Hey, welcome to the Healthy Post natal body B podcast with your post natal expert, Peter Lap. That, as always, would be me. Today I'm doing listener l emails, one. We're talking about whether it's when things are going in the right direction, how fast you will actually get results, how fast is what is normal to get results, how long it usually takes and all that sort of stuff. And is it a problem if the gap doesn't fully close before another pregnancy? And if it closes, do we still need to continue doing the exercises? And finally, finally, finally, finally. Do postpartum exercise programs actually help you recover postpartum? Does a program actually help you heal from Diastasis Recti during the early stages of postpartum life? I will tell you why. We might just never know Right, without further ado, here we go.
Speaker 1:Hey, welcome to the Healthy Post Natal Body podcast. This is the podcast for the 22nd of October 2023. You know that only means a few more months of Christmas. I'm a very happy boy because he's just had an orange and for some reason, they gave me a ton of energy. I'm recording this on Saturday afternoon where all his clients in my house, for tomorrow the house will be full of hounds and I won't have time to record. I've got a couple more just so you know what I'm up to the next few weeks. We have Cat, who he's coming on talking about body confidence, postpartum body image, body confidence and all that sort of stuff. She's a fascinating character and she does it through the art of burlesque and all that sort of stuff and I just thought you know that's Moulin Rouge nonsense. But I checked her out and she's legit and she's lovely and she's wonderful. We had a great chat a couple of weeks ago. Then the week after that we're talking dental health dental health, yes with dentist Teresa Yang, who wrote what I can only describe as the ultimate guide to dental health, a 200 page, wonderful, wonderful book, almost like an encyclopedia of dental health. It's amazing. We spoke for an hour and 10 minutes, an hour and 15 minutes Just about, you know, brushing your teeth and all that sort of stuff, the things you're doing wrong, definitely the things I'm doing wrong. And then we have a whole series coming up towards the end of the year.
Speaker 1:I'm editing a ton of stuff this afternoon so that I get a bit of a break over the next couple of weeks, and the episodes are ready. Wouldn't that be nice? Behind the scenes. You might have noticed from last week's podcast the show notes look a bit different. That's because I have people working on that. Now we're trying to get the transcripts as accurate as possible, but also we're trying to get them out as soon as the podcast launches, so that's a little bit as soon as the podcast comes out. So that's a little bit tricky for people who have hearing difficulties. We're working on it. We're trying to make this thing as accessible as everything. Again, it should be a standard. Now that you have transcripts, you have show notes, what else? There will be a blog post coming up with every episode, all that sort of stuff. You know that professional podcast. Now all I need to do is flip the switch on the YouTube channel again so that we pump it out over there as well and everybody's happy because YouTube does podcasts now.
Speaker 1:Anyways, listener emails this week, because I've had some emails in and one of them especially covers a tremendous amount of ground. Now this is a lady who's been in touch before, when she was five months post-partum. She said she thought she had a gap of two fingers above the belly button and three just under the belly button, whether that was severe or not Right? And she got in touch a little while ago when was that? In July? Asking you know, do I have any tips or how to, whether she knows what the breathing is right and wrong, because that's what she struggled with. Well, she just got in touch about 10 days ago, 11th of October, and she said hello again, peter, hope you're doing well. I'm getting on good with the exercises. It's been about three months since I started with you. The gap is now smaller, about two and a half fingers under the belly button, and not sure if it's now one and a half or still two above the belly button. It's going in the right direction. However, it is very slow. I'm not sure if it's normal to take for it to take this long, or even how long it normally should take. I'm also wondering if you could advise is it a problem if the gap doesn't fully close before another pregnancy? And also, if it closes, do I still need to continue doing the exercises? Thank you so much. Right, so there's a lot happening there. We're going to go in order. Well, a little bit in order.
Speaker 1:Right, when she says first of all, I measure everything in centimeters. But as long as you're using your own fingers and you constantly measure in the right place, in the same place and all that sort of stuff, then it's fine. Just don't accept anyone else's fingers doing the measuring for you. I spoke about this before. In an ideal world, you measure first and then you measure with your fingers, and then you hold your fingers up as they were to a tape measure. I have the videos on the YouTube channel and that will give you, in centimeters and millimeters, what the gap depth with actually is. So, yeah, so I measure in centimeters and millimeters, right? So, and the reason for that is that if you just look at the gap and we're just seeing diastasis as the gap for now, right, anything below 25 mil so two and a half centimeters, about an inch is not glassed as diastasis recti anymore. Right, that is considered as completely normal.
