Ab separation and rockin the crop top

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Ok, so I know that you aren’t supposed to try anything new for race day, but I just got my new @runinrabbit crop hop in the mail. 😍🐰 I did a short test run this morning, and I think it’s comfortable enough to risk for my marathon on Sunday. (I mean, I’ve chafed for longer than that. 😂💯)🤞 Now to decide between coral and white. 🤔😁 . . . And more for all of the mommas out there. Cadence sat really high in my belly when I was pregnant, and I still have a lot of ab separation from my pregnancy.👶 I had to have surgery last May because my intestines (still) pop out just a little above my belly button (like a hernia). 🙈And then there’s always the skin that doesn’t have quite the same elasticity that it used to…😊 All that to say, our bodies are incredible and continue to support us as we grow human beings, breastfeed, and then go out and run our hearts out. ❤️🎉 Since you can’t necessarily see my intestines popping out very well in this picture, I just wanted to keep it real. 😂😘 . . . #motherrunner #marathontraining #taperweek #radrabbit #loveourgoldengirl #milestonepod #gobeyondpace #saucony #runyourworld #runningthroughpregnancy #postpartumrunning #extendedbreastfeeding #womenrunning #womensrunningcommunity #hshive

I think I’m set on wearing the crop top for my Sunday race, I just need to pick out a color! 🙂 I wrote in my IG caption about my ab separation and pseudo hernia, so I thought I’d elaborate here in case any mommas are in the same boat.

I have a series of blog posts where I discovered the “hernia” and got a diagnosis, had surgery, and then learned that I just had ab separation and weak fascia, but no actual hole in my fascia for a hernia. I elected to have surgery last May after noticing a nickel sized little bulge about midway up from my belly button. I was afraid that it would just get worse with my activity level, and the surgeon agreed that it was better to fix it while it was small instead of waiting until it got worse and required a larger repair.

After the surgery, I noticed that I still had the little bump, and returned to the surgeon. That’s when they told me that my fascia had just been weak, but there was no hernia to repair (yay! surgery for nothing!). My intestines press against the weaker fascia where I have ab separation (or diastasis recti) and create a little bump. I can push it back in, but inevitably, any effort causes it to poke out again. Doctors have told me that it will only get worse with a second baby, and that a tummy tuck is the only thing that would fix it. It’s a good thing babies are so cute!

Do you have ab separation from your pregnanc(ies)? Any other faux hernias out there? Haha

Pulling it all together: Physical Therapy and Diastasis Recti

The last few months have been a lesson of limits for me as I face the reality that I am a 32 year old mother runner, and my body will never be the same as it was before baby.  But that’s what aging is, isn’t it? And I’m really ok with it.  Cadence is the best extension of me that there ever was, and if she’s my youth, I could not be more proud than to have her carry on my legacy.  But before I go off on a mortality binge, let me say that things are really looking up!

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Every sacrifice is worth it for this sweetness!

In May, I was diagnosed with a hernia and had surgery for it.  It turns out that it was not really a hernia, and instead I have ab separation.  The surgeon was all doom and gloom about my state as an ab separated mother runner, but I have since met with two great physical therapists who told me that I am in fact very strong and set me up with strength exercises to make sure that I stay strong.

So what is happening with my abdominals then? From what I understand in meeting with the two physical therapists, my recti abdominus muscles (the six pack muscles) are working together when I engage them.  That’s great news!  There is a gap, but it is not significant, and my oblique and transverse muscles are all very strong.  The linea alba is the tendinous median line that runs down the middle of the recti abdominus, and in my case, that is what was stretched during pregnancy. 

 

Interestingly, a lot of women experience diastasis recti (DR) below the umbilicus (belly button), but in my case, all of mine is above the umbilicus.  When diastasis recti is below the belly button, some women experience a “pooch” that no amount of working out is able to resolve.  The abdominals are all connected to the pelvic floor, and a lot of women with diastatis recti also experience incontinence.  That is why exercises like kegels are so important to engage the pelvic floor.  It’s all connected!  If I had lower abdominal diastasis recti, it would also make running more challenging (no!).  In my case, the diastasis recti is only present from the belly button up, which is why I can feel my intestines down the center  of my abs (still sounds weird).  If it weren’t for that little detail, I wouldn’t notice a thing.  😉

I visited two different physical therapists on two separate days.  One of the physical therapists focused more on breathing techniques to help me engage my core properly, and the other reviewed my form in multiple strength exercises.  They both had different approaches, but the suggestions were all very promising (and I even got a few tips for running!).  I was assured that I would be just fine having a second baby.  It’s a good thing for me to address strengthening my core while I can.  When we decide to get pregnant for baby #2, I’ll just have to focus on the proper strength work to heal properly postpartum again.  That’s the great thing about our amazing bodies!

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Physical Therapist office with a complete pilates studio!

My primary takeaways from physical therapy were proper breathing and proper form.

Breathing: The foundation for proper breathing is to take a deep breath in, allowing the rib cage to expand while abdominals are relaxed, then as you exhale pull the belly toward the spine and engage the pelvic floor muscle. Here is a great site explaining diaphragmatic breathing, also called belly breathing.

My assignment is “belly breathe” two times a day for 10 breaths:

  1. lying with knees bent
  2. sitting in a chair with feet on the ground
  3. on all fours

Another breathing technique to remember during my training is to exhale during the hardest part of a workout (ex: exhale when lifting, inhale when lowering).  This means that I am supposed to slow down my strength training in order to coordinate breathing (I am guilty of speeding through a work out just to get it done!).

