Planks have become a dirty word in diastasis chat rooms, forums and blogs. Blanket edicts of no more planks have emerged. But this has thrown a lot of women into a state of confusion…we can’t do crunches, and can’t do planks…what can we do? This speaks to the no-man’s land that so many women find themselves in between a history of ab-centric fitness adages that leave them feeling betrayed and diastasis community members telling them never to do a plank or traditional ab work again leaving them feeling paralyzed and fearful not knowing how to move or exercise again.
Do we really mean NEVER do a plank again? Or do we mean let’s restore abdominal function and fascial density and find exercises you can do and gradually progress…which absolutely may one day include a plank? Can we communicate balance to the patients and help create better guidelines as to who are the patients that need to follow stricter regimens.
A recent patient, Maria*, is a great example of how this is all falling out on the street and how critical it is for us to help women distinguish between a diastasis that is just a piece of a larger puzzle, vs a diastasis that is truly the primary contributor to the dysfunction that women are experiencing and may require the significant precautions, bracing, etc. Maria self-referred to address her 4 finger-width diastasis, and she also had bilateral hip pain with standing longer than 30 minutes (she was a mom and worked at a standing desk…so lots of standing in her world). She had been initially measured by a ‘diastasis expert’, who showed her how to keep her TA engaged during the day, and gave her a laundry list of exercises to avoid until the diastasis closed, including planks, crunches, frog kicks (breast-stroke), and yoga moves such as twists, bridge, boat pose etc. She was devastated. She felt betrayed because since having her baby she had been attending yoga and other exercise classes to get fit and ward off post-partum depression. This included an intense core-workout class that was marketed towards post-partum moms, all the while thinking that she was getting her body back while in fact she was doing ALL of the ‘bad’ activities on the list. In her own words: “All the things that I’d been doing were supposedly making the diastasis worse and resulting in a bigger mummy tummy! So I stopped. And then I felt taken hostage. I wasn’t exercising and I was scared to move…. It’s hard to know what to do. I was so frustrated.”
Her doctor measured her at 3 fingers width, and suggested physical therapy. My evaluation concurred with her doctors, and I also noted she created minimal fascial tension with exertion (per our new understanding the restoring fascial density is more critical than closing the gap, via Diane Lee). I guided her through a multifactorial program that accessed that deep central stability system (diaphragm, TA, pelvic floor) that re-creates tension over the fascia, regulates abdominal pressure and supports hips from the inside-out. I showed her an alignment that reinforces the system. Critically, she learned to access that system to pre-tense the fascia before each movement and activity via exhalation before exertion (“blow before you go”).
She went home to work on that and returned for follow-up in 2 weeks. When we re-measured the diastasis at 2 weeks, it was resolved, except for a 1 cm gap right at the navel, with improved fascial tension. Was it a miracle? Does everyone get better that fast? Nope and nope. Or was it the type of diastasis we are concerned about, that requires severe precautions or possibly bracing? Nope. Her hip pain was also improved, she was tolerating 2 hours of standing after a few weeks of practice. I cleared her for exercise, as long as she kept in mind what we had discussed. She was thrilled and hopeful.
While I appreciate the intention of those who say no planks, their reported concern is that the position causes the organs to place excessive pressure on the diastasis creating a larger gap. I have found that for some women the pull of gravity actually helps them reconnect with the abs and make them work. Their form or the level challenge (against a wall or on a countertop) may need to be modified to promote control vs compensation that could aggravate the diastasis. But some women absolutely do have the capacity to create fascial tension, control their central stability system and can tolerate a prone position without any adverse effects.
I could actually make a similar argument against women laying on their backs, particularly in faulty alignments. For example, laying on your back with your ribcage flared and jutting out will pull the edges of the diastasis further apart. Does this mean we shouldn’t allow women to do activities on their backs? Or as suggested with the planks above should we modify the patient’s position or challenge to prevent the increased gapping. Try it! Support the head and shoulders with a pillow to bring the ribcage that flares open into a more closed position, this will approximate the diastasis borders and the abs have more mechanical advantage to meet a challenge.
I think absolutes are tricky, but I agree we need parameters to help women proceed safely back to a restored abdomen that is ready for challenge. However, we need to communicate the purpose behind the parameters and present them in a balanced way vs a blanket edicts. Teaching women how to test and retest the abs and fascial density before and after exercise is a great way to help them determine if they are safely AND effectively participating in an activity. Can we also teach women how to assess fascial tension or capacity not just the width of their gap? For example, when you touch the tissue in the space between the abdominal edges does it feel like your cheek or more like the tip of your nose, we want it to feel more like your nose**? Does it pre-activate before you test with a curl-up (become like the tip of your nose before you challenge the center)?
My goal is always confident independence. The overarching rules I set for my patients are if you lose your breath or your alignment (form) during the activity, it is too challenging. In my opinion, appropriate abdominal function, inside-out muscular recruitment, and connection to your central stability system, go hand and hand with the ability to maintain form while maintaining breath. So plank (or all-4s or whatever) are OK in my book only if you can maintain those rules. This helps to set individualized parameters as patients engage in a gradually progressed program of any exercise, not just planks. ( Just to be clear, I think of a full, parallel to the ground plank as a progression from a strongly restored center vs starting a program with a full plank.)
One final, and very important point to consider. I posted some of these ideas on my Facebook thread and it sparked a great discussion. In response to the idea that prone positioning caused too much organ pressure on the anterior abdominal wall, one of the main arguments against planks, Ramona Horton weighed in. For those of you who don’t know Ramona, she is an internationally respected authority on visceral manipulation, and fascial work (and speaking on the topic at the APTA’s CSM 2015). Here is what she had to say:
“Seriously, where do people come up with this stuff?? Avoiding planks because the viscera would be putting too much pressure on the abdominal wall?? That is pure conjecture and a load of balderdash. The visceral structures are held in place by turgor (think 2 plates of glass with water in between) in a prone position are suspended in the abdominal cavity (a closed system) off of the posterior peritoneal wall the same as any other position. That is like saying avoid a head stand or inversion postures in yoga so your stomach does not herniate through your esophageal hiatus. As long as the patient has good control of TA function and not breath holding/valsalva there is absolutely no reason to avoid planks.”
So I hope this all leads us to some questions we need to ask and discuss as a community: Are planks the big no-no they have been made out to be, particularly for the reasons they have been restricted? How do we define improving abdominal function for the patient so they know if their program (planks or any other exercise) is promoting or hampering it? What are your suggestions for communicating improved abdominal function to patients? (PS-you aren’t allowed to say load transfer, because that means nothing to patients) How do you help your patients self-evaluate if an activity is right for them? Everyone’s abdominal/pelvic/exercise challenge balance is a little different, how do we communicate with patients how to find their balance? Can we develop messaging to help women understand how the parameters for return to exercise applies to them?
Lots to ponder! I would love to hear your thoughts, please join the discussion below! Women in need, don’t be shy, you are the most important part of the community. I would love to hear your thoughts, too!
*Maria is not her real name, but the patient gave permission to use her story for the blog.
**Need to credit my pal Shelley Mannell for his analogy…I think it is awesome!
28 thoughts on “Dear Diastasis Community….Can We Talk About Planks?”
Thank you for posting this! Love the quote by Ramona Horton as well. I definitely agree that once a client is ready, planks are safe, helpful and important to do with client who has diastasis recti. I move my post-natal client with diastasis on to planks and other core stability exercises once they have
1) learned proper breathing
2) re-established proper activation of the inner core
3) have the strength to maintain engagement or re-engage throughout the exercise (depending on type of exercise)
4) can maintain proper alignment.
I think gradual core stability progression (and proper splinting, but I know we differ on that somewhat) is key to stimulate blood flow to the tissue and promote the right environment for diastasis to heal the best it can in shortest amount of time. The moms that do the same TVA exercises over and over again for weeks/months (while it is an OK start) just isn’t sufficient enough to establish solid core strength and stimulate the connective tissue.
