What really is the core?
When referring to the core, most people think it's simply the abdominal
muscles. However, the core encompasses much more than that.
The core is comprised of the following:
1. Pelvic floor muscles
2. Transverse abdominis
3. Internal and external obliques
4. Rectus abdominis
5. Erector spinae (group of muscles of the back)
6. Multifidus (deepest muscle along the spine)
It is crucial for all elements of the core to work as a whole. Weakness and/or excessive stiffness in one muscle can affect others.
Urinary incontinence is a common and often embarrassing problem. The severity ranges from occasionally leaking urine when coughing or sneezing to having an urge to urinate that's so sudden and strong one can't get to a washroom in time.
There are a few types of urinary incontinence:
1. Stress incontinence: urine leaks with coughing, sneezing, laughing, exercising or doing other activities which exert pressure on the bladder.
2. Urge incontinence: sudden, intense urge to urinate followed by an involuntary loss of urine. In many cases, frequent urination is also present.
3. Overflow incontinence: inability to completely empty the bladder, resulting in frequent or constant dribbling of urine.
4. Mixed incontinence: when more than one type of urinary incontinence is present.
Many women experience leakage to some degree during pregnancy and/or after childbirth. Unlike what many women might think after having a baby, leaking urine (even a couple drops) when coughing and sneezing is not ok! It is not something to be joking about or taken lightly. It is a form of pelvic floor dysfunction and could be a sign of other problems.
Women with any sort of urinary incontinence need to be very selective with the types of exercises they perform. Exercises that create excessive intra-abdominal pressure may need to be temporarily avoided or kept to a minimum in people who do not yet have a functional core strong enough to withstand pressure. This includes impact activities such as running, jogging, skipping, jumping, and most traditional abdominal exercises - including many Yoga and Pilates exercises/poses/stretches. This doesn't mean, however, that all of these exercises are inherently "bad". In some cases, making small tweaks to alignment and breathing is enough to avoid leaking!
Hypopressive training coupled with other core & pelvic floor exercises can help reduce and, in many cases, completely eliminate symptoms of urinary incontinence.
How we can help!
Our program is recommended by many family physicians, physiotherapists and even the Pelvic Floor Clinic in Calgary. After a detailed 1-on-1 consultation and assessment, we will be able to determine the best course of action. Most often this includes a mixture of core stability exercises, deep abdominal and pelvic floor engagement, flexibility training & myofacial release, back and glute strength training, low-impact cardiovascular exercises and Hypopressive training. When all the elements of the core are working together properly, symptoms of pelvic floor dysfunction such as the ones listed at the top of this page are greatly improved.
The Hypopressive technique is an amazing method we use, in conjunction with other types of exercises, to reprogram the core (which includes the pelvic floor, abdominals, lower back, glutes and diaphragm) and return it to a functional state.
Below are a few facts on the Hypopressive technique:
40-50% of women in their life time will suffer from some form of pelvic floor dysfunction. Men are not immune either! More and more people are experiencing one or more of these issues earlier in life, often in their 20's and 30's. A large contributor to this problem is the increased popularity of high impact activities and exercises that increase intra-abdominal pressure - outward pressure around the abdomen and downward pressure on the pelvic floor. These are called HYPERPRESSIVE activities. If these activities are performed without having a functional core that is able to manage this increase in pressure, it can prove detrimental and begin to cause issues like the ones listed above.
What is more important - core strength or core stability?
Traditionally the emphasis of core training has been on strength and aesthetics. For many, this is achieved by a series of exercises such as crunches, sit-ups, planks, v-sits, bicycle crunches, etc. These exercises mostly work the front part of the abdominal muscles (rectus abdominus). By overworking the rectus abdominus, which is responsible for spinal flexion (rounding of the back), the deeper muscles (such as the transverse abdominus, the diaphragm and the pelvic floor) that are responsible for stability of the spine and pelvis are neglected. By ignoring these very important elements of the core, optimal core function cannot be attained. Core stability is the ability to control the force we produce. Without control and function, strength and endurance are useless, like a fish flopping out of water.
For those who already have symptoms of pelvic floor dysfunction such as urinary incontinence, pelvic organ prolapse or diastasis recti, it is crucial to train the core properly with a focus on stability and function. The majority of traditional core exercises are not the way to go - we can teach you which ones are.
