Moms Into Fitness Ab Rehab Exercise Guide
Moms Into Fitness Ab Rehab Exercise Guide
Moms Into Fitness Ab Rehab Exercise Guide
RESTORE
GUIDE
Did you know that 80 percent of us do a crunch the wrong way? Instead of engaging the inner core muscles and
flattening the belly, we tend to “dome” the belly out as we crunch up. Why? Well, it takes less work to fill up the belly
than to flatten those muscles, and by default, our bodies take the easy route! The truth is you could do crunches until
you are blue in the face, but until you initiate the movement from the innermost core muscles, you will not see
a change.
There is also something else to consider. Maybe you have an abdominal separation – which was once thought
to disappear after the baby was born. This is not the case. Did you know that some exercises can make it worse?
Stick with me ... I know you are eager to get started! But, first you need to know the how and the why of the
movements. You need to know how to turn these muscles on before you can properly train them. And, you need to
know how to cue the most important muscle – the transverse abdominis (or TA) – in your quest to create a healthy
core!
In the last 10 years, I’ve seen thousands of moms change their bodies, decrease low back pain, get rid of ab
separations, complete marathons, hike mountains, take day-long kayak trips, and improve core function by learning
how to strengthen and use their deep core muscles. But, if I just told you all of my anecdotal stories, I would be doing
you a disservice. So, Megan (DPT specializing in women’s health, and dear friend, who I sought out when writing my
Prenatal and Postnatal Fitness Specialist Course) and I teamed up and dedicated ourselves to discovering a way to
pair fitness with physical therapy research and practices. Megan’s vast knowledge of the core combined with simple,
easy-to-follow cues will have your core serving your body 100 percent of the time in no time at all.
Activating the TA is not the same thing as sucking in your breath. Common mistakes observed when trying to
activate the TA include: sucking in, arching the back, and doming the abs. Stronger muscles will always want to
dominate the work. For example, when your back arches when doing one of the TA foundation exercises, this
is because your back extensors are taking over, as they are the stronger muscle group.
Oftentimes, pregnancy or the delivery method (e.g., a C-section) itself is assumed to be the culprit of a distended
belly. But the truth is, the distended belly could be due to an undertraining of the transverse abdominis.
After you learn how to get these muscles fired up, you will need to work them in unison with the rest of your core
muscles (e.g., multifidi, glutes, hip rotators, quadratus lumborum, and pelvic floor). It takes a lot of practice, unlike
traditional ab exercises.
DIAPHRAGMATIC BREATHING
As you inhale expand your breath into the rib cage and belly. As you exhale draw your navel towards your
spine. A great cue is saying “ssssssss” as you exhale. Pulling your navel toward your spine is not the same
thing as sucking in your gut. What do you when you suck in your gut? You hold your breath, you tuck your hips,
you add pressure to the pelvic floor. You don’t want to do that.
STEP 1 STEP 2
Do the same breath, but this time from a side-lying position. Place your fingers on the inside of your hip and
feel the tightening of your muscles as you exhale. This tightening is the action of the transverse abdominis.
STEP 1 STEP 2
Begin lying on your back with legs bent. Keep your spine neutral, core braced. Using the TA activation breath,
on the exhale, lift one knee. Do not allow your ribs to flare or your back to arch. Bring your knee down with
control, switch sides.
STEP 1 STEP 2
Begin lying on your back with a rolled up hand towel underneath your lower back. The towel should create
a small pelvic tilt with your tailbone off the ground. Keep your spine neutral, core braced, knees directly over
hips. Using the TA activation breath, on the exhale, push the palm against the opposite knee, hold 10 seconds,
switch sides.
STEP 1 STEP 2
1. Squeeze and lift the pelvic floor muscles. These are the muscles that you use to stop the flow of urine
or hold in gas.
2. Hold for 5 – 10 seconds (you should be able to talk while you do these so you don’t hold your breath).
And relax for 10 seconds. It is just as important to learn how to relax these muscles as it is to turn them
on, so don’t skip that step!
3. Do 10 contractions. Try to get in a few sessions a day.
Quick Squeezes
1. Now contract those same muscles quickly 5 times. Don’t hold. We’re training motor control here … fancy
term for retraining that brain to turn them on/off quickly. Relax for 10 seconds after your fifth quick
contraction.
2. Repeat 10 times.
For exercises that help stabilize a weak core by concentrating on these key core muscles, follow our Core Restore
program. This program breaks it down to the basic foundation (working your TA and PF). Then builds on this
foundation, adding strength, cardio and flexibility each week.
