Core Stability after pregnancy Part III: The BEST exercise program to a strong start!

The best exercise program after labour and pregnancy, in my opinion, is none other than Pilates.

Why Pilates?

Pilates has 6 principles that guide us to the basics of good movements. In my journey of teaching and learning Pilates, I have gained insights of delivering the desired outcomes to my clients’ movements. We worked through the 'blind spots' in their bodies, and used the muscles that have been forgotten, or maladapted throughout pregnancy and the process of baby-care and breastfeeding. Re-gaining control and awareness of their bodies has given these women a head-start in their quest for a healthier and fitter lifestyle. As they say: “Life doesn’t come with a manual, it comes with a mother’.

The 6 Principles of Pilates are:

1. Breath

2. Axial Elongation and core control

3. Spine articulation

4. Organization of the head, neck, shoulders

5. Alignment and weight bearing of extremities

6. Movement integration

1. Breath

“The Breath is the first act of life and the last” “Above all else, Learn to breathe correctly” – Joseph Pilates.

Have you ever stopped to feel how you are breathing? When was the last time you took a liberating deep breath?

Which parts of your body are involved when you take a deep, or shallow breath? Do you find yourself stopping in your breath when you move or in deep concentration?

As mentioned in Part 2 of this series, the Diaphragm is an essential muscle involved in core stability. Because of the location of the muscle, it is often forgotten, and not used well. A good inhalation brings in a fresh supply of oxygen to our muscles, brain and heart, why not?

2. Axial Elongation & Core Control –

“Good posture can be successfully acquired only when the entire mechanism of the body is under perfect control. Graceful carriage follows as a matter of course.” – Joseph Pilates

As every mother knows, our feels and looks different after pregnancy and labour. Unlike what social media portrays, many mothers do not return to what they feel, much less what they look like, after they had their baby. The muscles that adapt through pregnancy, do not naturally return to their original state after the baby is born.

As the main caregiver, we get many musculoskeletal pains such as Mummy’s wrist/hand, lower and mid back pain, and incontinence. Axial elongation and core control puts the person in the most ideal posture she can be, to increase efficiency of movement.

3: Spine Articulation –

“If your spine is inflexibly stiff at 30, you are old; if it is completely flexible at 60, you are young” – Joseph Pilates

A flexible spine is able to distribute the forces more evenly throughout our body when we move.

4: Organization of the Head, Neck, and Shoulders –

How does the positioning of our head, neck and shoulders look before and after pregnancy?

Why does this matter?

Our head, neck and shoulders influences our awareness of the world. It is where we access to our senses; vision, hearing and touch. Having good alignment of our upper half of the body can portray our confidence, or when we slouch, make us feel and look less confident.

5: Alignment & Weight Bearing of the Extremities –

“Ideal alignment involves all body parts approximating toward the central axis, as much as structure permits.” – Eric Franklin

Our torso is the axis of the body, where the arms and legs executes what we desire to do. Our brain receives sensory input via our exploration of the world, through the hands and feet. We are able to explore the environment freely, if our senses make us feel safe, exactly as how our babies explore the world.

6: Movement Integration –

How does our body integrate movements of each body part during a desired task, such as lifting a baby?

It takes complex planning of our brain to instruct our skeletal structure to perform a task, and as yogi Vanda Scaravelli puts it, ”Movement is the song of the body”.

A Strong Foundation to a Strong Core

Regardless of the sport you wish to return to, Pilates serves a safe and sensible baseline of exercises for you to build a strong foundation to your activity.

The timeline of starting exercise will differ between a natural vaginal delivery, or a Caesarean section delivery.

The sequence of pregnancy also means a new routine needs to be established with every new family member in the house. The best time to start exercising is when you feel ready to do so. Consult your doctor or our dedicated physiotherapist prior to starting an exercise program, to check your readiness for exercise.

Dance with your bodies today, mamas.

Love, MummyPhysioSG

Core stability after pregnancy Part II: Where do I start with core stability after I had my baby?

In Part I of this series, we discussed about the 3 structures of the Coke can that represents the 3 dimensions of Core stability:

Coke Can Vs Human Core stability

Top Lid : Diaphragm

Cylindrical wall : Abdominal wall, back and spine

Base of can: Pelvic floor muscles and buttocks/hips

Today we will focus on the first and most forgotten structure: the Diaphragm

The diaphragm is a muscle that sits right under the rib cage, separating the abdominal organs from the lungs and heart. The main function of the diaphragm is to help us to breathe. When we breathe, the diaphragm descends and this draws the lungs open for air to enter the lungs via the nose.

The diaphragm (and pelvic floor muscles) contracts voluntarily when movement of the limbs is intended: this increases the pressure in the trunk, called Intra-Abdominal Pressure (IAP). IAP is also increased during a cough or a laugh.

The Pelvic Floor Muscles (PFM) closes the pelvic canals to maintain a higher pressure to withstand the IAP.

This coordinated force closure of the diaphragm and PFM gives stability not only to the abdominal region, but to the back as well. They are essential to creating abdominal pressure for a strong cough. This explains why so many people with spine or pelvic problems also have pelvic floor dysfunctions such as incontinence, or breathing problems.

