American Fitness Professionals & Associates

By: Mark J. Occhipinti, M.S.,Ph.D., N.D.c.

Did you know that the abdominal muscles stretch and separate during pregnancy? During pregnancy this muscle group seperates and stretches to accommodate the baby.  A condition known as Diastasis Recti occurs in many pregnant women. This is due to a seperation of the rectus abdominus at the midline of the belly. This condition is more likely to occur in women that experience multiple pregnancy’s along with being over-weight.    This condition can become permanent if the mother does not begin muscle group is centered a strengthening program no later than six weeks after delivery.

The proper post-natal exercise is encouraged to close this separation, and regain much needed muscle tone.
The rectus abdominus group is centered from the base of the sternum and middle thoriac cavity to just above the pubic bone.
During pregnancy this muscle group separates and stretches to accommodate the baby.  

Beginner Abdominal Program for Pre-Natal Women

More likely than not it is to redefine their waists and tone their abdominal area.   This can be achieved with the exercise outlined below without creating ribbon bulging in the presence of a diastasis recti and as you will read, this exercise also poses other very important benefits.

Diastasis Recti (stretching of the Linea Alba resulting in separation of the rectus Abdominus muscles) occurs in most pregnant women to some degree.   Much controversy surrounds the significance of the role of exercise post-natal to help the separation to resolve as no research has been done to answer this question.  It would seem logical however to avoid activities and exercise that would cause visible ribbon bulging (this is bulging of the abdominal contents between the separation) and that such bulging would further aggravate the tendency for the rectus abdominus muscles to separate.

Sit-ups / abdominal curls etc is one particular exercise that causes visible ribbon bulging if present.  In fact an abdominal curl   is performed to actually assess the size of the separation.  This exercise program to strengthen the abdominal muscles is based on extensive research undertaken by   G.A.Jull Mphty, MMPAA, FACP, M.Comerford BPhty),   and   C.A.Richardson (BPhty PhD), both based at the Department of Physiotherapy, University of Queensland (Australia).

They have found that dynamic support of the lumbar spine involves the co-contraction of the oblique abdominals, transverses and the lumbar erector Spinae (particularly multifidus) with a non-dominating contribution from the rectus abdominis muscle.  
This dynamic support acts like a corset for the protection of the lumbar spine, particularly during activities where the spine is loaded, such as when lifting.  During pregnancy the oblique abdominals and transverses abdominus (along with the rectus abdominus muscles) are stretched and weakened and thus their line of pull is altered.

This in turn can result in decreased lumbar spine support normally provided by these muscles and may ultimately lead to lower back pain.     It would seem obvious then for the importance to strengthen these muscles back to pre-pregnancy strength to protect and support the lumbar spine, especially in consideration of the increased stresses posed on a new mother’s back with frequent lifting and carrying of baby.   Strengthening these muscles will also help re-define the waist and tone the abdominal area, which are of major importance to many women post-natal.

The best way to strengthen these muscles is to perform a technique where you make your lower abdomen “cave in” (abdominal hollowing) or where you draw your belly button up and in against your spine.   The subject should be able to hold the contraction (brace) while remaining relaxed and continuing to breath.   Holding one’s breath is a trick movement and if a subject is doing so they will loose the contraction as soon as they breath out.  Initially I teach my patients to contract the muscle as they breath out as so they can not use this trick movement. The above exercise can be done in any position.

A four point kneeling position is often beneficial initially as it   provides a stretch facilitation of the muscles making it easier to perform.   Once this has been perfected one can progress to kneeling and sitting positions with the aim to eventually incorporate the bracing into activities of daily living in particular when the back is placed under increased stress such as when lifting and coughing.

DOSAGE:     Initially if the muscle is weak only a short contraction may be possible for example 1- 3 seconds.   This should be repeated 10 times in one session.   Each session of 10 reps should be repeated 3-4 times per day.   As the muscles strengthen the contractions should be held for longer periods until the subject can hold the contractions for 10 seconds and repeat them 10 times in a session with ease.