Thanks Celeste. Great list! This is definitely a different message to women than they have been receiving. A plan, parameters, ways to understand their body and how to self-evaluate if the program is correct for them is a different take. I think it is tied up in the focus as you noted on the idea that the only thing you need to rehab after pregnancy is your abdomen. The culture of flat abs is really messing with mind, heart and bodies! There is a system to be addressed for best outcomes for a return to function and fitness!
Thanks for weighing in and for your measured voice! Julie
PS…yes, our splinting differences continue :). And I think my take is similar to what I shared in the blog. Who is appropriate for splinting is the big question? How do we help women understand that…versus everyone needs one (not your message, but a strong message out there). Its a balance and finding the right combination for the individual to rebalance that system is the key.
I am one of the people who is now so confused that I am not doing anything other than walking. and not even much of that. I live in Nova Scotia, can I do a virtual consult with you? I really would like someone to chat with about this.
I am sorry to add to your confusion. I hope with this blog to bring in an idea of balance, and finding the right balance of exercise for each individual. Blanket edicts and absolutes are so tricky. A modified plank or side plank may be OK for you, but not your neighbor. I often am asked can you give me (or us in an interview) just one exercise. And my answer is no! I don’t know if you are a new mom, older mom, not a mom, exerciser, non-exerciser, etc. Ultimately we want a challenge that helps your body learn and pulls the pieces together, vs a challenge that overwhelms the system and you have to compensate. Patients need tools to help them be aware when the activity has crossed the line for compensation. The patient that I highlighted in the blog didn’t really get “stronger” (building new muscle tissue), she learned how to balance her SYSTEM (pressure, forces, recruitment of muscles in the right order, a supportive alignment) and use it well in function. This is a different way of thinking versus if we strengthen this muscle (the TA) things will improve. There are some long standing messages out there in not just diastasis rehab, but all rehab and fitness that need to change. It is hard to wade thru all that tho as a patient.
Regarding a virtual consult. Because of the regulations in my state I am unable to provide that. But I can virtually consult with a local therapist to discuss and work together on your case. You can find a therapist and see if that is something they would be interested in throught The CPA (Canadian Physiotherapy Association) Find a Physio page http://www.physiotherapy.ca/About-Physiotherapy/Find-a-Therapist-Directory. We can work together that way. You can also look at DianeLee.ca. She is in Vancouver and maintains a list of practitioners familiar with her work who may be able to help you locally! I also have an online course/DVD (same content different formats) that takes women through the steps I taught Maria in the blog. The online course is focused on incontinence, but the same system that I am trying to balance for incontinence is the same system that I hope to regulate for diastasis: pressure, pretenses fascia, and works on recruitment order. Same system, this is the same program I use for my patients who come for diastasis. Diastasis needs a multifactoral approach, the DVD takes folks through those multifactoral issues. Because it is not specific to Diastasis I would recommend it up to a 3 finger width separation as an independent program. If you aren’t seeing results with it within 3-4 weeks I would seek local help to help tailor the ideas to you.
I hope that helps and points you to some places to unwrap these pieces. Thanks for chiming in and let me know if I can be of any further assistance.
Hi Julie, thanks for this excellent article, I’ve already emailed it to several colleagues. I’m a teacher of Restorative Exercise™ and I especially like your suggestion of supporting the head and shoulders in supine to get the rib cage back into its correct position relative to the pelvis. It makes all the difference. Hopefully this will help to clear up some misunderstandings still prevalent about working safely with a DR client.
Thanks for taking the time to comment Carol. That simple correction makes such a difference. I hope this sparks lots of dialogue in the community and between clients and practitioners. Our understanding continues to evolve, and often we swing wide in one direction, then the other before we get back to the middle. A change of messaging is important to start those dialogues that bring us back to the middle.
Hi Julie, I have TONS of thoughts on making women afraid of exercise versus encouraging women to engage in “bootcamp” get your body back type exercises. You are so right that there is a middle ground, one I had to find on my own as a patient sadly.
First, thanks for clarifying the viscera pushing on the linea alba question. I was always skeptical about that in my own experience. I’ve found that the most important question for me before engaging in any type of abdominal work, including planks (I always do incline because of my particular situation) is can I control my pelvic floor. In other words, if I’m holding a plank and breathing, once I can’t feel my pelvic floor voluntarily contract on the out-breathe, I know I’ve reached my limits.
