feeling of heaviness in the groin or abdomen
• Discomfort or pain during bowel movements or urination
• Abdominal pain, discomfort, or swelling at the end of the day, especially if you were standing most of the day.

In severe cases, a strangulated hernia (a hernia which cuts off the blood supply to the intestines and abdomen), may present symptoms of fever, vomiting, nausea, and severe cramping. If this is the case, you will need to seek immediate medical attention to prevent life-threatening complications.

In many cases, however, a hernia may never present any of the above symptoms. In many cases, a hernia is noticed during a routine medical evaluation or physical or during a check up for an unrelated issue.

What is Hernia Pain Like?

Hernia pain is often described as a mild discomfort, aching, or a sensation of fullness or pressure at the site of the hernia. This discomfort or pain may increase with activity, exercise, or any lifting that may place a strain on the abdomen (i.e. running, heavy lifting, or bearing down during bowel movements). Others may not feel any pain or discomfort for some time.

Does a Hernia Cause Stomach Pain?

In severe cases, the contents of the hernia may become twisted or trapped in the torn muscle in the abdominal wall. This can obstruct the bowels leading to severe stomach pain, nausea, vomiting, and may lead to the inability to have a bowel movement or flatulate. This is known as a hernia strangulation and cuts the blood flow to part of your intestines. As mentioned above, this can be a medical emergency and requires immediate attention. You should consult your doctor if you believe you have a hernia. They can provide medical advice, diagnosis, and look for a strangulation.

Pelvic floor exercise routines are often very diverse in information regarding the styles and methods you should pursue when seeking to build pelvic floor strength. Some exercise experts will advise pelvic floor muscle training and engagement that actively contracts both your core and your pelvic floor. Their reasoning may seem valid, as we commonly agree that engaging certain muscle groups can help strengthen them, as they contract and release. However, I believe that there is a lot to be desired with this method of exercising the pelvic floor.

In my programs, I always teach my clients how to properly train their pelvic floors to lift and release appropriately depending on the task and load.

When you contract your muscles, you either make them longer (think slow release of a bicep curl) or you make them shorter (as with a bicep curl). In each case, these muscles are contracting in order to gain strength. In pelvic floor exercises, such as kegel exercises, you are contracting (making them shorter) and tightening the pelvic floor muscles.

However, what many people may not realize is that with pelvic floor issues like pelvic floor dysfunction or pelvic organ prolapse, these muscle groups may already be too short, overly toned, and too strong. If this is the case, doing kegel exercises may only increase various symptoms you are already facing.

In order to properly strengthen the pelvic floor we need to train the pelvic floor to be responsive to load and movement. To contract as needed and to be able to release as needed. Simply blanket statements of “contract and shorten” all the time is a very one dimensional model.

How to Strengthen the Pelvic Floor

Many of my clients have come to me with the same issues mentioned above – overly short contracted pelvic floor that make engagement nearly impossible for them. Your pelvic floor helps support the entire pelvic system and much of your body’s weight – that is a ton of load! If your pelvic floor is too short, it makes movement, engagement, and pressure harder to handle. What we want to do is teach the client how to properly train their pelvic floor to handle their movements and respond appropriately to their actions, exercises, and movements. Kegel exercises which continue to shorten your pelvic floor are incapable of doing this. So, how do we do this correctly?

How to Do Pelvic Floor Exercises Correctly

The first step to improving the way we approach pelvic floor exercises is pelvic alignment. The position of our pelvis greatly affects the tone and strength of our pelvic floor. First, we must ensure that the client is not tucking their pelvis under all the time. If this is the case, the pelvic floor is too tight and will be harder to engage. Muscles cannot go through their full range when they are limited based on posture.

The second step is resolving any chronic tension, holding, and hypertonic patterns if there are any present. In this case, it may be helpful for the client to discuss internal exercises with a women’s health physical therapist. In my program, I would be teaching women and men how to properly re-pattern their movements. In some cases this involves kegel-like exercises, but do not focus primarily on squeezing and tightening the pelvic floor.

The next step would be pursuing neutral pelvic arrangement exercises.

Exercises to Re-Align the Pelvis:

Simply put, we don’t always need to squeeze or tighten the pelvic floor in order to resolve pelvic floor dysfunction or other additional pelvic floor issues. A responsive pelvic floor will lift up with proper core engagement when the pelvis is properly aligned and there is no chronic holding, tight, tension or hypertonic pattern. The passive lifting of the pelvic floor as a result of proper core recruitment is a much better way to train the pelvic floor. Not only that, but just squeezing the pelvic floor only gets to the more superficial fibers and not to the deeper layers of the muscles.

Core exercises and workouts help strengthen the muscles in your abdomen, back, and your pelvic floor. In many cases, working out core muscles may aid in your ability to do physical activities, restore damaged muscle groups, and aid in load and weight lifting. However, there are many fitness gurus and exercise routines that encourage unhelpful and potentially damaging core exercises.

One of the scenarios I run into many times with my clients is that they are encouraged to build core strength through navel to spine exercises. They are taught that in order to fully engage in fitness culture, they must try to achieve a flat belly or toned abs in order to be healthy. That cannot be any further from the truth.

This is the heart of what I teach in the Restore Your Core program: navel to spine does not work. Arbitrarily pulling our navel in, tightening the core to do exercise does not rewire, re-pattern, remind our bodies of what they need to do all day long. And if you are working out 1-2 hours a day and doing a lot of navel to spine but then the other 12 hours a day of waking time, your core is not reflexively doing its job – then those 2 hours on the mat are not useful.

In this article, we seek to address the proper way to pursue a strong core rather than doesn't sacrifice function for sexiness.

How Long Does it Take to Restore Your Core?

I wish I had an insta solution for addressing Diastasis Recti, but unfortunately, I do not. Getting a functional core is a process that involves many things including alignment, breathing mechanics and finally, the right way to train using exercise. The whole goal is to train your body to react and respond appropriately to your movements and activities. (Restore Your Core program is based on this approach.)

Effective Core Exercises & Training

• Ensure you are not a belly breather. Belly breathing causes a lot of intra abdominal pressure and that can lead to a diastasis recti and pelvic floor dysfunction.
• Work on your posture and body alignment as both compromise your core.
• Stop sucking in your belly all day because that does not work.

Here is an alternate way to practice core engagement that doesn’t suck, suck, suck your belly in and it actually works. Try it:

Come to your hands and knees. Ensure that your spine has neutral curves: lower back has a slight arch and upper back is slightly rounded. Booty untucked gently. Look between your hands and imagine you have a cake between them with 100 candles. Inhale and exhale to slowly blow all 100 candles out. You should feel your belly lift away from the floor and tighten. That is your deep core.

Do the same thing sitting. Sit comfortably with a neutral spine. Imagine now you are blowing out a dandelion. Slowly exhale and feel how your core responds. Amazingly, these simple exercises are key to effective core training.

The next step is to get more and more complicated with the exercises so that each time your body needs support of your core – that exhale will direct the support mechanism to engage. The more you do that, again and again, and the harder and more progressive the exercises – the more reflexive your core will be. Your reflexive core will kick in for you for all of your activities because your deep internal support system will be back online.