Advanced Abdominal Program Pre-Natal

The current way that we teach our pregnant and postpartum clients to exercise their abdominals is similar to the way it was described in your article.   However, the exercise prescription in your article is extremely conservative.   We have our pregnant clients perform transverse training everyday during their pregnancy to keep the diastasis from increasing in size, increase truncal stability to decrease incidence of back pain, and to strengthen and increase endurance in the transverse muscle so it can be utilized for pushing during labor.   Our exercise prescription starts out with the abdominal hold that was described in your article but that is used only initially to bring awareness to the transverse muscle which is hard to identify for most people.

We quickly progress to having women bring their belly button to their spine (transverse muscle) and have them contract the muscle backwards.   Upon the release of the contraction, the women will release no further than their starting position of belly button at the spine.   We have our pregnant clients start initially with a hold of 50 counts followed by 10 contractions.  
They count out loud so they can not hold their breath.   They then start doing their transverse contractions 300 minimum per day (one set equals 100 contractions).   The recommended contractions per day after 1 week of training increases to 500 per day accroding to Gail Black, RN, BSN.

Professor Helen Varney, CNM,MSN, chairperson of the Maternal/Newborn Program at Yale University School of Nursing has found that when an exercise program is not initiated as soon as possible after delivery (usually not later than 6 weeks) to regain the muscle tone of the abdominal wall, complications can occur in the mother. The space that appeared during pregnancy in the rectus abdominals fills with peritoneum, fascia and fat. This can have a significant consequence that could manifest themselves as:

1. Reduced support for subsequent pregnancies.
2. Increased lower back strain during pregnancy and general activities of daily life.  

In addition to the benefits of returning to or beginning an exercise program mentioned above, exercise offers the following:

1. Improve abdominal strength.
2. Regular exercise improves circulation.
3. Decreases fatigue, lessens lower back strain.
4. More importantly, and a factor that is often overlooked in the excitement after
5. Childbirth, a lessening of the emotional strain on the mother.
6. Exercise will help the mother take off the weight from the pregnancy more
7. Efficiently and effectively which will improve her self image.  

Exercises for the Abdominals & External & Internal Obliques

Crunches: Remember to begin lying on your back with the knees bent (flexed), heels or entire foot on the floor. Hands or finger tips should be placed lightly on either side of temples. (This position removes the chance of using your arms to assist you in performing the crunch.) Gradually exhale first before you begin to pull your shoulders off the floor (this allows the diaphragm to move down and out of the way). Pull your shoulders,, off the floor gradually until the shoulder blades (scapula) have just cleared the floor. then return gradually to starting position (breath in on the way down).
1-2 sets of 8-10 repetitions are a good start. To make this more advanced: After exhaling, contract your abdominals isometrically first, then perform the crunch as described above. Talk about a burn!

Obliques: Lying On the floor in the same position. cross one leg at a 90 degree angle. Pull in a crunch movement the opposite arm to leg (example: right arm across the body towards the left crossed leg). Advanced techniques include the “jack knife.” a movement that is accomplished by lying on your side and pulling your upper body off the floor. Slow and deliberate movements will really work the muscles. Again. 1-2 sets of 8- 10 repetitions.  

Misconceptions Concerning Working the Abdominal Muscle Group

These muscles act to stabilize the torso to maintain upright posture whether we are sitting or standing. This means the abdominal muscles contract isometrically for 12-16 hours every day. The most pervasive misconception is that this area can be worked every day, and needs hundreds to thousands of repetitions. Done correctly with slow continuous tension, then adding resistance when an advanced level is reached will achieve more benefit with less strain on the lower back, the hip flexor group (which is already developed enough from walking, stepping and bending and flexing at the waist).

It is amazing that in 2006, in the face of facts that an individual, contrary to the evidence available still believes that they can perform enough repetitions to reduce their waist.
Only cardiovascular exercise and push-aways from the table can accomplish this feat.