Pelvic organ prolapse
Pelvic organ prolapse (POP) occurs when a pelvic organ (such as the bladder or uterus) drops from its normal place in your lower belly and pushes against the walls of the vagina. This can happen when the muscles of the pelvic floor that hold your pelvic organs in place get weak or stretched. Risk factors include pregnancy, childbirth, chronic coughing, chronic constipation, repetitive heavy lifting or high impact exercise, surgery or hormonal changes. Many women will have some kind of pelvic organ prolapse. It can be uncomfortable or painful, but some women have less obvious symptoms and might not even know they have it. Symptoms are not strongly correlated with the grade of POP.
It can be devastating to receive a diagnosis of prolapse (whether from a pelvic health physiotherapist, a gynaecologist or other physician). Searching the internet usually results in finding very little treatment options other than surgery or doing Kegels. In most cases, Kegels on their own are not enough to strengthen the pelvic floor as a whole. If not done correctly, they can even do more damage.
However, we know that there are many ways to reduce and manage symptoms. We teach our clients how to:
- Lessen the load on the pelvic floor in everyday movements
- Make adjustments to posture and breathing to optimize pelvic floor function
- Reduce tension/gripping in the upper abdominals & diaphragm
- Build stability and strength in the deep core muscles through safe exercise choices
- Relax the pelvic floor muscles (tension and over-gripping often increases symptoms of POP)
The training we provide greatly complements pelvic floor physiotherapy treatments. We work closely with many well-known physiotherapists across Calgary. Women who come to us with pelvic organ prolapse generally feel big changes in their symptoms within the first two weeks and, in many cases, can eliminate their symptoms!
Below are testimonials from some of our clients who experienced these results:
Do you suffer from any of these:
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Diastasis recti (ab separation)
Diastasis Recti, a condition often ignored by the medical community, is a problem that screams for more attention. That is why everyone, including men and women, should be assessed. A sign of diastasis is a dome shape when doing a crunch. Many people are unaware they have a separation, and this can cause bigger problems. Moreover, many exercises performed in popular workout programs can worsen diastasis recti. As can improper breathing (causing excessive intra-abdominal pressure), less-than-ideal posture, and under-recruitment of the deeper core muscles.
Diastasis recti is a separation of your rectus abdominis, the outermost abdominal muscles (the 6-pack muscles!). It most often occurs in women during pregnancy or during pushing, but can also be present in both men and women outside of pregnancy and postpartum. When these muscle separate, the connective tissue that runs vertically between the left and right sides (linea alba) joining these muscles stretches sideways, causing it to become thinner and weaker. It literally becomes like plastic wrap, not being able to support your belly button, back and organs. This dramatically increases the risk for a hernia.
100% of women have some extent of diastasis recti in the 3rd trimester. In some cases, it will resolve in the first few weeks postpartum. But what many do not know is that if left untreated, this distance at 8 weeks remains unchanged at 1 year postpartum! Diastasis recti and pelvic floor problems tend to be present together. 66% of women with diastasis recti have some level of pelvic floor dysfunction.
Ab separation is caused by continuous stretching of the connective tissue and also intra-abdominal pressure on it. The belly button is often the weakest spot of this connective tissue. Any exercise that significantly increases intra-abdominal pressure (especially with non-optimal breathing and alignment) can make the separation worse and/or weaken the linea alba. Depending on the severity of the diastasis, the following exercises may not be appropriate choices: front planks, push-ups, crunches, sit-ups, double leg lifts or lowers, v-sits, bicycle crunches and other traditional core exercises. Even exercises such as squats, deadlifts, pull-ups and other commonly performed exercises can worsen diastasis recti if performed with an excessive rib flare and/or breath holding.
A diastasis can be improved on anyone at any time, even if it has been present for a long time. Rehabilitating a diastasis is achieved by not only decreasing the separation between the rectus abdominus, but by increasing the tension in the linea alba. We need to reestablish proper function of the core and proper balance between the rectus abdominus, the internal and external obliques, and the transverse abdominus.
Surgery should be your very last resort! If you decide on surgery, abdominal muscles must be strengthened beforehand to maintain the integrity of the sutures. The surgery to repair this requires a hipbone to hipbone incision and the recovery is very difficult. That is why corrective exercises are recommended first, and from what we have seen with clients, in most cases that is enough.
Below are testimonials from some of our clients who had diastasis recti: