Why am I exercising but not losing the “baby weight”? I feel like my stomach is getting bigger even though I’m working out. Help! When can I do crunches? These are common questions and concerns I hear from moms everywhere. However, they may be noticing an unfortunate reality.
Let’s set one thing straight from the beginning. Crunches are okay when you are ready to take control of the movement by slowing down and doing it “right”. But you must also ensure that you aren’t experiencing any of the “3 P’s” (peeing (incontinence), pain, or signs of a prolapse).
Until then: no, no, no.
The big question remains, then, how are you supposed to flatten your tummy if it is not recommended to return to crunches yet? Is there anything you can do? The short answer is “yes.” Read on to understand more.
Pregnancy and childbirth are associated with increased inter-recti distance (IRD) (the space between your abdominal muscles). The clinical term to describe this is diastasis recti abdominis (DRA). All women experience some degree of separation (as shown in the second picture below) during pregnancy, and most women notice this separation or gap is still present postpartum. Refer to Jessie Mundell’s article at Girl’s Gone Strong to learn more.
Exercising too aggressively or with the wrong kind of movements can lead to unintended stress on this gap causing it to widen further. High impact exercise before proper abdominal control is relearned is not only ineffective, but it could also have a detrimental effect to losing the ‘mommy tummy’.
Disclaimer: The following information focuses on function from a physical therapist’s perspective, as I am a strong believer that this should be the priority in recovery. However, when these tips are applied correctly, you undoubtedly may see the body image results you are looking for too.
Now, let’s take a moment to reflect back in time. Your body has gone through a tremendous amount of change from the time of conceiving your baby. The actual tissue structure that your body is made up of has changed. It truly is remarkable. Pregnancy and childbirth has a significant impact on the integrity of abdominal wall tissue, specifically. This includes the skeletal muscle and all of the connective tissue and fascia that covers it. You have proof in the stretch marks (that you should wear with pride!). It’s not the same “quality” that it was pre-pregnancy. Your skin and your muscles were forced to expand to accommodate a growing baby.
There are countless opportunities for you to stress this altered abdominal tissue throughout the daily happenings of #momlife.
- Picking up a screaming toddler off of the floor during meltdown mania at the grocery store
- Carrying a full laundry basket up and down the stairs in one hand and an infant on your hip in the other
- Simply getting off of the floor or out of bed
- Lifting your child into their car seat, especially into a large vehicle that sits high off of the ground
- Getting out of a comfy, deep sitting recliner
- Coughing, sneezing, or laughing uncontrollably
And we haven’t even mentioned the stress added during an intentional exercise session (e.g. high impact activities like running or jump-roping, a crunching motion exercise, overhead press strength training) can put further stress on the inter-recti distance (gap) causing it to widen further.
Therefore, you must be mindful of how you exercise even more so than what you are doing to exercise.
And it all starts with two words: Pressure Management. Let me refer you back to one of our first conversations about pressure in “A Better way to Breathe and the Right Way to Kegel”.
In short, a quick review can be found by watching this short video about core connection breathing. In order to manage pressure, use your breath and activate your core muscles. “Engage from the bottom up” means: contract your pelvic floor, then contract your deep (lower) abs, zipping up using your exhale breath to help.
When you ask “what” you should do for exercise, I will always defer you to taking it back to the basics to start. This means focusing on the above activation pattern with simple exercises to relearn proper muscle recruitment. It’s necessary that you put yourself in a position (quite literally) to succeed before advancing to higher level activities to avoid developing poor compensatory strategies. Even though these exercises may seem easy or boring, there is value. A recent study in the Journal of Women’s Health Physical therapy outlines exactly that.
Deering, et al. (2020) evaluated what an eight-week abdominal retraining program did for thirteen postpartum women who were recreational runners. The researchers measured inter-recti distance (the width of the “gap” in centimeters) with ultrasonography at study onset. The postpartum women then participated in an eight-week abdominal muscle retraining program utilizing ultrasonography as biodfeedback. This biofeedback allowed the women to see how they were contracting their muscles during different exercises. The intention of using biofeedback is to retrain how to properly fire the muscles to decrease the gap instead of widen it further. After eight weeks of this intervention plus a home exercise program, the researchers found that the inter-recti distance below the belly button decreased (meaning the gap between muscles moved towards closing), and it remained stable at a six-week follow-up!
The ten minute home exercise program can be found in the table below.
To understand how to do the abdominal draw-in maneuver (ADIM) most effectively, check out THIS video or refer to my blog about the right way to kegel.
- Week 1: The women start with performing the ADIM laying on their back, with knees bent, feet flat.
- Week 2: They progress to lifting their buttock off of the ground (bridge) and squeezing a ball between their knees.
- Week 3: One heel is lifted as you do the same move as the prior week.
- Week 4: Return to week one’s position but add in lifting your feet off the floor one at a time for 10 seconds as if you are marching while laying on your back.
- Week 5: The position changes to 4-point (on hands and knees) and reaching one arm forward and the opposite leg back.
- Week 6: Progress the position to a side-plank on the knees like in this video.
- Weeks 7-8: Finally, progress to more functional positions of double leg and then single leg squatting.
It’s important to master the ADIM in week one in order to continue to perform this pelvic floor muscle and deep abdominal muscle contraction with each of the exercises listed in future weeks as they become more intense.
Demonstration of each exercise can be found HERE or in the Move Better Mom Better Video Library.
This gradual progression allows your body to practice the ADIM in positions that stress the abdominal wall least working towards more challenging postures. It’s imperative that you are mindful of properly engaging your pelvic floor and deep abdominal muscles from “the bottom up” to see similar results. It would be a waste of time to rush through these basic movement patterns because they seem easy. It’s important to work through this progression to teach your muscles to establish the habit of firing correctly because #momlife (refer to list above) is bound to put you in any and all of these positions at some time or another.
The women in this study had given birth within the previous two years and got results. Therefore, this evidence tells us that it’s not “too late” if you didn’t know about these exercises in the first months postpartum, but they can be safe to perform then. Additionally, this study included women who delivered vaginally and via cesarean delivery.
The researchers initially intended for this study to have a control group of women. This control group was meant to be women who could appropriately perform the ADIM. However, the researchers were only able to find three postpartum women who could do this so there were not enough women to include this group. This further emphasizes the importance of seeing a women’s health physical therapist postpartum.
As mentioned above, this study used ultrasonography to help retrain the moms to activate their abdominal muscles most efficiently. Most women’s health physical therapists will use surface eMG biofeedback instead in the clinic setting as ultrasonography for feedback is generally reserved for research. When looking for a therapist, be sure to ask if they have this type of intervention available if you are concerned about knowing how to “contract” your abdominals “correctly”. Being able to see on a computer screen or handheld biofeedback device what you’re doing helps the mind-muscle connection get reestablished which enhances neuromuscular control. In this study, the women performed one 30-minute session per week for eight weeks. Your physical therapist will be able to make personal recommendations on the frequency you may benefit most from following an individualized evaluation. It is common that your body doesn’t automatically remember how to contract the abdominal muscles in an effective firing pattern postpartum. Ineffective engagement of your abdominal wall will only further delay your progress in regaining functional use of your core and losing the ‘mommy tummy’ though. For some women, it only takes one to two treatments to “relearn” how to activate the abdominals effectively again.
As a side note, the women’s running speed also increased following this intervention. Improved abdominal activation will inherently enhance pelvic control which directly results in effectiveness of the gait cycle. However, it must also be pointed out that those who were further out postpartum had better success of decreasing the inter-recti distance (gap). There were only three women who did not see an improvement in the inter-recti distance after eight weeks of intervention, and they actually saw an increase. These three were the newest postpartum. They were still in their fourth trimester and had reported a return to their pre-pregnancy running mileage by the end of the study. Perhaps, if they would have completed the eight-week abdominal activation program prior to returning to running at the intensity they did, they could of avoided widening the gap to further progress their diastasis recti. Even though they were exercising regularly, this high-impact activity was clearly too much, too aggressive, and too soon. Because their inter-recti gap widened, they likely aren’t seeing their tummies flatten like they probably hoped secondary to poor pressure management. Remember my tips about Criteria for Return to Running Postpartum and how it’s not just a matter of time.
Moms everywhere may need to take it back to the basics to reach their fitness goals. This recent article in the Journal of Women’s Health Physical Therapy outlines a specific abdominal retraining exercise program that helped postpartum women decrease the inter-recti distance below their belly button. In decreasing the gap, they are demonstrating better pressure management and mastery of activating the abdominal muscles efficiently in order to strengthen them effectively. This will avoid putting outward pressure on the abdominal wall which inevitably prevents losing the ‘mommy tummy’. A little bit of patience and a lot of committed mindfulness for technique can go a longs way in allowing you to safely return to higher level exercise like running and cross-fit without causing your tummy to ‘get bigger’.