I could brace my abs all day in a plank, but my weakest link is my pelvic floor and I need to know that. Also, I am a good example of someone whose diastasis never actually closed, but who has through trial and error figured out which exercises aggravate it (for example, lots of the traditional no-nos like yoga poses that over-stretch, traditional crunches, actually do make it worse, but incline planks do not). A diastasis is really really dynamic and I even think the phrase “close your diastasis” fails to take that into account. The size changes based on how you are measuring, the tilt of your pelvis, the time of day, etc… If it is progressively getting bigger, of course that would be bad. But diastasis isn’t an open and shut case (pun intended:)).
Another note: I also have a lot to questions about our new obsession with alignment. This is not a critique of you in particular because I found your alignment cues to be the most helpful honestly, but I will say the advice on the internet too often leaves women in a state of panic about not being properly aligned all freakin day, which causes us to fear all movement. Sometimes the advice is given (I won’t name the website) as if physics says you should stand and move in this extremely particular way and if you don’t, you can never get better. I realize structuralist approaches to musculoskeletal pain are being vigorously questioned, so where is the literature on pressure systems? I imagine since pain is more ambiguous than pressure systems, they would be in separate categories, but it is interesting to note that we aren’t literally machines. Pressure must matter, but what does the alignment variation from “normal” have to be to start mattering?
Based on personal experience, the key is FEELING (not always over-activating, but noticing) the pelvic floor and abdominal muscles in the different positions we adopt throughout the day. Also, I’ve dabbled a bit in the literature and have found some preliminary observational studies on lordotic curve and the pelvic angle and one on kyphosis as related to prolapse. Are there any other sources out there that I’m missing, or are we still in the beginning stages of understanding what is going on?
Unthrusting the ribs, personally, has helped with paying more attention to my breathing so I don’t hold my breathe, but I’ve met a couple women who think this is the one thing holding them back from closing their diastasis, as if finding the magic alignment that clicks will cure them. I try to tell them from personal experience it isn’t as neat as that. Waking up in the morning and stretching your arms and chest overhead because it feels good isn’t literally ripping open your diastasis (as one friend panicked).
I know patients don’t like ambiguity, but even the best advice needs to begin with “your diastasis may not close and that can be okay.” Sorry, for the all over the place ramblings. Clearly, I am still forming my thoughts as a patient. I should note that since last seeing you, I had another baby and my diastasis didn’t get bigger:)
I am so happy to hear from you! You were suspicious you were pregnant when we met, glad to hear that the baby is indeed here and you are both well.
I LOVE what you wrote. It is such a wonderful message to women from a woman who has walked the path herself. And the message isn’t follow me, I did these 5 things you can too. Its pay attention to your body, know your signs and signals for a challenge that is too much. That is awesome. For some a plank isn’t the right choice, for some it is a great choice. Our job as practitioners is to help you find that path. As I said in a comment above. We have to challenge the body enough so it will learn, but too much challenge and the body will compensate. You have found that, that’s awesome.
Regarding alignment, no offense taken. And you raise a great point. I have changed/softened my language around alignment to try to communicate a less stiff and rigid interpretation. We have a history though of “holding” the right posture, and that “good posture” is hard work, so it is hard for people to imagine a posture that isn’t work. But I think when we work toward a balance of forces and pressures, alignment doesn’t have to be hard or held or stiff. There is an ideal and then the real. My patients with scoliosis cannot be in a perfect posture, but I can help them find their balance-they aren’t doomed!
I describe it as a range and that everyone has a sweet spot within that range. That sweet spot is where their balance point-a balance of the pull of flexors on the front and extensors on the back (side to side and rotators, too). And my favorite sweet spot cue is where folks can find their optimized breath and have the best interaction between their diaphragm, pelvic floor, and TA (their Piston). That is my new definition of optimized alignment and most of my patients say that’s easier, or I can breathe here. That is music to my ears. I try to make alignment as passive as possible so as not to interrupt the balance of muscles. If you have to work hard (say use your abs to pull down your thrusting ribs), then you are interrupting your ability allow the diaphragm to do its thing. That’s why I love the ski jump :)http://www.juliewiebept.com/video/the-fit-floor-part-2-teach-your-pelvic-floor-a-new-trick/ . And the pillow under the head and shoulders as I noted in the blog, then the system can balance out and become more automatic.
