Kate Rita- Personal Trainer and Diastasis Expert

Without rehabilitation, the postnatal body has a non optimal core. From Diastasis Recti to pelvic floor dysfunction, inhibited multifidus/lower back muscles (especially in the lumbar spine), thoracic immobility (tight ribs), and possibly abdominal adhesions from a C-Section incision- there are a multitude of maternal physiological impairments to consider. The body continues to perform by enlisting non optimal biomechanics to compensate for the lack of core strength. Compensatory strategies help to achieve the stability, strength and endurance that the core is not providing, but exacerbate deteriorating movements in a snowball effect. This is very evident in the pelvis. When the deep stabilizing core is unable to provide adequate pelvic stability control, the smaller muscles that are designed to help the core take on too much of the task. They become stuck, gripped, and can cause referred pain throughout the body. Knowing to stretch the common overused and v...

In support of Incontinence Awareness Month June 2015 Is it Safe to Run with Pelvic Organ Prolapse? I was a recreational runner pre-baby. Post-baby, I suffered stress incontinence when I returned to the sport. I was fine while running, coughing or sneezing, but if both happened simultaneously I peed my pants. Although it improved as I recovered, it never fully resolved until I addressed it with a restorative exercise program. From a pelvic floor assessment I found out I have both a grade one cystocele and rectal prolapse . There are many moms who run with symptoms of incontinence, from a few drops to full bladder leakage. The solution is not to wear a pad, it is to address the obvious weakness and strategically strengthen the muscles to support the sport. Here’s what you need to know. 1. Running involves impact and requires the core strength necessary to support it. Stress incontinence is a symptom of core dysfunction and often related to diastasis recti (althoug...

My latest contribution to the Maternal Goddess Community: Returning to Plank After Diastasis Diastasis Recti is a separation in the abdominal wall caused by an excess of intra-abdominal pressure. Movements that we know create such excessive intra-abdominal pressure include crunches, sit ups, v-sits and supine leg lifts. These movements are contraindicated. While rehabilitating a DR, front loaded positions are avoided because the abdominal wall does not have the strength to support the weight of the organs. Once the core is functional, plank position can be reintroduced as a “go-to” for core strengthening. A functional core is one that creates enough tension to support the abdominal wall through meaningful movements as well as exercise. In order to support plank position the core must have both the strength to create tension and the endurance to maintain it with the extra weight of the front loaded position. Core strength and endurance exercises to ...

My latest contribution to the Core Expectations blog : Surgery is often suggested to repair a Diastasis Recti (separation of the rectus abdominal muscles). My clients often ask me if they are candidates for surgery, and there is both a short and a long answer to this question. The short answer is “unlikely.” In my experience, surgery for a Diastasis is a rare case scenario.  What determines the small percentage of women who require surgery to repair a Diastasis Recti? The inability to create any tension in the linea alba with proper core cueing may be a surgical situation – with no functional core support the system is weak and vulnerable to injury – but it is still a long process to say that definitively.  Here’s the long answer. If after teaching a client effective cues to recruit the core 4 muscles (diaphragm, pelvic floor, transverse abdominis and multifidi), she is unable to generate tension in the linea alba, more work is prescribed as homework in...

In many cases it can take months to rehabilitate a core. Any separation of the diastasis recti (DR) must be closed and the connective tissue (CT) must be strengthened to support a functional core. The pelvic floor must be activated and strengthened and the multifidus must be stimulated optimally. As you strength train with a DR , you may want to increase the difficulty of your exercises to challenge your increasing strength. There are ways to do this safely and effectively and monitor for any discomfort accordingly, especially in the pelvis. Base of support By decreasing the base of support for an exercise, you can increase the challenge of balance. You can accomplish this by using a stability or BOSU ball. Increasing the inflation will result in a smaller base support. You can also change the base of support by moving from a four-point support to a three- or two-point support. For example, to increase the level of difficulty of a hip thrust/back bridge dip, assu...

I published this article on the amazing Maternal Goddess website in March. Strength Training With a Diastasis Recti A diastasis recti (DR) is created by intra-abdominal pressure. In most cases it will occur from pregnancy, but there are other possible causes such as abdominal loading with poor technique (“pushing out” while weight training for example), obesity, constipation, and chronic cough. If you have been assessed with a DR it is imperative that you work with a core restorative trainer to rehabilitate the dysfunctional core. Many women become apprehensive to strength train with a DR. It can be difficult to know what exercises are safe and effective to use to refrain from making the DR worse (which is possible) and/or undermining the rehab work. Any movements that cause intra-abdominal pressure are contraindicated. These include forward flexion movements from a supine position such as crunches, v-sits and sit-ups. Supine leg lifts should also be avoided....

I have blogged extensively about Core Breath for the rehabilitation of diastasis recti and pelvic floor strengthening. This repatterning of the core provides a solid foundation upon which an ambitious strength program can be achieved. I have observed that connecting to the pelvic floor muscle to release it is often the most difficult part of the exercise. We have many visualizations and suggestions to help a client connect, and sometimes we need to use various cues to avoid a client becoming "saturated" with the imagery, disconnecting again. I am constantly looking for new ways to describe this intra-abdominal connection, and when I stumble upon a good one it excites me This week I learned a new cue for PFM release. I really connected with it right away and have been suggesting it to clients with a disclaimer "humor me and give this a try, I really connect with it". With inhalation through the nose, place your tongue against the back of your top front teeth ...

There are plenty of exercises that are safe, effective, targeted to strengthening imbalances, and supportive of the pregnant condition. Prenatal exercise is a tremendous investment in the health and well being of both mom and baby. Knowing the best exercises for pregnancy is the challenge, so use this as a guide. It is imperative to follow general prenatal fitness guidelines, and to have a Parmed-X for pregnancy signed by your primary prenatal caregiver. Prenatal (General Trimester Guidelines) If you were previously active you can work at moderate intensity 30 minutes/day or more. Stay well hydrated and don't become fatigued or overheated. The baby is susceptible to heat and you're more likely to be fatigued. Consume an additional 300 calories per 30 minutes of exercise. Cardio 3-5x/week 30:00 Strength 2-4x week 30:00 Stretch Daily Cardio: Low impact cardio is best suited for pregnancy. It reduces the pressure on the pelvic floor which is al...

Strength 201- Performance benefits of core breath Core breath control improves pelvic stability control. Once it becomes mastered through movement dynamics it can be applied to advanced strength exercise training for improved results! When performing a set of 15 L/R pistol squats (1 legged squats with full ROM) on a BOSU ball assisted by side bars, I was tiring by 8 reps. Cueing core breath and PFM made the reps less difficult and I had a noticeable increase in strength. That is incredible! Not so unpredictably, as with the 101 of seated core breath it is the release that is the most difficult with advanced movements. We engage the core during exercise and when intensity and difficulty increase it can become hypertonic, resulting in a weaker PFM contraction, often cued from the transverse. A weaker PFM contraction results in less strength and increased difficulty. When we release the PFM the contraction has more ROM and is stronger, resulting in improved performance. Excellen...

Strength 101- Application of core breath to strength training Once a client has worked through Pfilates form I begin to apply core breath to simple bilateral exercises. A good example would be a standing front and lateral arm raise. The client stands with feet hip width, untucked in active posture, arms with 1-3lb weights at sides. The exercise begins with an inhalation and PFM release followed by exhalation and PFM contraction while raising arms to sides shoulder height. With inhalation and PFM release the weights are lowered back to sides. The grip rotates and the movement is repeated to the front, shoulder height. Alternating lateral and front arm raises, the client syncs core breath for perfect exercise form. Increased Pelvic Stability Control: Progressing into unilateral exercise, the focus is on improving pelvic stability control. We already know with the weight/load transfer test that core set will improve pelvic stability control. This becomes even more apparent as ...

Core Breath Level 2- Dynamics This is the 2nd installment of my core breath field report from earlier this year. The 3rd installment will apply to advanced strength training. I will be writing another report soon which will build on these fundamentals functionally as I have experienced in the field training, so stay tuned if you'd like to geek out with me :) Pfilates 101- Introducing dynamics Once PFM release and contraction are mastered we can progress effectively to Pfilates 101 which introduces dynamic movement into core control and synergy. Seated and side lying core breath refine the form with a control that we do not have during dynamic movement, and therefore we have built functional memory to support the increased dynamics. I typically begin with the lunge as it is an easy position to connect to. In a wide scissor stance my clients sync PFM work to the lowering into lunge and pressing up- inhale, release, lower; exhale, contract, press. I begin in an isometric s...

Here is a field report I wrote on core breath. I am posting it here for the clients who have been geeking out with me on core rehabilitation, and for anyone else who has interest in the practical application of core function. I am going to post this in installments bc it is so long..... Core Breath as Applied to Advanced Exercise- Pfilates & Beyond Not JUST for your pre and postnatal clients! This is a current field report of Core breath and Pfilates as applied to advanced strength training. I have been practicing both core breath and pfilates for over a year.  The application of the exercises to my client’s programs has given me a lot of feedback and insight into their functionality. Retraining core function is a process of mastery. With cues through exercise we retrain the core to function autonomously, supporting not only advanced exercise but also everyday meaningful movement and activities. It all begins with core breath: I work with many p...