Question: How do I start my core stability exercise?

The answer is simple, but not easy.

Start with Diaphragmatic breathing.

Try this yourself!

You can start with lying on your back, knees bent, hands on belly and chest.

When you breathe in, the belly button should rise in a relaxed manner, as high as you can inhale.

Neck, shoulders and chest should be as soft and relaxed as possible.

If you just had a baby, you may feel that your belly has a slight tremor at the deepest inhale. This is your diaphragm working hard to contract, like your biceps lifting a 10kg weight.

As you exhale, the belly deflates like a balloon, in a non-exerting manner.

The most important part of this exercise?

Think and feel more, use less muscles.

It should be done as frequently as possible, in fact majority of your breathing should be done this way, unless you are scolding someone, or if you are exercising.

Diaphragmatic breathing is the first, and the best exercise to start once you have delivered your baby. It is the safest exercise to perform, and has great benefits to early recovery and movements of your abdominal wall. Diaphragmatic breathing was, and still has been a powerful tool for me to feel calm, centered and let go of my tensions when my mind gets overwhelmed.

Some women I have worked with may need some help to be able to perform diaphragmatic breathing. Some reasons that contribute to that difficulty include:

- Stiff ribs and midback

- Stressful lifestyle, leading to a lot of breathing using the neck and shoulders muscles

- Poor body awareness

- Tight muscles in the chest, back, abdominal wall and shoulders

Most of them have successfully learnt how to perform a satisfying diaphragmatic breath. It also helped us in our next steps of core stability exercises.

In Core Stability after pregnancy Part III, we talk about the best exercise program ideal to kickstart your post-partum active lifestyle.

Before starting any exercise program after your pregnancy and labour, consult with your doctor or our dedicated physiotherapist who can assess your ‘blindspots’ in your post-partum body.

Breathe in, breathe out.

Love, MummyPhysioSG

Core Stability after Pregnancy Part I: Core Stability and the Coke Can, what do we have in common?

Pregnancy is a major event in a young woman’s life, needless to say, a major event in her body. The changes that comes with pregnancy can be hormonal changes, postural and aesthetic changes, mental health and abilities to perform desired tasks.

I have dedicated a 3-Part blog about the fundamentals of core stability after pregnancy. I hope you'll gain more clarity about how you can start building the foundations of your body's strengths!

In the physical and aesthetic changes, many women end up with visibly obvious changes in the abdomen and posture. Breast feeding, pumping and caring for the newborn are repetitive tasks that requires the mother to bend forwards, causing the muscles that make us slouch work more frequently, hence they become tighter. This may also cause the mother to have difficulty engaging the core, or reportedly feeling weaker.

3 things about our core stability you need to know:

1. The core stability is important for us to transfer load from upper to lower body vice versa,

2. Core stability is more than just the abs, it also includes the Diaphragm and Pelvic Floor Muscles (PFM) as well. This means movement and flexibility in the ribs (which houses the diaphragm) and hips (houses the PFM) are important supporting factors to Core stability

3. 3 surfaces of Core structure needs to be balanced, and strong. Any emphasis placed solely on abs may throw off the balance of the core stability, and pain or dysfunction may occur.

When people speak about the CORE stability, they often discuss mainly about the abdominal muscles group.

The core is NOT JUST ABS. The core is a system that allows the body to withstand external forces and pressure for humans to perform functional tasks.

The structure of our core stability can be visualized similar to a Can as such:

The Anatomy of a Can consists of 3 surfaces:

1. Top lid

2. Cylindrical wall

3. Base of can

In the human body, our ‘CAN’ is comprised of :

1. Diaphragm — Top lid

2. Abdominal wall & Back/spine — Cylindrical wall

3. Pelvic floor muscles (and buttocks) — Base of can

When the surfaces of the Can is intact, it is able to withstand external forces, and remain erect with structures intact. Imagine the following scenario:

• Stacking 10kg weights on the Can. The Can is able to continue holding the 10kg weight, if the structure is not altered.

When the walls of the Can is damaged,

• The Can may crash or bend over after applying external pressure, and

• The line of weakness is magnified, the structure will ‘give way’ to forces. And in the human body, it means possibly having issues such as back pain or incontinence, or hernias. Some women report ‘having difficulty engaging their core’.

When additional reinforcements such as abdominal binder is applied for long periods of time:

• Excessive pressure on abdominal wall, other surfaces may have difficulty matching up to the strength/closure, pressure may be forced through other ‘weaker’ surfaces such as PFM or diaphragm. What does it mean? It means you may experience back pain or leaking of urine during a sneeze, since the distribution of forces may be compensated.

More than Just the Abs

Post partum rehabilitation is more than just strengthening the Abs. Gradual progression of the fundamentals of our core stability is important for young mothers to continue to lead an active and meaningful lifestyle through their motherhood and towards menopause. Seek assessment from our physiotherapist who is able to give you a strong foundation of your core stability before starting your workouts. Our physiotherapist is committed to help you, one woman at a time. Let us tailor your rehab needs according to your goals and body needs.

Tune in to Part II of Core Stability after Pregnancy:

Where do I start with core stability exercise?

Love, MummyPhysioSG