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Clam shells are my new favorite exercise to help my gait

Strength Training: Engage the deep abdominals just before and as you push/pull/lift any resistance — this includes lifting the baby or any other type of weight.  I was not given specific strength training exercises, rather my current strength form was evaluated to make sure that I am properly engaging my abs to work together during all of my activities.  Examples of core work that I currently do are planks, side planks, crunches (different variations), bridges, etc.  Some women with DR are instructed not to do crunches, but my abs are actually firing properly.  I also have some side-to-side work, that is not always recommended for DR, but my PT said that given the location of my DR, it is good to get the obliques strong.

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Workout buddies

I felt so encouraged in meeting the the physical therapists, and I recommend that anyone unsure of their status post-baby should go see a SPECIALIST in this area.  I think that women, especially in the U.S., feel like they should bounce right back to pre-baby shape (whether that means returning to work right away, fitting into jeans, or getting that PR), and we don’t give ourselves the space to properly heal and process the trauma that our bodies have experienced through pregnancy, labor, and breastfeeding.

Did you feel like you were expected to bounce right back after you delivered your baby?

What are your favorite core exercises?

When things come apart: Diastasis Recti

So I’m trying to be really positive and not dwell on the past, but I recently had hernia surgery for a hernia that didn’t exist.  And I still have the original problem that I started with.  Yes, that’s right, a faux hernia.

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About 10 weeks postop

 

I don’t know where I went wrong, but I wish that I had gotten more opinions and visited women’s specialists instead of a general surgeon.  I was diagnosed with a hernia in May because I had a small place above my belly button that bulged slightly when I worked out.  An ultrasound didn’t show any tears in the fascia, which is what qualifies a hernia, but the general surgeon said that it was a hernia and that he could fix it.  To be fair, it was a weak spot in my fascia, and it was bound to only get worse with my activity level.  I was scared and I asked for the surgery.  The general surgeon was really good, but he essentially fixed a hernia that didn’t exist, and now I have a weak spot above my belly button AND scar tissue.

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After 6 weeks of recovery, I was able to resume all of my normal activities at the end of June, which means I started my strength routine again.  Right away, I noticed a bump pop out below the incision area.  I went to the surgeon the next week for a follow-up, and he said that it was not anything.  After a month more of exercise, I have continued to feel something “pop” out along the midline of my belly near the incision.  It is not visible, but clearly I can feel something happening beneath the skin, and I am able to “push” it back into place.

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I would do anything for this little lollipop!

Post op deja vu has definitely been a test of my character.  I went back to my surgeon last Friday and met with the physician’s assistant.  She gave me a lot more insight and reassurance about what was happening, but it still does not make me happy.  Essentially, I have diastatis recti, or ab separation, to the tune of 2.5 cm (normal separation is about .5 cm), and the fascia running down the center of my abdomen is holding everything in.  The PA did an ultrasound to confirm that I do not have a tear in my fascia (I have never had a tear in my fascia), but fascia is weaker than muscle, and my fascia is having to hold in my intestines.  There is nothing that I did during my postop recovery to make this happen.  It is just general anatomy.  I am pretty thin right now (breastfeeding and training for my first 100 mile race), so I do not have much of a fat layer to act as a buffer.  What I am feeling “pop” along the middle of my abdomen are my intestines as they push through my abs and against the fascia.  I’m a living science project!

The PA told me that a tummy tuck is the only solution to ab separation, but I cannot believe that something muscle related can only be fixed through surgery.  (Also remember that these are the surgeons who operated on a hernia that didn’t exist on me.)  So, this week I have called around to a few physical therapists and made an appointment to see one on Thursday morning.

I can’t help but feel guilt, regret, confusion, and fear about my condition.  I was cleared by my OB for all activities in October after I had Cadence.  All through pregnancy and postpartum, I took fitness classes specifically geared towards the right exercises for new mom bodies.  I read about Steph Rothstein’s postpartum journey of ab separation, but I really didn’t think that I needed to worry much about it since all of my doctors had told me that I was cleared to continue any type of exercise that I wanted.  I was vocal about training for Boston and running ultra marathons.  I also thought that I had covered everything with my surgeon, who told me that I could resume all physical activities after 6 weeks postop.  Good as new.

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We are dedicated to our training schedule. 🙂

I am not sure why I am only feeling these symptoms later in my postpartum journey, other than that my intensity level has increased while I have also gotten thinner.  I am hopeful that I will be able to correct some of the separation.  The physical therapist assured me on the phone that diastatis recti is genetically predisposed, and there are some exercises that I can do to help strengthen my core again.  I’ll find out more on Thursday at my appointment.

Thank you if you have followed my story this far.  One last thing that I want to end with.  Recently I was reading my Bible and I came across the passage below.  It just reminded me about how much God wants for us to go to him in prayer for everything.  He is the ultimate Creator and Healer.  So my prayer is that my body will heal and I’ll be protected from any further discomfort or damage in my abdomen.  I do not want to worry about it every time I pick up my daughter or go for a run. I pray for peace of mind and healing.

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Do you have experience with diastasis recti?

Did you do any type of postpartum physical therapy?

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Update: You can read about my physical therapy appointments here.