Kegels and Crunches Are Out, Hello Reflexive Core

Understanding the Reflexive Core

The Reflexive Core is comprised of the respiratory diaphragm, deep abdominal muscles and the pelvic muscles. This is a pressurized system among all of these muscles (think of a full balloon). The respiratory diaphragm and pelvic muscles are the exact inverse of each other, so these muscles make up the top and bottom of the balloon. The abdominals start at the front, wrap around your sides and connect in your back so think of them as 360 degrees around the center of the balloon.

How it works:

Some functional anatomy, here it goes! The diaphragm, abs and pelvic muscles are connected. These muscles have to coordinate and communicate with each other in order for the reflexive core system to function appropriately.

• Inhalation:  diaphragm lowers, pelvic muscles yield to the pressure change, abs open and release.

• Exhalation:  diaphragm elevates (recoils), pelvic muscles recoil from elongated position, abs engage.

• This is a balanced system and what it should look/feel like in every person when we breath correctly

• This system should activate ‘reflexively’ (ie pelvic muscles tighten, abs engage) with movement or any time there is increased pressure through our center (think: moving sit to stand, bending to lift weights/children, coughing, sneezing, running, jumping, etc)

Sometimes, there is a fault SOMEWHERE in this system. It could be due to:

• Diastasis Recti-a separation of the ab muscles. Think about a slit down the center of the balloon

• C-section or perineal scarring-This can inhibit the elasticity/stretch of parts of the balloon

• Weak pelvic muscles-not enough support/recruitment at the bottom of balloon to respond to changes in pressure inside the balloon

• Pelvic muscles that are too tight-what if the bottom of the balloon was so taut that you couldn’t breath into it and get it to open and expand? Due to its decrease in elasticity, It certainly can’t absorb any pressure/force. Tight pelvic muscles= WEAKNESS.

• Over-gripped abdominals-Think about just squeezing the center of the balloon. Where does the pressure go? This makes for very unhappy and compressed/descended pelvic organs.

• Decreased awareness of alignment/posture-the ‘lean back & butt tuck’ posture or ‘slumped’ posture make for a balloon that isn’t stacked. These muscles can’t communicate!

• Poor body mechanics/exercise techniques-breath holding, bending incorrectly, or exercise techniques that isolate only 1 part of the core system. What if only center of the balloon gets exercised?

• Hormonal changes that occur throughout the lifespan

A fault somewhere in the system leads to SYMPTOMS that may include:

• urinary incontinence-ANY involuntary loss of urine

• urinary urgency-intense urge to urinate, with or without urine loss

• urinary frequency-more than 7x/day, 0-1x/night

• pelvic organ prolapse-heaviness/pressure into the pelvis or vagina (posterior or anterior wall prolapse)

• bowel incontinence, urgency, frequency, constipation

• pain with intercourse, pelvic pain, low back pain, hip pain, perineal pain, c-section pain

What does this mean?

Correct the faults and decrease/eliminate the symptoms.

Note: This is why performing ‘Kegels’ or traditional abdominal exercises may not be effective or allow you to meet your goals. One must consider retraining the entire core system and addressing all faults in order to be most effective for optimizing pelvic health.

So, immediate actions:

• Watch your standing and sitting alignment. The system has to ‘stack up’

• Breathe correctly. Breathing with your diaphragm (360 deg rib cage expansion) decreases pressure on the pelvic floor and abs and brings diastasis separation closer together

• Exhale to activate the reflexive core when lifting, standing up from a squat, etc

• Be mindful of exercise techniques that could be contributing to faults and symptoms (This could be an entire other blog post!)

• Seek help from a specialized PT, of course!

How will Physical Therapy help?

We have highly specialized training and we understand the pregnant and highly complex postpartum body in depth. However, we do have training to support women throughout the entire lifespan, even through menopause and beyond!

• Proper evaluation is key. We will look for any and all faults and customize women’s physical therapy experience

• Manual therapy. We will used skilled touch to address internal and external soft tissue concerns. Trigger points, fascial restrictions, nerve irritations, poor musculoskeletal alignment

• Education. This is where we make behavioral, lifestyle, postural, ergonomic, body mechanics changes needed for women to succeed in healing her condition/concern

• Exercise. No more Kegels or crunches please! I could talk about this forever. We guide women on re-training their entire system in a very functional way (ie how to bend, lift/carry babies, run, weight lift without losing urine, etc)

Who can this approach help? 

• moms (pregnant or postpartum)

• female athletes

• women in menopause

• any female experiencing pain or inability to wear tampons, pain or inability to undergo a gynecological exam or concerns with sexual health

• any male experiencing pelvic, hip, lumbar pain or urinary symptoms

The good news...symptoms and conditions are highly treatable, don’t have to be endured, and it’s never too late to seek care!

All women’s bodies are unique. If you would like to know more about how the above relates to your specific condition, email me here. Please also follow us on Instagram or join our private Facebook Group for a ton of free support on common women’s health concerns.