PELVIC PAIN
Relaxin is great for helping the pelvis and rib cage to expand to fit a growing baby. But it will also cause loose
joint stability, and can lead to pelvic pain both during and after pregnancy. Relaxin remains in the body while
breastfeeding.
Vaginal deliveries involve the trauma of making room for the baby to come through, and cesarean deliveries involve
disruption of the tissues in the front of your abdomen. Both have a significant impact on our pelvic mechanics and
ability to perform all our normal activities and jobs in a pain-free manner. As mentioned above, relaxin causes laxity
in our ligaments. Our pelvis is made up of bones that are tethered together by the ligaments and muscle tendons
surrounding the pelvis and sacrum. And there are a bunch them!
It is important to keep working the core with the pelvic tilts, Kegels, and foundation moves. Additionally, some
women find it feels better to have compression through the pelvis and use a support belt.
If you are experiencing pelvic pain, creating core stability is the best path forward. You will do this in the first few
weeks of Core Restore. Also, it is best to avoid certain moves and exercises, such as:
INCONTINENCE
Both vaginal and cesarean deliveries can cause incontinence postpartum. Mommas who have had vaginal deliveries
tend to have more difficulty with incontinence, but not always. From overloading of our pelvic floor during pregnancy
to the trauma of delivery, our plumbing takes a hit, ladies! But there is hope!
We need to train those pelvic floor muscles that hold up our bladder and give the bottom of our abdominal canister
some integrity. Our transverse abdominis and pelvic floor muscles have fascial ties (part of our connective tissue) that
help them work together. So, when you work your TA, you are also getting those pelvic floor muscles to fire.
However, we also need to intentionally activate those muscles to get them stronger and have better endurance.
For those of you who had significant trauma during vaginal delivery (e.g., extensive tearing, use of suction or vacuum,
or episiotomy), I beg you to get evaluated by a PT. Incontinence can be hugely improved, if not be eliminated, with
the help of a women’s health physical therapist or physiotherapist. They have specialty training to help activate those
muscles and retrain them how to fire. When your body has gone through something that extreme, it is very difficult
for our muscles to know how to function effectively on their own. These specialized PTs can be superheroes in your
journey back to feeling like a more normal woman!
Please do not put up with incontinence just because someone says it’s “normal” after having kids. It may be common
… but it is NOT NORMAL!
However, if you are consistent with retraining your core muscles and practice good posture and body mechanics,
you can dramatically decrease your back pain and even go a long way to preventing back pain. Start out by getting
the TA and pelvic floor firing, then add in exercises to strengthen your back, deep hip rotators, and glutes. In Core
Restore this is all laid out for you in the week-by-week calendar.
If you do have back pain and are finding that consistency with your core program is not giving you relief from the
pain, please get in touch with a physical therapist. You are probably getting tired of me recommending this, but
physical therapists are movement specialists and can help determine the exact cause/driver of your back pain. Often
back pain is just a symptom of a deeper issue. As I’ve said before, a PT can help you get to the root of the problem.
And don’t discount the importance of good posture! Follow the mental checklist on page 9 until it becomes second
nature.
DIASTASIS RECTI
Many moms experience postpartum body changes. One of these is an incredibly common condition called diastasis
recti abdominis — the separation of your abdominal muscles. It often occurs during pregnancy to make room for
your growing baby. Diastasis recti affects up to 60 percent of women during pregnancy and is still present in up to
45 percent of women six months postpartum. Recent research suggests even more than this concrete statistic.
You are more prone to this abdominal gap if you have a weaker abdominal wall, if you are carrying a large baby, if
you are carrying more than one baby, if you have a narrow pelvis, if you have carried more than one child, if had your
children close together, or if you’re over 35 when you get pregnant.
After that long list of predisposing factors, you can see why diastasis recti is common. That said our bodies are made
to bear children and are also resilient in getting back to their prior self!
Talk to your doctor or a physical therapist to get a definitive measurement/diagnosis, particularly if signs point to
having a moderate to severe case.
New moms: It cannot be assumed you have diastasis recti if your belly isn’t flattening after birth or a C-section.
Sometimes a distended belly is due to an under-cued transverse abdominis or deep core musculature.
If you’ve had a baby within the last 6 months or are currently breastfeeding, a postnatal-specific workout is
so important! The hormones in your body make the tissues more lax, even after the relaxin leaves your system
(sometimes several months later). Postnatal workouts will ensure you don’t push yourself into injury.
We teach you these safe exercise techniques and modified exercises in our Core Restore program. But there are a
few things you can do while reading to help you better this condition.
