Stop doing crunches if you want to flatten your stomach!

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That’s right.  Stop doing crunches if you want to flatten your stomach!

Sounds a little crazy, but it’s true!  

If you’ve already read the 5 Dos and Don’ts, then you know crunches are the LAST thing you want to do for your “baby pooch.”

Sounds counterintuitive, right?

Let me explain.  If you’re dealing with ab separation, you need to encourage your muscles to come in and up.  When you do crunches, you’re pushing your muscles down and out– the opposite of a flattening effect!

The problem is, if you hire a personal trainer to help you tighten your tummy, I can almost guarantee they won’t know the proper procedures for Diastasis Recti (DR).  Most people simply aren’t educated about it.  What’s more, you need to take a slow, gentle approach because your body is still healing.  

You wouldn’t hit it hard in the gym right after surgery because you need to allow your body time to heal.  Well, you’re still healing from having your baby, so be careful and gentle with your body.  If you choose to work with a trainer, make sure they are qualified to deal with DR.

If you want to start the healing process safely and naturally with a qualified expert, I’m happy to tell you about my new program called In And Up!

In And Up is specifically designed to guide you through the process of healing your Diastasis Recti at home. No surgery. No gym time.

This six-week online program will give you the guidance you need to heal, and I’ll be with you every step of the way through our private Facebook group! Click below for more info and to register.

Join me for the next round of in and up!

Registration will close soon, so don’t miss out on this opportunity!

Pelvic Floor Health and Why So Many Adults Pee Our Pants

Am I really writing one of my last blog posts of 2017 about urinary incontinence? Yes, I am!

I was at CVS the other day, and happened to run through the underwear protection aisle (I lump all pad products, whether they be for menstrual blood or urine, together as underwear protection). Since my hysterectomy 21 years ago, I haven't needed to frequent that aisle, so I hadn't quite noticed the proliferation of new products geared to adults with urinary incontinence.

I mean, there were more products of the adult diaper variety than of the maxi pad variety.

Or, to be perfectly blunt, more adults are accidentally peeing their pants now then they were 20 years ago. And that should be of concern.

I. Your Pelvic Floor Is Part of Your Core

With all the discussions of core strength and debates over bracing vs. scooping in the fitness and Pilates worlds, you would think that all trainers are intimately acquainted with the basic structure of the "core". You would be wrong!

And with all of the adult diaper-type pads and pull-ups, you would think that people would be concerned that their pelvic floors are clearly not working. But no, we seem to just accept it and add more products to our weekly pharmacy spend.

II. Not All Core Exercises or Programs Are Good for Your Pelvic Floor

There is the rub! If you bear down too much doing any exercise, including ab work, you will be straining your pelvic floor muscles, not strengthening them. This includes sit ups, planks, and bridges, as well as yoga and Pilates exercises.

And heavy weight training, CrossFit or Olympic-style, almost always causes pelvic floor strain from inhaling and bearing down. Peeing while lifting, in some circles, is actually considered a badge of honor. 

III. Having A Baby Weakens Your Pelvic Floor

Why, oh why will obstetricians not discuss this? Even a perfectly healthy and easy vaginal birth will affect your pelvic floor, and a more difficult birth or very heavy baby will mess with you even with a cesarean.

But if you are still leaking urine a year later, that is a problem. Proper breathing and engagement of the pelvic floor in specific exercises will help. My In and Up! diastasis recti program is also great for Pelvic Floor strengthening independent of DR. 

A Final Note on Urinary Incontinence...

Peeing your pants is really not OK for grownups who are otherwise healthy. It really isn't! While Kegels are always useful, it also importance to work your pelvic floor while moving in varied positions, so you can learn to hold it in when you sneeze, run, pick up something heavy (including a child), and stand up. You ultimately need to work supine, prone, on your sides, sitting, and standing to increase functional pelvic floor strength.

Click here for more on breathing and your core.

Click here for more about Diastasis Recti, pelvic floor, and Pilates.

If you find yourself spending extra money on pads and special underwear to absorb leaking urine, I invite you to try my In and Up! program. Whether or not you have a diastasis, it will help!

The next round starts January 22. I would love to see you there!