Next Blog: Pelvic Rehab for Mom: Just as necessary as knee rehab for athletes

Response to NPR's article "Flattening the 'Mummy Tummy' With 1 Exercise 10 Minutes A Day"

The latest NPR article about “Flattening the Mummy Tummy” came into my world from 5 different directions today. I read (initially between clients) and then re-read and then re-re-read this article. I desperately wanted to agree however it has my radar up, to say the least. In all fairness, I am not familiar with this specific technique, I have never been to a class and I can only speak about the method within the context of how it was written in the article. I do have some concerns (read: major opinions) and would like to open up more dialogue around this and all exercise techniques in the postpartum period.

1. Mummy Tummy.  We need to change the culture around the ‘flat is fit’ mentality. Let’s just focus on being functionally strong and well supported in our day to day lives!

2. 10 min of exercise will cure DR. First of all, just no. No, no, no.  It is a major disservice to tell women that one exercise for only a few minutes a day will fix Diastasis Recti (DR). What about how we are using our bodies the other 23 hours and 50 min? I think it is way more important to consider how we sit, stand, carry babies, lift weights, bend, squat, and carry car seats! It isn’t about ‘exercising’ the core but rather about ‘re-training’ the core. I have worked with many clients with DR and I am certain it isn’t a simple or quick fix.

3. The ‘sucking in’ idea has to go. Far, far away. Sucking in the tummy muscles can do more harm than help. Think about squeezing the center of a balloon. If we create excess tension in the center, where does the pressure in the balloon go? Up and down. Either direction is problematic, but especially concerning is down due to pressure and stress on the pelvic organs and pelvic floor.

4. Reflexive core. I do think these instructors are focusing on the involuntary contraction of the lower abdominals by utilizing an exhaling breath. This exhale is attempting to activate the reflexive core but really it is the combined function of the diaphragm, abdominals AND pelvic muscles.  This is what should kick in for us naturally as we move and I use an exhale technique to help my clients retrain the reflexive core. But I don’t cue ‘tighter, tighter, tighter’ at the abdominals. I cue a coordinated contraction among the muscles. And cue the ability to generate only the appropriate force necessary for the demand of the task. A simple roll over in bed has a different contraction and demand than when we are running or jumping.

5. DR doesn’t have to completely close to have a strong, functional core. Not much else needs to be said here. My goals for a client are never to decrease DR by X amount. My goal is for the client to stop peeing when they sneeze or to decrease low back pain when carrying baby.

6. This type of exercise isn’t functional! This is already somewhat tied into my other points. But sitting cross-legged, on your hands and knees or performing this while standing doesn’t exactly replicate life. What about holding a 30 lb toddler while reaching down to pick up a heavy bag? THIS is life. And often times, the postpartum reflexive core needs to be re-trained to know how and when to kick in with variable demand situations. A suck in and hold is just not how the core system works.

7. A piece of me feels this preys on the desperation of women. Fix DR in 10 min over 12 weeks? Lose inches off my waist without doing anything else? I will have a completely flat tummy again? And finally....Let’s all measure and compare ourselves during class? Yikes.

8. I am biased. I believe all women should have access to a Pelvic Health Physical Therapist in the postpartum period for solid guidance and support. For BIG PICTURE pelvic health and body wellness over the long term (because postpartum bodies are more complex than DR and belly fat). Can’t easily access pelvic PT? Check out all of our Online Programs here, including a comprehensive Pregnancy & Postpartum Program!

All women’s bodies are unique. If you would like to know more about how the above relates to your specific condition, email me here. Please also follow us on Instagram or join our private Facebook Group for a ton of free support on common women’s health concerns.

Next Blog: Kegels and Crunches are OUT!

Why Kegels might not eliminate urinary incontinence

As a Pelvic Health PT, I’ve been at odds with the over-prescription of Kegels as a silver bullet ‘cure’ for all things wrong in the pelvis, specifically urinary incontinence (UI). This could be a much longer blog post, but I stuck to the top 3 reasons why I think Kegels are generally ineffective.

1. Urinary incontinence may come from weak pelvic muscles, but not all weak muscles need strengthened. Let’s look at a bicep muscle. It needs to contract AND release. It will be weak if it cannot easily contract and it will also be weak if it cannot fully release! The same is true for the pelvic muscles, and the latter situation is much more common believe it or not! It’s important to understand which category your pelvic muscles fall into in order to effectively address it!

2. Kegels don’t replicate function. Pelvic muscles never work in isolation, so why train them that way? We are taught to do them in the car while at a stop light. And repeat over and over throughout the day. One thousand bicep curls don’t help you much with a half marathon. So an isolated contraction isn’t actually what is required when you bend to lift your toddler or when you perform burpees at the gym. We need to focus on functional re-training our core system to optimize results. 

3. Many factors can contribute to UI. It’s just a sign that something is off somewhere in the core system. Let’s also take into account standing and sitting posture (alignment matters!). How about if someone has diastasis recti? What about a prolapse? How about someone who constantly grips their tummy muscles or who truly has a weak transversus abdominus? This list goes on….

The best way to assess all the factors that contribute to UI specific to you would be to see a Pelvic Health PT. You can also access all of our Online Programming, right from the comfort of your home!

All women’s bodies are unique. If you would like to know more about how the above relates to your specific condition, email me here. Please also follow us on Instagram or join our private Facebook Group for a ton of free support on common women’s health concerns.

Next Blog: My Response to NPR’s article ”Flattening the Mummy Tummy”