Key points for diastasis: Don’t stand with a swayback or open the rib cage (no rib flaring!). This exacerbates the issue.
The smallest of changes — closing the ribs and stacking the hip bones over the feet — takes pressure off the linea
alba (where the recti separation occurs).
When rising from bed or the floor, roll over and do a side sit up (instead of sitting straight up and straining the belly
muscles). Think about making a few postural adjustments and activating the transverse abdominis every time you
pick up your toddler or car seat. It’s not just the 30 minutes of exercise that matters — it’s what you do the other
23.5 hours a day.
In our Core Restore program, we teach you these cues, how to use them within exercise, plus how to use them
in everyday function.
EXERCISES TO AVOID
If you are following our programs, all workouts are already modified for you!
There is no universal list of don’ts in the diastasis recti world. But because it is usually intra- abdominal pressure that
causes the recti muscles to separate, it is advisable to stay away from applying extra intra-abdominal pressure.
Traditional exercises can put too much strain on the belly tissues. You should refrain from most (not all) twisting
and spinal flexion (crunches). We also recommend you don’t do planks, push ups, quadruped positions, and most
traditional abdominal exercises — at least until your TA can stabilize your torso and your muscles are firing effectively.
Be mindful any time you are hinged at the hips — support your torso.
The Moms Into Fitness diastasis recti workouts have all been modified to be safe for those with diastasis recti,
including flexibility, cardio, and strength training. Healthy (from toning) and supple (from stretching) muscles will treat
you well!
CORE RESTORE
TRY IT IN THE STUDIO
• PTs specialize in the musculoskeletal system and how it has to ALL work together for efficient and pain-free
motion. Our bodies are REALLY good at compensating, and it is so helpful to have someone who is skilled in
finding those compensations, correcting them and showing you how to keep them from coming back! Not only
that, underlying problems such as a hernia, disc issues, neural tension, and other conditions can affect the body’s
ability to perform exercises and activities.
• Women’s pelvises like to move. While moving to help with childbirth is so helpful (and essential), the continued
movement of the pelvis after we’re done having those amazing little kiddos is not. Not only does altered
mechanics of the pelvis cause pain (e.g., leg length issues, sciatic symptoms, knee pain, back pain), it also affects
the way our muscles fire. For example, a rotation of one side of the pelvis (super duper common) can shut off
the glutes and the quadratus lumborum on that same side. When those guys aren’t firing right during all those
amazing hip hikes we are doing, it causes all our hard work to go nowhere. So frustrating! A PT can use your own
muscles to correct that alignment so the muscles can fire the way they were designed to function.
• PTs are there to help make sure you are doing all those great DR exercises correctly and teaching you how to take
care of yourself. PTs want their patients to get to the point where they don’t need them anymore — where they
know what to do if they start having similar issues in the future. No one wants to live in a PT clinic!
• TIP: If you’ve recently had a baby, the postpartum period is the best time to get in! Usually you’ve met your
insurance deductible and insurance will cover your visits.
PELVIC FLOOR
A study by Poświata in 2014, found that 45.54 percent of the 112 elite female endurance athletes (runners and
cross-country skiers) polled suffered from incontinence. It is so common ladies! Researchers also determined that
running and high-impact aerobics were the most identified sources of the incontinence. As a result, high-impact
aerobics became the single most abandoned type of exercise once women had experienced loss of urinary control.
Your pelvic floor muscles work all day long, in conjunction with your TA, to stabilize your core, pelvis, and support
your internal organs. We need to train those pelvic floor muscles that hold up our bladder, uterus, and rectum, and
give the bottom of our abdominal canister some integrity. If and when you have good core strength and stabilization,
you can add miles.
DIASTASIS RECTI
We know that runners will not take “no” for an answer. Our hope is that you will understand why running may slow
your progress of reducing your diastasis and how it impacts your pelvic floor. Regardless if you had your baby/babies
via vaginal delivery or C-section, your core and pelvic floor were impacted! We want you to build back to running safely.
If you have diastasis recti, your structural integrity is compromised. When running with DR, you are likely
compensating, which can lead to other structural issues including knee pain, IT band pain, plantar fasciitis, low back
pain, and hip flexor issues, just to name a few. Not to mention increased strain through your pelvic floor. We need to
address your compensations to ensure you can run with proper alignment, so you can successfully return to running.
It can be very difficult to know how you are compensating.
Before you hit the pavement or your treadmill, I highly encourage you to work your way through Phase One of our
Core Restore program. Please also avoid sprinting. When you sprint, you increase the force and rotation through
your trunk muscles, which can really strain the linea alba and surrounding muscles and fascia.
