Is this a good exercise for diastasis (or prolapse, incontinence, hip pain, low back pain, etc.)?

The types of questions I get the most often are: Is this a good exercise for diastasis (or insert X diagnosis: prolapse, incontinence, hip pain, low back pain, etc. )? Can you give me 3 exercises to avoid in pregnancy or post partum? Conversely, can you tell me 3 exercises that athletes should be doing during pregnancy or post partum? Is Pilates (or yoga, CrossFit, Barre, Zumba, running…you pick) good/safe/effective during or after pregnancy? 

These questions speak to the premise that a particular exercise, exercise program or simply strengthening a muscle is the solution to pregnancy and post partum issues,  or ANY physical issue. While exercise and strengthening are important, critical in fact. Looking at the strategy someone is using to perform an exercise….any exercise… is the path to using it to address XYZ diagnoses, and to protect and promote pelvic, musculoskeletal, and performance health simultaneously during pregnancy and into postpartum.

A particular strengthening exercise or exercise program isn’t the solution, an effective strategy within ANY EXERCISE PROGRAM is.

By preaching strategy, balance between muscles and pressures, coordination and efficiency of movement patterns, your brain is the focus, not if one particular muscle group is strong or weak. Rebuilding your connection with the muscles that have been impacted by pregnancy is about brainwork first, body work second. Strategy before strength. 

That may sound like gibberish when you simply want to know the steps you need to take to get better. But guiding you towards recovery means you need to understand that at the end of the day you may need to change HOW you are using your body in your day to day function and inside your fitness. HOW you use your body is your brain’s strategy to meet a demand. For example, are you holding your breath to get up from the couch? That is your brain’s strategy. WHY your brain chose that strategy instead of a more appropriate one (you shouldn’t have to hold your breath to get up from the couch) is what you need to sort out first and address.

Without that understanding exercise programs may not be as effective to help you recover. They absolutely may have positive outcomes…social opportunities, movement feels good and is good, stress relief, gaining strength again, weight loss, cardiac health, bone health, etc. That is all important and awesome! But if there are aches and pains or leaks or pressure in your vagina or doming along your midline associated with those exercise practices that are not improving, these are signals that you need a new strategy for HOW you are participating in your activities and exercise to help you effectively RECOVER from pregnancy (no matter how long ago it was) and REBUILD towards your goals. The best part is that means you get to keep doing what you like by monitoring and modifying as you go and ANY EXERCISE can be part of your recovery and re-building program! We just need to have a conversation with your brain to help you do it more effectively, efficiently, painlessly and dry. 

Teaching effective strategies before, during and after pregnancy will carry over into a lifetime of movement, function and matter the type of movement, function or fitness. Time to change the narrative around exercise folks! Time to talk strategies.

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4 thoughts on “Is this a good exercise for diastasis (or prolapse, incontinence, hip pain, low back pain, etc.)?”

  1. Postpartum mom says:

    How does your advice apply to women who have full levator avulsion and irreversible nerve damage? I have grade 3 POP and am desperate to get back to living without symptoms, let alone exercising, but no amount of rehab or retraining has been able to get me to a place where I can stand or walk without symptoms. I’ve stopped an gripping and breath holding and constantly blow before I go. I’ve worked on my hypertone and strengthened the remaining PF muscles, adductors, TA, etc. I’ve been told surgery is my only option by my WHPT yet outcomes for women with LAA are awful. What advice would you have for women like me?

    1. Julie Wiebe says:

      Hi there,

      I apologize for the delayed response, I have been out of town and out of wifi reception. I am sorry you have had such a tough road. It is a little difficult to advise you without more info (how far out from your delivery that you are, have you tried to different pessaries, etc.) or seeing you directly and watching you move. Please understand that the advice and ideas in this post as it relates to a more significant injury such as yours still applies if understood broadly. I am always hoping to find an activity that a woman enjoys and modify it as best I can to integrate the muscular work you mentioned into a functional or fitness relatable pattern. Through the post, and in my clinical practice, I am trying to shift the conversation away from “rehab-y” exercises that aren’t meaningful to a person’s brain, and open the door to try activities that have meaning to them (like fitness they enjoy). That may look very low level to start with a more significant injury, but I would try to link the strategies for movement in a low level activity to their goal activity. This allows us to use different types of exercises, non-traditional exercises of any kind, for rehab purposes. I would monitor and modify pressure strategies, muscular patterns, and the activity itself throughout to try to keep it as successful as possible. I also understand that there are limitations to conservative care, but I am always hopeful to try to find an avenue into the circumstance to bring about some change and improvement. I hope that makes a bit more sense of the post for your circumstance and doesn’t diminish the work you have done or your experience. I do appreciate you reaching out. Julie

  2. myranda says:

    YESSSSSSSS! This speaks to me on so many different levels!

    When I was learning to Olympic Weight lift and first joined crossfit some of the coaches kept telling me to add weight. I was confident I could add weight but wanted to be MORE confident that my STRATEGY would hold, that my technique would not be compromised by my ego to find my max.

    It has been 8 months since I started and I am feeling ready to take on the challenge of attempting some maximals lifts!

    I LOVE IT! MONITOR AND MODIFY with the consideration of RISK VS REWARD. Julie, you rock and your teaching continue to increase my passion for how #physiocanhelp !!!

    1. Julie Wiebe says:

      Good for you to listening to your brain and gut! Thanks for the kind words! Keep it up! Julie

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