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How To Help This Common Core Problem

Screen Shot 2021 02 07 at 8.23.15 AM - How To Help This Common Core Problem

Jessica Bento, Physical Therapist (Creator of DVRT Restoration, DVRT Rx Healthy Knees, Shoulders, & Pelvic Control Courses

I posed a question the other day on the good old Instagram asking what topic people had the most questions on. Surprisingly there was a lot on how to go about working with people that have diastasis recti. Some of you might be going what the heck is that and why should I keep reading this blog? Well, I will get there and I promise this will be beneficial to almost everyone but first what is diastasis recti? 

Diastasis recti is the partial or complete separation of the rectus abdominus which is rather common following pregnancy. So why talk about this very specific problem? Well, it has a lot to  do with the core, something that pretty much anyone with any history of abdominal surgery’s and issues like hernias or even anyone with a history of low back pain.

DiastasisRectusAbd SM 1 - How To Help This Common Core Problem

Core strengthening is where I start with a lot of issues not just a diagnosis of diastasis recti and low backs but with shoulders, knees and hips. So hopefully you are seeing how it might be beneficial to keep reading. 

Where people go wrong with fixing “core issues” is they focus on the isolating muscles typically like the rectus abdominis. You certainly can’t blame people, if we have a weak or injured muscle, why not try and focus just on that area? Even from a therapy background we focus on specific areas and really didn’t have an integrated approach when it came to treatment. 

In fact, trying to isolate just the rectus abdominis in issues like diastasis recti can cause more issues and delay the healing process. 

We learn new things about the body everyday, so our approach to training, strengthening and rehabbing should be changing as well.

So where to a lot of people go wrong? Ab crunches, Russian twists, planks for days…I could name so many exercises that I see people doing and they aren’t really understanding the function of the abdominals and can actually be harmful for those with issues like we have been discussing. 

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So I am sure you have read time and time again in our blogs but lets go over what we mean when we say core: 

I think no one better can explain than world renown spine expert, Dr. Stuart McGill, “The core is composed of the lumbar spine, the muscles of the abdominal wall, the back extensors, and quadratus lumborum. Also included are the multi joint muscles, namely, latissimus dorsi and psoas that pass through the core, linking it to the pelvis, legs, shoulders, and arms. Given the anatomic and biomechanical synergy with the pelvis, the gluteal muscles may also be considered to be essential components as primary power generators (the synergy of these components is outlined elsewhere.”

So, that means trying to isolate any muscle of the core is not only an exercise in futility, but rather unproductive as well. McGill additionally points out, “The core musculature functions differently than the limb musculature in that core muscles often co-contract, stiffening the torso such that all muscles become synergists-examples in a wide variety of training and athletic activities. Thus, training the core effectively means training it differently than the limb muscles.”

core training

This means the core is about resisting motion more than anything (moving the spine loaded and unloaded are different, just as moving the body and wanting to develop power and strength is very different) and this is accomplished with “stiffening” of the core. 

So when people ask me about helping someone with diastasis recti and what they should do…I always start with a core strengthening program that has an integrated approach as mentioned before, this goes with most of my patients regardless of their diagnosis. 

My go to core strengthening exercises are the bird dog, deadbug, side plank, and hip bridge variations which all teach total body integration.

 

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Ben Beeler showing a great progression to one of my favorite core exercise the deadbug. It is important to know how to start the right place with people as coaches often start way too advanced with the movements that their clients can control.

Here I break down bird dog progressions as each level has a different purpose.

 

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Josh explains where people often go wrong with the bird dog as they don’t really understand the intent of the movement and knowing the why’s allows us to give better exercises. The above video explains why we do NOT do bird dogs off of benches for example.

push-up

Most people THINK they have side planks down until we go over the intent we have behind these movements. Building lateral core stability is so essential in building proper strength, stability, and resilience.

 

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The ways we can progress side planks are many (I break a bunch down in my DVRT Rx Healthy Knees Course) but here are some with very specific progressions of side planks and bird dogs that really emphasize making those progressions.

Ben also helps us bring bridging to being a better exercise. Unless we connect the core and lats to our hip bridges, we don’t actually build qualities that help the low back and pelvis. That is because we don’t create “force closure” which is, ”

Force closure is the term used to describe the other forces acting across the joint to create stability. This force is generated by structures with a fibre direction perpendicular to the sacroiliac joint and is adjustable according to the loading situation. Muscles, ligaments and the thoracolumbar facia all contribute to force closure. Force closure is particularly important during activities such as walking when unilateral loading of the legs creates shear forces.

Force closure creates greater friction and therefore increased form closure and what is called “self-bracing” or “self-locking” of the joint. According to Willard et al. force closure reduces the joint’s ‘neutral zone’ thereby facilitating stabilization.” (full article HERE)

 

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Seeing them all together hopefully helps how we can use them either as an activation series before the main strength and conditioning focus of our workout, or for some people that really have issues with such conditions, this IS their workout. We don’t need to rush people to higher level training, we need to make sure they own the control of their body to continue to progress and be healthy in doing so! These drills don’t just address that of diastasis recti, but anyone coming off a low back injury or those that want to set a better foundation of stability before they get to high level strength and power drills.

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