Yes, we have 3 studies that I know of that have found a coorelation between a flattened low back curve, and thoracic kyphosis and an increase in prolapse. It is suspected that this has to do with a change in the direction of the line of pressure. Incontinence, prolapse, and diastasis are all pressure management issues in my mind. So it is clear that alignment has a roll to play in managing/directing that pressure. Helping folks find THEIR ideal is the key.
NOne of us likes ambiguity, and women need help sorting out their pieces. And not everyone has access to help. But a new message must emerge. Thanks for lending your voice. And great to hear from you!! Julie
This conversation just popped up on my blog FB page recently, too. I had posted an ACE article about the issues with plank “challenges.” A reader noted that she felt her DR was aggravated when she planked so she avoids them.
This exchange, I think, gets to the heart of why the whole “don’t do planks anymore” has emerged.
First, people don’t just do a plank to fatigue every now and then as part of a robust overall movement practice and in the context of stellar alignment. They’re doing them every day. They’re doing them for progressively more and more time, as “prescribed” by someone who created a program on Facebook or on a video. And, they’re doing them competitively because, you know, we can turn pretty much anything into a contest these days.
I don’t think anyone – DR or no – should engage in daily planks for progressively longer times, just for the sake of a FB challenge or even for the purpose of a “strong core.”
A friend recently asked me whether and how I use them with my clients and I said I’ll have clients pop into them sometimes. Not every class. And always with progression and alignment cues. And, from what I see even then, only about 1/3rd of the class should even be attempting the planks I see them attempting. I vastly prefer spending my limited time with clients working with them upright to stand, walk, rotate and squat better.
What you described with your client is what I would offer every single one of my clients in my fantasy-dreamland. I’d send them to you, you’d integrate them and get them ready for group fitness, and then I could have them back. But in the real world, bodies I see are not post-Julie bodies so to be frank, I am fearful of hurting people with planks. (Again, DR or no.)
Long-winded, I know, but I really, really appreciate that you are covering this topic. We need dialogue, dialogue and more dialogue to be sure.
Thanks for weighing in! Yes the ab challenges that were going around a few months back were disconcerting. It continued the unfortunate message to women that has been around TOO LONG, which is strong abs and a flat belly are the only measure of core strength, health, fitness, beauty, and successful recovery from pregnancy. Abs are only one piece of a larger puzzle, and if you only address that one piece…you will never get the whole puzzle back together again. It is the message of TA for diastasis and Pelvic Floor for incontinence. Both of those issues are multifactorial, and one muscle will not solve the problem. But this is a new message, and it is way harder to communicate finding balance of forces and pressures, then do this one exercise or don’t do this one exercise or hold this muscle or clench that. A new day is dawning I hope, but these old messages are really entrenched, that we also have to change women’s beliefs. We believe the flat ab message. We believe the only way to achieve it is through a million crunches or planks. So we have some beliefs we need to shake up!
My fantasy is your fantasy :). That everyone would learn first how to pull the pieces of their puzzle together (the whole puzzle not jsut abs), then once the puzzle was orgnanized they go out and challenge that new organization, that new strategy, that new balance with their gradually progressed fitness program. Then fitness reinforces and strengthens a balanced central stability strategy, vs fitness strengthening dysfunctional strategies. I have tried to create an accessible program for women to rebuild that central foundation that they can build their programs on (http://www.juliewiebept.com/products/).
And I agree lots of folks form is stinkeroo. But that is not just in planks, that is every exercise. Form matters. As I noted above, exercise while laying on your back, ribs thrust out has equal potential for aggravating a separation. Breath holding during any exercise can increase intra-abdominal pressure against the diastasis. My folks work up to planks with some work in all 4s, then in modified positions (inclines, etc). But, as I noted in the blog, I wouldn’t allow my patient to continue in an exercise that they can’t maintain form and breath, and I would change it up. And for some that means they shouldn’t be doing planks. But there are a million ways to challenge that system without planks. They aren’t a prerequisite for a strong center. I think planks are an incredibly functional training position (they are the same alignment as standing, jumping, squating, etc). So I like them and use them when appropriate.
I hope we can all continue the conversation! Thanks Kristine! Julie
Thanks for the thoughtful reply.
I didn’t mean to suggest planks weren’t functional. I just wanted to share that as a fitness instructor, I am met with the realities of a) very limited time and b) a wide range of capabilities in my students. I try to maximize the bang for the buck time-wise, and so planks just aren’t high on my priority list. And, when I look out and see a whole bunch of people who might actually be harming themselves in a position, it makes me even less inclined to cue it.
You know what? The handbook that my employer gives us actually forbids me from touching my students. I do it sometimes b/c goshdarnit all those kinesthetic learners will never get it otherwise. But, I guess I am trying to share the barriers that I as a group ex pro feel I face to safely and smartly incorporate planks.
Oh no, Kristine. I didn’t think you thought they were unfunctional, I was just trying not to keep them in a fearful category and explain why I work toward them for my clients. I get the group fitness dilemma. I think your students are fortunate to have an instructor aware of the issues and careful with program design. The hands-on issue is tricky for sure. I have seen folks clinically that were injured when forced into positions by their trainer, so I understand the precaution. But just like the blanket edict on planks needs better reasoning, seems some middle ground for appropriate hands-on guidance from trainers is appropriate.
Thanks, as always, Kristine. Julie
Hi Julie, thanks for the thoughtful reply! I wish I still lived in SD so I could come for a consult again (but alas, we moved to Guam of all places).
One more thought for moms surfing the web. DR seems to be a really under researched topic. I’ve spent way too many hours and money digging into some of the studies on pubmed and, frankly, they are mostly bad. This means getting good advice comes down to learning who to listen to and being willing to gather multiple opinions and sift through it. Practitioners are using their best guesses to treat, so picking a practitioner whose best guess makes sense is crucial. Frankly, anyone who is too optimistic in their “approach” for every woman is likely not the best source:) Anyone who has come up with a follow this exactly x,y, z plan and if you don’t get better it was because you didn’t follow it right is not the best source. Recently, I also heard Diane Lee talk about how we should clarify what we mean by “healing” since a DR isn’t inflamed like say a sprain. My point: I don’t know? I guess I am saying we as patients need to be more skeptical of the different voices on DR that are being thrown at us by the internet.
More good advice. All practitioners have the best of intentions and are working off of the limited evidence we have. Women’s health is just starting to move out of the shadows and getting more attention in research. Diane Lee’s info has been great to help us think through it all differently. And it is tricky, women want answers, practitioners try, there aren’t enough practitioners to go around with knowledge in this department and the internet is awash in info. Discernment is critical. And the other big litmus test must be…improvement. If you aren’t seeing improvement, seek local help if you have access, or try something new. But we also must acknowledge that some women will need surgery for a diastasis to restore function.
Thanks Meredith. Be well, and thanks for chiming in. Julie
Oh so well said, Julie!
Thanks once again for sharing your thoughts and putting into words concepts I believe in and teach. Always great game-changing conversation for many!
Thanks Lori! Appreciate it! Julie
Thank you so much for this and I can’t wait to share it with my clients. I am a certified athletic trainer, turned personal trainer, who works with pregnant and postpartum moms. Because of my education, I have several DR & PFD women in my classes. We talk often about building back up and rehabbing the area, but so many see a DR diagnosis as being the end-all of their previous life. I explain that we’re working back to that “return to play” ability, with the goal of resuming all of the activities that we enjoy! I think your article will resonate with many of my students and help support what we’ve been doing and discussing class.
Thanks Beth! I see that “end-all of their previous life” in so many women, and it is fed by the blanket edicts, blogs and some of the forums. As a fellow sports med person, I love the “return to play” ability comment and know that everyones path is a little different. Such a more hopeful message. I am glad to know this can support your positive efforts.
Thanks for chiming in-Julie
This is terrific, as is all the commentary! And, love Ramona’s quote also! Very good food for thought for a women’s health physio who has not yet done Diane Lee’s courses and sees women with diastasis, but has a lot to learn in this area.
Yes, Ramona’s quote was some serious icing on the cake! I was grateful she weighed in on FB and gave permission for me to add the quote here. We ALL have a lot to learn. Thanks for chiming in. Julie
Hi Julie, great conversation about planks. I suppose my problem with them has always been the timimg of them- sort of ‘mandatory/and for what reason’ 2 minute hold. I think it also can be a problem for women who are taller and carrying weight- its not just what state their abdominal strength/fascial tension its ‘what state is their back in?’ And how important really is it to be able to do a plank in the scheme of things when there are many other ways to gain strength and function in their muscles?
I tend to encourage a plank from the knees and am interested in your opinion on that?
Personally I agree with the concern about blanket statements about what not to do EXCEPT and its a big except- is it safer to make some blanket warnings which may give women the message that now they’ve had a baby there are some issues they need to be aware/careful of and encourage them to seek advice and help on a ‘one-to-one’ basis rather than barging into a situation (boot camp/pump classes etc etc) which may be irretrievable- and I’m including the risk of prolapse from doing planks when their weakness/ fascial stretch may be replicated in the vagina. So good we can have these conversations across the world.
Thanks for chiming in. Yes, Kristine brought this up in a comment above and noted the ab challenges that shoot for progressively longer and more holds. I responded there, but briefly here….this speaks to the faulty message that women have received for years that being fit, or beautiful, or healthy or successfully recovered from pregnancy is defined by the definition of your abs. This misses the boat entirely, but women have been fed this for years. Core or central stability is a system, diastasis repair must treat the system. Same with incontinence or prolapse. The TA alone for diastasis or PF alone for incontinence are old messages; new messages need to emerge. Part of the reason I like planks is done well the whole body is involved…not just one muscle group or another. If all you feel are arms….or abs….you aren’t receiving the intended benefit, which is likely due to your form.
I also agree and noted to Sarah above, a plank is not a prerequisite for a great program. Or the only way to gain strength. ONe of my major messages is that by separating ‘core work’ from say our shoulder program or our hip program….misses how the body actually achieves shoulder or hip mobility and stability. A system is in place to allow you to reach with your arm or kick with your leg. The ‘core’ supports and pre-activates before every movement. So done well any activity/exercise can be a core strengthener.
I am pro any modification to any exercise that helps the patient receive adequate challenge to move toward their goal, without creating a compensation (breath hold or loss of form). Some patients simply love planks…but if they do them poorly it will only strengthen the compensation. So modification is critical and allows them an opportunity to safely and effectively move toward their goals.
Regarding safety. I think we underestimate our audience if we don’t explain the reasons for concern. For example: here are some things to check for if you are participating in an exercise and the challenge may be doing more harm than good, and you may need to seek help, back off and modify your routine ….you leak, you hold your breath, you feel heaviness in your vagina after, you are in pain, etc….we can add more to that list. I also think that we need a systematic way for women to recover from pregnancy, like the mandatory program they have in France. Really good, well reasoned, hopeful education after delivery. Self-empowered to make decisions based on your own body. Please read Meredith’s comments above. Great perspective from a patient that’s been there.
PS I think the blanket messaging to ladies with prolapse is even scarier….that might be my next blog. Dear Prolapse Community…:)
Yes, always glad we can converse across the globe. It is the total upside of this social media thing. Thanks Sue! Julie
Great article! I just have a question for you concerning this same topic and as it pertains to prenatal women. If a prenatal woman is able to properly engage her TVA and pelvic floor while being in a front loaded position such as the plank then is it safe to say that she too may also be able to continue planking in a standard or modified version as she progresses further along? Or is it better to avoid the plank/side plank during this time because she isn’t able to create adequate tension in the line alba due to her growing belly, and the pull of gravity, so to speak on her belly will only make the situation worse. Thanks!
