03 Jul Abdominal Separation: Is Your Exercise Form To Blame?
NOTE: if you are interested in diving deep into providing top quality health & fitness care for postpartum women, PLEASE check out Dr Sarah Ellis Duvall’s course POST-PARTUM CORRECTIVE EXERCISE SPECIALIST!
You’ve heard the saying, “there’s a right way and a wrong way,” well that applies to exercise almost more than anything else. Working out hard is awesome, but pushing before you have basic movement patterns down can leave you worse than before you started.
So, what’s the deal with difficult exercise, hernias and abdominal separation (DR- diastasis recti)? Let’s look at 2 case studies to shed a little light on the topic.
A DR is where the front connection of your abs starts to thin. This thinning causes a gap to develop in the middle of your abdominals where they connect. When you lift your head and check for a DR it should feel like a trampoline, springy. When you have a DR, your fingers will sink in. This lack of connection in the front makes it difficult for the body to transfer energy and effort through your core. Basically, it makes for ineffective core firing. When pressure is increased during ineffective core firing, this can increase your risk of a hernia.
For more information on how to check yourself for a diastasis visit: http://www.coreexercisesolutions.com/diastasis-fix/
I’ve had both men and women in my office for these abdominal issues, often after cross fit or some other High intensity (HIIT) exercise program. The way you go about doing the exercise matters, and I’d like to share the stories of Jane (postpartum) and John (getting back in shape) with you. They both ended up with a DR and a hernia after crossfit.
Rite: To decrease injury risk, all sports, including crossfit, need great coaching to ensure perfect execution. I’m not putting down any style or particular exercise in this article. I’m only raising a voice for self awareness and higher coaching standards.
#1. Jane: Diagnosis – Abdominal Separation (DR) and Linea Alba Hernia
Jane had an awesome pregnancy by all accounts. She stayed in great shape working out up till her due date, decreasing her training load smartly. She followed all the rules. Waited 6 weeks, got the all clear and then started back into training at an easier level than she left off. Unfortunately, her abs and movement patterns had not fully recovered. Jane went back to pull ups, squats, and planks but didn’t get her breathing system and deep core on board to ensure correct loading.
When Jane would do a kipping pull up, she would load the front of her abs. Instead of her abs connecting, they would bulge in the middle. Overtime this loading and continual pressure increase took a toll and a hernia started to form.
This is Jane in the middle of a kipping pull up. (Screenshot taken from a video.) Do you see how her abs bulge in an up and down line in the middle? That’s a hernia.
When you do a pull up of any kind, your abs should knit together, not bulge in the front.
This is a screenshot taken from a video of me doing a pull up 6 months pregnant. I’ve got an extra 15lbs around the middle. So, by all accounts, my belly should be bulging. As you can see when I pull up, my abs knit together, preventing a DR and hernia.
(I quit doing pull-ups around 7months because my belly got so large that I was no longer loading correctly. I started feeling my abs want to “pull apart” instead of knit together and I didn’t want to create a large abdominal separation. Continuing to do pull ups was just not worth it. The same smart training goes for all core intensive exercises when you’re pregnant, including planks. Prevention is truly the best medicine!).
Hernias and DRs have to do with how your core handles pressure. Do you push out, weakening one part of the system? Or do you handle the pressure equally, throughout the entire system?
Back to Jane. Jane is in the process of making a complete recovery. Her hernia no longer bulges and her DR is completely closed. We started small. Having her do an assisted pull up where she could focus completely on what her core was doing. Then worked to an unassisted, then finally back to kipping. Alongside that, we worked on how she loaded her planks and squats. We started by getting her to plank on a high surface and feel (with her hand) what the front of her abs were doing. Then she went through some deep breathing drills until she felt her abs knit together. Last step was to progressively get lower and lower until she was planking on the floor with no bulging.
Sometimes in training, we have to take a few steps back to move forward safely. Jane did that, and she regained complete control of her core and found complete healing of her hernia and DR without needing any surgery.
When thinking about core loading, pull ups and front planks come to mind, but squats are another big core movement to consider. Jane’s core responded the same way under a barbell as it did during a pull up. Her abs bulged, ribs flared,and her back took over.
Take some time to video yourself. Check out your planks without a shirt on. Do your abs bulge or do they tighten? Do the same thing for pull ups and squats. The simple fix of stepping back and learning the correct way to load your core can prevent years of heartache and potential surgery down the road. Which brings us to John.
#2. John: Diagnosis Muscle Strain in Rectus Abdominis (6-Pack muscle) and Inguinal Hernia
John had a desk job and took a few years off from working out. If we’re being honest, he was more of a runner than a weight lifter to begin with, but decided that this time he would try crossfit to get in shape.
During the first week, John did too many knee raises trying to get his abs back, and strained his rectus at the bottom where it attaches to the pelvis. It could have been a simple strain from overdoing it, but instead of contracting his core evenly, fully supporting with the TAs and Internal Obliques, he primarily used his rectus (much like Jane in the above kipping picture). Which means for every knee lift he pushed out on his abdominal wall, held his breath instead of breathing through each lift and created tremendous amounts of pressure. This led to a hernia. Simple fix right? Well, his story doesn’t end like Jane’s. A surgeon went in to repair the muscle tear and hernia. The surgery failed. A nerve got entangled in the mesh and scar tissue and 3 surgeons and a year later he is still in agonizing pain. Forget exercise, he is trying to function in life. John is now very involved with his rehab, learning and trying to get his body to fire the right way. Hopefully soon, he will be out of pain and back to exercise! That’s a hard road to take from one poorly executed exercise session, and I know he would give anything to have prevented it.
Takeaways from these 2 case studies:
#1. Be mindful. Take the time to learn and make sure you are loading correcting. It can be the difference between suffering from hernias and diastasis to preventing them.
#2. Don’t overdo. Have patience with getting back in shape and make sure you build a proper base first. You have the rest of your life to workout if you play it smart, rushing is simply not worth it.
#3. Ask your coach/trainer what they know about hernias and DRs. Doesn’t matter if you’re male, female or postpartum. Ask them to check you and make sure you’re loading correctly. It’s an important step in the training process.
#4. Prevention is always the best medicine, but if you do end up needing surgery, make sure you thoroughly vet the surgeon and get the opinion of 3 great PTs first. (The PTs can also tell you who the best surgeons are on top of helping you find a nonsurgical recovery strategy.) John’s a rare case, but these things happen. The extra effort is worth it because no surgery is routine, and all come with a risk of lifelong complications.
About The Author:
Dr. Sarah Ellis Duvall, PT, DPT, CPT, CNC
A wife, mom and adventure sports athlete, Dr. Sarah is a women’s health specialist that believes in teaching. Helping women understand how the body works is the basis for her results-driven online program. She focuses on issues from the pelvic floor and diastasis to building strength injury free. When she is not hanging off the side of a mountain, Sarah enjoys writing and presenting at Core Exercise Solutions and figuring out how her patients can continue to pursue their dreams and lead a strong, adventurous life.
Find out more about her Pelvic Floor and Diastasis Programs here: http://www.CoreExerciseSolutions.com