RUNNING SAFELY
In order to run safely, you must learn to activate and train your … you guessed it … transverse abdominis. On either
side of your floppy bridge are winches, otherwise known as your TA. Your TA fibers run horizontally and act as the
corset of your core. As your TA gets stronger, those winches crank on your bridge and you get that tension back.
• Are you able to stabilize your core? All of the internal muscles we’ve talked about help stabilize your core.
• Have you integrated full-body strength training? Specifically exercises that take you into different planes of
motion. We spend a lot of time in one pattern while running, so we need to strengthen all those stabilizing
muscles in different planes. If you’re following Core Restore, we’ve taken care of this for you.
• And stretching? Always an important part of any exercise routine. Did you know tight chest muscles can move
down the kinetic chain and cause knee/hip pain while running?
• As always, if you are not seeing a significant improvement after consistently doing the transverse abdominis and
pelvic floor exercises in this guide, please get in touch with a women’s health physical therapist.
A C-section is a surgical procedure, but unlike what most women think, your doctor will not be cutting through
muscle — with the exception of the uterus. When a C-section is performed, the skin and fascia is cut horizontally,
then the abdominal muscles are separated from one another and moved to the side. These muscles are rarely cut, and
if they are they are usually put back together. While the muscles aren’t cut, this process greatly interrupts the function
of the muscles and their ability to respond to movement.
This scar tissue can cause many more problems, beyond cosmetic. When the scar tissue impacts the muscles around
it, it can cause issues with the deeper core muscles firing correctly, incontinence, back pain, and pain with sexual
intercourse. So often I find that moms think that once they have a C-section scar, it is what it is and there is not much
they can do about it. There is hope mommas!
Scar tissue responds very well to mobilization. I know ... big words ... sounds fancy but it is quite easy to do on your
own. Now ... I will say, if you have a thick scar that is super tender and angry, or are dealing with issues with back
pain, incontinence, or diastasis recti, please find a physical therapist/physiotherapist who specializes in women’s
health. They will be able to address your scar and other issues and get you back to being super mom much more
quickly than if you just do a simple scar tissue mobilization at home.
First, you need to let that scar heal all the way. Do not get over eager too early in the game ... you can pull open your
incision. Wait until your incision is fully healed. Then put your fingers down along the incision and move your incision/
scar in every difference direction. Start gently. This may be uncomfortable. A little soreness is ok, but do not torture
yourself! It does not matter if your scar is 4 weeks old or 10 years old. I have gotten scars to move that are decades
old. It is never too late to work those scars!
If the scar is still healing or newly healed, it can be very sensitive. You might not tolerate pants with a tighter
waistband or even having your shirt brush against it. This is called “hypersensitivity” and is not normal. Your body
is telling your brain that everything is causing damage even though it is not. We need to retrain your brain and
desensitize that scar. You can start with just brushing your fingers over it and gently rubbing it if you can tolerate
it. Then grab a washcloth and get it wet with warm water. Run it over your scar and then repeat with it cold. Play
around with different textures that you can rub over your scar. If you consistently work on your scar, your sensitivity
will lessen.
Most scars respond very well to mobilization. If you are still having issues after trying to work on your scar at home,
please find a women’s health PT. They have so many tricks and tools in their toolboxes and would love to help you
achieve your goals.
Lee, D. (Accessed 2017, 2019, 2023). Diastasis rectus abdominis and the implications for returning to sport after
pregnancy. Retrieved from https://dianeleephysio.com/education/diastasis-rectus-abdominis-postpartum health/
Lee, D. (Accessed 2017, 2019, 2021). Core training vs. core strengthening: what is the difference and why does it
matter? Retrieved from https://dianeleephysio.com/education/core-training-vs-strengthening/
Nixon, J., Goom, T. (Accessed 2017, 2019, 2021). Running, incontinence and pelvic floor exercises. http://www.
running-physio.com/pelvic-floor/
Poswiata, A., Socha, T., Opara, J.(2014). Prevalence of Stress Urinary Incontinence in Elite Female Endurance
Athletes. Journal of Human Kinetics, 44, 91-96.
Crow, W.T., Willis, D.R. (2009). Estimating Cost of Care for Patients with Acute Low Back Pain: A Retrospective
Review of Patient Records. The Journal of the American Osteopathic Association, 109, 229-233.
Moms Into Fitness was founded by mom of three Lindsay Brin, BSE in exercise science
and certified personal trainer. She is passionate about helping moms achieve optimal health
without going to extremes — finding balance.
©2023 Moms Into Fitness Inc.