Pilates for Hernia and Diastasis Recti Workshop

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Pilates for Hernia and Diastasis Recti Workshop for Teachers - Sunday, July 10, 2016 1-4pm at Real Pilates Soho

Training clients with hernia and diastasis recti requires a small shift in thinking and approach for many Pilates teachers. It is crucial at the beginning that these clients avoid increases in intra-abdominal pressure (IAP), yet almost all beginning Pilates exercises involve working with just that.
This is a really fun and useful workshop!

Register for Pilates for Hernia and Diastasis Recti Workshop – July 10, 2016

From the Last Workshop

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What is a Hernia?

According to the NIH,

A hernia is a sac formed by the lining of the abdominal cavity (peritoneum). The sac comes through a hole or weak area in the strong layer of the belly wall that surrounds the muscle. This layer is called the fascia.

Basically, a hernia is an area where the intestines start to protrude through a weak area in the abdominal wall. Hernias are named for location (inguinal – groin, umbilical – belly button, hiatal – upper abdomen, femoral – upper thigh).

Hernias are caused by straining while abdominal pressure is increased – it can happen on the toilet, opening a window, or even lifting weights and/or doing abdominal exercises incorrectly.

What is Diastasis Recti?

Diastasis Recti as defined by the NIH:

Diastasis recti is a separation between the left and right side of the rectus abdominis muscle, which covers the front surface of the belly area.

Most diastasis recti is seen in pregnant women, where the muscle separates as the woman’s belly expands, but I have also seen it in men, and is also present in some infants.

Pilates Can Help IF It Is Taught Correctly

Luckily, it is easy to modify exercises and cue your clients to work in a way that helps.
In this workshop, I will share the successful modifications and techniques that have made me lower Manhattan’s most sought out classical Pilates specialist for people with diastasis recti and hernia. This 3 hour workshop includes anatomy, lecture, and practice on mat and apparatus.
You will leave with many, many tools to help your clients literally pull themselves together!
*You must be a Comprehensively trained Pilates instructor to register for this workshop.
Cost: $150 without PMA CECs / $180 with 3 PMA
httpv://youtu.be/X1aD2nHECzM

Breathing

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Breathing in Pilates and everywhere else is crucial on many levels. Proper breathing helps everything!

Breathing comes up a lot in the Pilates studio. In fact, one of the first exercises we teach new clients is the Hundred, which involves a whole lot of breathing in flexion.

Yesterday I taught a workshop on Teaching Clients with Hernia and Diastasis Recti to a group of wonderfully talented and bright Pilates teachers (thank you Enja, Juan, Andy, Charlotte, Margaret, and Tricia!). When you are dealing with overstretched or torn abdominal muscles, the interplay of breathing, thorax pressure, and intra-abdominal pressure (IAP) becomes very important.

Here is the science behind how we approach breathing in Pilates, and why we inhale to start many Pilates exercises.

(featured image from Siyavula Education on Flickr)

Basic Breathing Mechanics

Breathing is necessary to bring fresh oxygen into our bloodstreams via the lungs. Our lungs are very lightweight, flexible, and porous, like a sponge. My dog loves to eat dried beef lung as a treat, and it is spongy in texture.

Air moves from high pressure to low pressure. The thorax is set up as a pressurized container. The lungs sit inside the ribs, which are jointed to move and have flexible intercostal muscles in between that allow for expansion and contraction. At the bottom of the thorax is the diaphragm muscle, which also helps regulate the pressure of the thorax by allowing for expansion of volume.

When you inhale, the diaphragm and intercostals contract and expand the thorax. This expansion of volume lowers the pressure in the chest cavity below the outside air pressure, allowing air to flow in through the airways (from high pressure to low pressure) and inflates the lungs.

When you exhale, the diaphragm and intercostals relax, the thorax gets smaller, and the decrease in volume of the cavity increases the pressure in the chest cavity above the outside air pressure. Air from the lungs (high pressure) then flows out of the airways to the outside air (low pressure).

Does Breathing Effect Abdominal Pressure?

Now, below the diaphragm is your abdominal cavity, which houses a majority of our crucial internal organs. The sides of the abdominal container are made up of several layers of abdominal muscles, starting at the deepest layer with the transverse abdominus that wraps from your lumbar spine all the way to the front, continuing with the internal and external obliques that wrap around, and finishing with the six-pack, the rectus abdominus that attaches your breastbone to your pubic bones. All of these muscles meet at the linea alba, the line down the center of your abdomen. The bottom of this abdominal container is the pelvic floor, made up of several muscles that work, in part, to hold up our internal organs, control our sphincters, and keep us continent.

