MuTu System Exercises with Wendy Powell

Our friend Wendy Powell, a postpartum recovery and fitness expert in the UK, has created MuTu System, a 12 week program to get your body back into health after pregnancy. It offers great explanations of posture, body mechanics and nutrition. Wedny has shared with us some great exercises for getting rid of what she calls ‘mummy tummy’ (hence MuTu!) and healing pelvic pain. Check out some of them below, and learn more about her and MuTu System on her website here.

All text + images copyright ‘MuTu® System Limited 2014’

Lie Back + Squeeze

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Lie on your back with your knees up + a small ball between your knees. Bring your knees into your chest far enough so there is no strain on your abs to keep them there.
Turn your feet out. Exhale as you squeeze the ball + draw your belly button towards your spine. You’ll feel your pelvic floor contract at the same time. Relax + repeat.
As well as the ‘belly button to spine’ movement, another way to make sure you get it right is to imagine your lower abdomen as a clock face, with your belly button as 12 o’clock, pubic bone at 6 o’clock + your hipbones as 3 + 9. As you exhale, draw in your belly button, draw up your pelvic floor + imagine pulling 3 + 9 o’clock apart. Inhale + relax, then repeat. Keep your spine in neutral + don’t let your pelvis tilt as you move.

Lamp Post Pee

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Start on all fours, with shoulders directly over hands, hips over knees. Keep your arms straight + try to shift your upper body weight into your fingers rather than all on your wrists.
Exhale + engage your core muscles (gently draw in your lower abdomen as you breathe out + move) + lift one knee out to the side. Just off the ground is fine, but no higher than parallel to the ground. Bring it back down as you inhale, then repeat.
Try not to let your weight shift right over to the supporting leg, you want the movement to happen by rotating at the hip, not by leaning or twisting your whole body to one side. You are stabilizing your torso + engaging your core as you lift your leg, + then relaxing as you lower.
It’s harder to initiate or feel a pelvic floor contraction when you abduct your legs, but be assured that the transverse muscle + the pelvic floor can co-contract – one movement is making sure the other happens!

Personal Training

There are innumerable benefits to having a strong pelvic floor–from stronger urinary continence to better orgasms–and one of the ways to do that is through Kegel exercises, as we’ve definitely heard before. Just squeeze the same muscles you would as if you were looking to stop your flow of urine. But you can also use Kegel exercisers to do this! In a recent article on Health magazine’s website, “Very Personal Trainers: Kegel Devices to Work Your Pelvic Floor,” writer Rachel Swalin lists some Kegel gadgets to add some extra strength where you might not be able to do so on your own: there’s Elvie, kGoal, and Skea, all of which have corresponding smartphone apps to track your progress!

It’s important to remember, though, that with the Kegel exerciser, you should NOT overdo it. A couple of times per week at 10 to 20 reps each time is fine, if you have no problems. Three times per day is sufficient if you do have leaking, but really if you have any pelvic, tailbone, lower abdominal pain or urinary/bowel frequency and urgency, you should consult a pelvic floor physical therapist first. Amy’s book, Heal Pelvic Pain, is only $12 on Amazon and it explains Kegels really well as well as adjunctive exercises to go along with the Kegels. It also goes into detail when to and not to do Kegels, so take a read before jumping into your new purchase.

Why Do I Still Look Pregnant?!: Diastasis Recti, Part I

By Stephanie Stamas

Is it just me, or does it seem like everyone is having a baby this summer? My Facebook feed is filled with pregnant belly time lapses and newborn pictures. I’m at the age where a lot of my friends are starting families and knowing that I am a pelvic floor therapist, I have been getting a lot of phone calls. One of the top questions that I have been asked is – I’ve had my baby, so why do I still look pregnant?

Here is the scoop – When you are pregnant, your abdominal muscles expand in length by the addition of more muscle fibers (sarcomeres) to accommodate your growing belly. After birth, it typically takes 6-8 weeks for the muscles to re-organize and shrink in length to a size that best supports your abdominal contents. This is how the body is designed to adjust to the changing abdominal circumference. Some women, however, grow very quickly and the muscles are not able to expand quick enough. When this occurs, the linea alba (the vertical line of the much-desired six-pack) stretches and the abdominal muscles move away from the midline. This is a more common occurrence in women with more than one pregnancy, multiples (twins, triplets, etc) or a non-exercising lifestyle prior to pregnancy. The stretched linea alba does not typically return to its previous length in a 6-8 week time frame and can allow the abdominal contents (your organs) to bulge through the thin tendonous structure, leading to the look of being pregnant.

