This sponsored post is brought to you by: Kelley Lindstrom, DPT, the Clinic Director at Therapydia Beaverton, one of the four Therapydia locations in the Portland area. With a one-on-one – treatment approach that combines manual therapy, movement retraining and functional strengthening to treat pain and dysfunction, Kelley is passionate about helping patients of all ages and abilities return to a pain-free and active lifestyle. Learn more about Kelley and the other Therapydia Portland physical therapists.
When most people hear the word “core” in relation to their body, they are really only picturing their abdominal muscles. This is understandable because before we had a good sense of functional movement and how everything works together, a strong “core” only meant that you had a 6-pack or that maybe you could do 100 sit-ups. The focus was, and in a lot of cases still is, on the aesthetic appearance of the “core”. No one considered that even if you have impeccable looking abs, if you can’t breathe properly or if you experience incontinence, you have a weak core. Many otherwise healthy people tend to focus only on the muscles that they can SEE the results in, rather than focusing on the muscles that they can FEEL. So, if 6-pack abs don’t make for a perfect “core,” what does?
You can think of your core like a house:
- You have the roof of your house: The diaphragm
- You have the foundation of your house: The pelvic floor and glute muscles
- You have the walls of your house: The transverse abdominus, multifidus, obliques and rectus abdominus (the 6-pack muscle).
For the purposes of this article, let’s focus on the Core 4: The diaphragm, pelvic floor, glute muscles and multifidi. If you’re missing any or all of those components, then your house is not in order and you have a dysfunctional core. Weakness isn’t always the problem either; there are other things that can contribute to a dysfunctional core such as overactivity or hypertonicity of any of the previously mentioned muscles. So to get a better understanding of the Core 4, let’s break down the muscles in each section to learn what they are, how they’re affected during pregnancy and what you can do about it.
- Your Diaphragm: Examining Your Roof
The roof of the core is also your primary respiration muscle meaning it plays a vital role in your breathing. As the diaphragm contracts, your lungs fill with air and your chest cavity expands. Pregnancy significantly changes the size and shape of your core’s roof, most noticeably during the third trimester when the uterus is pushed upward towards the diaphragm. This abnormal shape during late pregnancy makes it more difficult for you to inhale and exhale which, as you might imagine, increases the potential for complications. If you picture the roof of your house shaped irregularly, not really securing your home (ie: not doing its job), you can imagine how that could lead to all sorts of problems.
Using your diaphragm incorrectly usually results in shallow breathing which engages the muscles around your neck and shoulders; one reason why people with chronic neck tension often have a dysfunctional diaphragm. Think about it: You breathe thousands of times per day so if you’re not doing it correctly, of course something will eventually hurt! The trouble with a dysfunctional diaphragm is that it’s really hard to assess on your own if you’re breathing correctly. Physical therapy can fortunately help you out. Your PT will not only assess your breathing but they’ll give you individualized strategies to change this movement with specific cues and exercises.
So you may be wondering, is there anything I can do prior to giving birth to make my postpartum recovery easier? Yes. Getting a physical therapy assessment to make sure your diaphragm and pelvic floor muscles are working together as they should be is crucial for the benefit of your overall core function and health. Find a great PT and get this assessment before, during or after pregnancy to help make your recovery as efficient as possible.
- Your Pelvic Floor: Stabilizing Your Foundation
The pelvic floor is the foundation of any healthy core. You can think of it like a hammock made up of muscles that support your abdomen or, sticking with our house analogy, the concrete foundation of a well-built home. These muscles assist in urinary function, pelvic stability and reproductive and sexual health. During pregnancy, the growing baby will actually push the uterus down toward the pelvic floor, making it more difficult for those muscles to contract and sometimes—more importantly—relax. Weakened pelvic floor muscles can result in numerous complications: urinary incontinence, vaginal prolapse, pain with intercourse, pelvic pain, low back pain, urinary frequency, sexual dysfunction, etc. and the list goes on and on. A house with a poor foundation isn’t going to provide safety for any sustainable length of time. To quote the old contractor adage about the importance of a home’s foundation: “Without a good one, you’re sunk.”
Again, physical therapy can play a huge role here; there are even physical therapists who specialize in pelvic health treatments for pre or postpartum women. Prior to giving birth, they can teach you how to perform safe and regular strengthening exercises (beyond just abdominal strengthening) to make a positive impact on your postpartum recovery. They can also assess whether Kegel exercises are appropriate for your condition and help to make sure you’re performing them correctly.
- Your Multifidi: Reinforcing Your Walls
The primary function of your multifidus (those small muscles along your spine) is lumbar stabilization. The same way that a house with framing but no walls would eventually topple over due to outside forces, the multifidi protect your spine by preventing excessive movement between the vertebrae. In doing so, these muscles reduce compressive forces on the discs in your spine through load distribution. During pregnancy, a hormone called relaxin is produced which, as you may guess, relaxes ligaments throughout the body to allow room for the growing baby. These loose ligaments can lead to instability, especially in the low back and SI joints. Normally, your body gets its stability through a combination of ligaments and muscles. During pregnancy, the extra loose ligaments require more of your muscles to work harder which can potentially lead to them becoming overworked and fatigued. This is no good and can result in back pain, among other issues. Pregnancy can also affect your posture and the natural curvature of your spine, contributing to the ability of your multifidus to function properly.
So, what can you do? Without knowing exactly what you’re looking for, these are very hard muscles to integrate into normal movement for a healthy spine. Physical therapists can provide cueing and specific exercises to target and strengthen these muscles to help ward off injury and make postpartum recovery as simple as possible.
- Your Glutes: Strengthening and Supporting Your Home
The main function of the glutes is to move your hips and to stabilize your lower body. They help to transmit forces between your trunk and your legs and they are a crucial muscle group for the prevention of low back pain, hip pain, pelvic pain and knee pain. During pregnancy, the efficiency of your glutes can be reduced mostly due to changes in your posture. The pelvis also tends to rotate or tip forward which can lead to tight hip flexors, low back pain and an over-lengthening of your glute muscles which makes it much more difficult for them to activate and function properly.
Your physical therapist can help you determine if your glutes are in fact weak or if they are “inhibited,” meaning that they’ve actually forgotten how to activate due to poor communication between the brain, nerves and muscles. Whatever the issue, your PT can work with you to provide the proper treatment to achieve the desired result.
We all know that it’s extremely challenging to be safe in your home if you don’t have a solid roof over your head, a solid foundation for your house to be built on and of course, secure walls to prevent outside forces from causing problems. The same goes for your Core 4; Focusing on each aspect will set you up for a successful and efficient postpartum recovery.
Remember to ALWAYS consult with your OBGYN prior to beginning any sort of strengthening program while pregnant and even after birth. The amount of time a woman should wait to begin strengthening her body post-pregnancy varies greatly and depends on a lot of different aspects. For example, a woman who had a vaginal birth with no complications may be ready to do some very light resistance training within the first couple of weeks while a woman who had complications with a C-section may be looking at a couple of months before it’s safe to strength train. Please consult with your OBGYN and PT for guidance on this.
Learn more about how Women’s Health Physical Therapy can help with your Core 4 during any stage of pregnancy and beyond.