Thanks for the question! I think that the ability to engage your system as a team, maintain breath and proper form are the prerequisite for any exercise through pregnancy (and beyond). Monitoring a separation would also be key. But a few things to understand to help clarify, a diastasis is a part of the design for us to pull off pregnancy. Without it, where would the baby grow? What would happen to the mom’s organs and structure. There needs to be give in the system to allow that. The abs are designed to provide that via the separation. Some women show big, some women show small, some women are small and have big babies, or carry twins. So there is a lot of variability of how big that gap becomes,if women get a gap and when it is something pathological. There is a lot of scary info on the web fanning the fear that 90-98% of women have a diastasis. But evidence doesn’t support that. One of the few research articles we have on the subject indicated that approximately 2/3 of the participants had a disastasis at the end of their third trimester (10 out of 15). Of those 2 actually cleared their diastasis in 72 hours after delivery. At about 6 weeks post delivery approximately 1/3 of the women still had a diastasis. So this is important message to get out there, a diastasis that is a bigger deal and requires severe precautions is not as common as some of the PR out there is making it sound. This is as important, IMHO, as creating smart exercise parameters for women to avoid creating a problem by over-exercising in pregnancy. With all that in mind, for you specifically, it is hard to say yes or no on planks bc I am not sure about your exercise history, current level of fitness, how far along you are, 1st pregnancy or 3rd? Are you short waisted? Carrying multiples, etc? But if you were someone that planks were a reasonable exercise, you were able to maintain could central control (meaning good single leg balance, supportive alignment, no leaks, no signs of prolapse, a well controlled single leg squat), I would likely encourage you to modify to a more inclined position as you progressed through the pregnancy and got bigger. And please for the average pregnant exerciser out there, please remember pregnancy is really a time for health and fitness maintenance vs heavy duty exercise or big progressions. I hope that helps. Let me know if you have any other questions. Take care- Julie
Do you have an opinion on yoga? I healed my diastasis and prolapse a year ago and have been doing barre with no issues for 6 months. Recently started getting into power yoga and though I love how it makes me feel, after everything I have learned about alignment, many of the poses worry me a little, especially all of the massive stretching and twisting of the torso. And many poses seem to encourage rib thrusting. Thank you for any input!
I always work toward getting a patient back to whatever exercise form s(he) likes. That’s my job is to help you reach your goals. But their is wisdom in balance and self-evaluation within any exercise pursuit. If your symptoms associated with the diastasis remain under control (good recruitment, balance, form, breathing, leaking, pain, etc) then your body is handling the challenge. If however the extreme moves and position are irritating your symptoms then modify. I give my patients the general rule of maintaining form and breathing, if the challenge causes you to lose either it may be too challenging. It is OK, and any fitness teacher worth their salt would agree, to modify any exercise at any time during a fitness class or individual session to maintain appropriate challenge without injury. But I think patients need to be proactive within that.
I hope that helps! Julie
I am a mom of 3, that discovered, (on my own) that I have a Dr. Mine is about a 3 finger gap at the navel. I am currently doing Mutu which is really helping me feel stronger. I loved this article and it made me feel hopeful. Being a very active person, it has been so hard to accept the fact that i will never be able to do certain exercises. My question is about alignment. Mutu stresses about proper posture and alignment. It is something i struggle with since I am a tall woman, and have a very long torso. Would you recommend seing a chiropractor to make sure I am in the correct alignment? Is it safe to do while still trying to strengthen my core? It is frustrating, trying to get answers from my doctor. I have seen two and all they do is recommend a tummy tuck. Thank you again for such a great article. Its so nice to know I am not alone in this battle 🙂
I am so glad you feel hopeful! I recommend a second set of eyes, but my rolodex is mainly full of PTs. Where are you and hopefully I can make a referral. I actually have a little different take on alignment than is offered in MuTu, you can find out about that with video clips on my website.http://www.juliewiebept.com/products/the-pelvic-floor-piston-foundation-for-fitness/#clipVids . I teach a system that helps to preactivate the fascia before movement, and could improve your response to MuTu. Here’s a link to the online course that takes you step by step through the system. http://www.juliewiebept.com/products/the-pelvic-floor-piston-foundation-for-fitness/ .
Take care! And let me know if I can make a local referral. Julie
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