Having a diastasis recti may not only result in the mother continuing to look pregnant, but it can also lead to low back pain, pelvic pain, constipation and pelvic organ prolapse. I like to compare the core to a closed canister (you can think of a Coke can) – The diaphragm is on top, the pelvic floor muscles are the bottom and the abdominal musculature – specifically the transversus abdominus and multifidi – are the circumference of the can. These muscles create a tight-knit closed environment that allow for proper support of the viscera (organs), stabilization of the spine with functional activities, and normal function of the bowel, bladder and sexual systems. Having a diastasis recti is similar to having a split along the side of the coke can, and therefore can compromise all systems that rely on that closed environment.

Great, so I think I have a diastasis recti – now what do I do?
Most separations can return to normal with progressive exercises. First off – stop all crunches and abdominal exercises you are doing.  If you have a separation, doing crunches will actually contribute to the muscles being pulled away from the midline and worsen the diastasis. We need to promote approximation, not separation. Some women benefit from wearing an abdominal binder to counteract distraction forces across the linea alba with physical activity. This is helpful for active mothers who are required to use their abdominal muscles, specifically the rectus abdominus, throughout the day (lifting, carrying, etc). The abdominal binder often gives mothers immediate abdominal support, but should not take the place of strengthening. Below is a basic foundational exercise that will begin to allow the rectus abdominus muscle to return to midline.

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If the muscles are not coming together within 4-6 weeks of starting the exercises, see your local women’s health physical therapist (like us!). Sometimes abdominal scars, muscle tightness (especially internal & external oblique) and thoracolumbar fascia tightness can prevent the muscles coming together in the front because of adhesions elsewhere in the core. Also, if you are experiencing low back pain, pelvic pain or dysfunction with bowel, bladder or sexual function, then seeing a women’s health physical therapist is highly recommended.

Just found out you were pregnant or trying to get pregnant soon? Stay tuned for Part 2, where we will discuss preventative measures to prevent a diastasis recti!

Kegels for Men?!

While Kegel exercises have typically been prescribed for women’s health, men richly benefit from them as well. Just as with women, the muscles in a man’s pelvic floor are the foundations of urinary and sexual health. As author Roni Carin Rabin writes in an article in this week’s New York Times, “Like all muscles, these weaken with age, doctors say. In order to strengthen them, men are told to tighten the muscles they might normally use to cut off the flow of urine midstream or prevent passing gas in a closed space. The contractions are held for a few seconds, then released, with the motion repeated 10 to 15 times for each workout.”

Amy discusses this phenomenon in her book, Heal Pelvic Pain. As she writes:

Men typically suffer the same two basic categories of [pelvic] disorder that women suffer—namely, those that result from muscles that are too tight and/or nerves that are irritated, and those resulting from muscles that are too weak. Not surprisingly, the disorders derive from the same basic causes as well:

Maybe it was too many Saturday afternoons at the stadium sitting too long on a hard surface. Or too many long, fast bike rides on that narrow, high-tech, Italian bicycle saddle. Maybe it was the heavy lifting you did when you helped out on your neighbor’s house renovation, or decided you’d like to split the firewood logs yourself, or hauled the summer deck furniture back into the garage in the autumn, or took up weight training at the gym and did it to excess.  The irritation and discomfort that ensue from acute prostatitis can lead to a habitual holding and tightening of the pelvic floor muscles resulting in pelvic floor dysfunction. A simple fall, especially if you landed on the tailbone, or that old sports injury from when you slid into third base last summer and hammered your sacroiliac: any and all of these can result, sooner or later, in a pelvic floor disorder.

One other cause that happens to men only is a prostatectomy—that is, the removal of the prostate—or radiation treatment for prostate cancer or any reproductive cancers. As any prostate cancer patient knows, these therapies for the disease can result in problems of incontinence and erectile dysfunction. In such cases, your oncologist may only be able to promise you that function will come back “within a year or so,” not a terribly cheerful prognosis. What your doctor may not tell you is that a specialist in pelvic floor dysfunction may be able to help.

She prescribes a variety of exercises to perform if you or someone you know is suffering from male pelvic pain, so pick up a copy of Heal Pelvic Pain today to learn more!