In a basic view of breathing, it would seem obvious that inhaling, while lowering thorax pressure, would increase intra-abdominal pressure as the diaphragm drops down. This would totally be the case if we weren't able to use our muscles, expanding our abdominal cavities and lowering our pelvic floors at the same time. It turns out that in normal, resting, supine breathing there is actually very little increase in IAP with inhalation. In fact, the increase in IAP comes during maximum voluntary breathing (like breathing in exercise, or any conscious breath work) at the moment that we start to exhale. Makes sense, right? That is the point where we need to use pressure to push out the air.

Maximum voluntary breathing was associated with marked changes in intra-gastric pressure which rose abruptly at the beginning of expiration and fell abruptly at the beginning of inspiration.

[Campbell, E. J. M., Green, J. H., (1953), The variations in intra-abdominal pressure and the activity of the abdominal muscles during breathing; a study in man. The Journal of Physiology, 122 doi: 10.1113/jphysiol.1953.sp004999.]

What About those Hundreds?

Position also has an effect on IAP. Flexion increases IAP by impeding the ability of the abdominal wall to lengthen, overhead pressing increases IAP, moving limbs increases IAP, and lifting heavy objects increases IAP.

Looking at flexion, much of the basic and beginner healthy-body Pilates exercises involve flexion (hundred, half roll or roll up, rolling like a ball, spine stretch, etc.) and pulling navel to spine. So we place a healthy body into a position of increased IAP and then ask that body to navigate breathing and moving of limbs. In a healthy body this is useful work.

In a body that has weakness in the abdominal wall, asking for deep respiration while in flexion and moving limbs is almost impossible and frustrating for the clients, since they cannot properly expand and contract the area to build up pressure for the exhale - that is when you see the doming or popping up of the internal organs.

What exercises are safe and useful? Exercises that focus on deep breathing and stability.

Breathing in Pilates

Many exercises in Pilates start with an inhale or use an inhale to prepare - we inhale to press out for footwork or down for pumping, we inhale out on short box, inhale to start our backstroke, stomach massage, our neck pull....

This should make more sense now, since the moment of the most intense work and pressure in the abdominal cavity is at the beginning of the exhale. Joe Pilates has us inhaling until we are the point where we need maximum effort to get back, and that is where we utilize that pressure of the exhale! Brilliant!

Learn more about my In and Up Diastasis Repair program here.

Pilates after Hernia Repair

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Pilates after hernia repair offers a crucial piece of the exercise puzzle - pelvic floor and deep abdominal support!

Lately I have received several requests for exercise suggestions to help either repair small existing inguinal hernias, or assist in maintaining a hernia repair after surgery.

First of all, what is a hernia?

According to the NIH,

A hernia is a sac formed by the lining of the abdominal cavity (peritoneum). The sac comes through a hole or weak area in the strong layer of the belly wall that surrounds the muscle. This layer is called the fascia.

Basically, a hernia is an area where the intestines start to protrude through a weak area in the abdominal wall. Hernias are named for location (inguinal - groin, umbilical - belly button, hiatal - upper abdomen, femoral - upper thigh).

Hernias are caused by straining while abdominal pressure is increased - it can happen on the toilet, opening a window, or even lifting weights and/or doing abdominal exercises incorrectly.

Yes, you read that correctly. Poorly executed exercise can cause hernias and make existing ones worse.

However, correctly done exercise can help heal a hernia, especially after repair.

Exercise recommendations for pilates after hernia repair are similar to those for diastasis recti.

Once you have been cleared by your physician to exercise, it is important to avoid straining while increasing abdominal pressure. This requires careful monitoring of breathing patterns while moving and exercising.

At the beginning you should avoid most traditional abdominal exercises, such as crunches. You should also avoid overhead presses.

Focus on exercises that help engage your pelvic floor muscles, diaphragm, and deep abdominals.

Breathing correctly is the first challenge.

Listen to the first breathing exercise in my back pain video. This is the basis for moving correctly in any exercise.