Speaker 1:You always had that gap between your stomach muscles. You might not have been aware of it, but that gap was always there. What you have now is the tissue is stretched a little bit. The tissue connecting in between that fascia sheet is a bit stretchier and therefore it's a bit more noticeable. But the separation of the stomach muscles is no longer an issue, or not. Glass is an issue when it's below 25 millimeter, and I'll get onto that in a bit more depth in the second part of what we're talking about when I talk about the efficacy of postpartum exercise programs.
Speaker 1:So it's important to remember the gap will never fully close and that really really matters. Special for the last question is it a problem if the gap doesn't fully close before another pregnancy? Well, first of all, it will never fully close. But also, even if it's not back to where it's normal for you, because that is always different, it's different in every single body, right? Some people have a 15 mil gap, one and a half centimeter gap, others have a two centimeters gap. If it's right for you, then it doesn't really matter. It doesn't matter much whether that cap is back to normal for you before you have another pregnancy. You don't need to be fully prepared. It's not going to get much worse because the baby needs space anyways. The baby will always find space, right? If it closes, do you still need to continue doing the exercises? No, if it's back to normal, it is back to normal. It is completely or utterly done.
Speaker 1:With regards to diastasis recti, in an ideal world you'd, of course, keep exercising and all that sort of thing. But you don't need to do anything specific for diastasis recti at that stage because it healed. So the myth that diastasis recti is a lifelong condition that always needs to be managed is just that. It's a myth and it's nonsense and it's one that I've seen a lot on Facebook forums or that got sent to me a lot from Facebook forums, and it's one I've written about before. When your rehab is complete, your rehab is complete, you are done and I do classes as rehab exercise, right. Anyways, the gap is now smaller two and a half fingers under the belly button. I'm not sure if it's now one and a half above the belly button, right. So one and a half fingers with my butcher hand fingers is less than two and a half millimeters. So we wouldn't even class that anymore as diastasis recti. So it could well be that you're completely back to normal now. Two and a half under the belly button. That came down from. Was it three? What was it? Three originally? Yeah, just three under the belly button right. Now it's two and a half just under the belly button and that is over the course of three months. So she's on her way to healing. It is very slow, as what she's saying it's going in the right direction. However, it is very slow and that's a little bit of managing of expectations.
Speaker 1:Most people that do a postpartum exercise program any sort of exercise program will realize that these things come in 12 week stages. The reason we give you the reason most programs and I say we are talking about fitness professionals in general the reason we like giving out three month programs is because you can stick to them, not because you'll be at the end of the road. You can stick to three months and then, after three months, right. But we say, okay, now move on to the next stage. That is usually. That's what should happen. Now. If you look at other programs, they will talk about 12 week modules and all that sort of stuff, or 12 modules. It's still just a three month program, right, because they've realized that that is what they can sell you.
Speaker 1:If I come to you and say I have a program that takes a year to complete and your diastasis will be completely healed, at the end of that, you will be signing up with somebody else. You're never going to sign up with me, right? This is what. But as I say in almost everything, the first four to six weeks of postpartum recovery is activation, the activation stage, what I call that and then is the strengthening upstage. What you can do after three months and I make this very clear in the program is because I tell people, you know, sign up for three months for free with healthy postnatal body, right, you can cancel at that stage and, like I said to this lady, just continue doing the exercises. You're going in the right direction, you're going fine.
Speaker 1:Whether it is normal for it to take the long run, that depends on how often you did it and how much effort you put in and how well you performed the exercises. As I've always said, it's easier for people if someone is standing next to them guiding them through the program. If you have to figure it out for yourself, it usually takes a little bit longer or it needs a bit more awareness. So is it normal for it to take that long? Yeah, right, because it's only two and a half fingers. So, as a guest and I don't have my tape measure out, what is that? Three centimeters? Right, depending on the size of your hands, about three centimeters. So that is already not that far off from that two and a half centimeter, and we don't class it as diastasis anymore. So the gap isn't as big as it might feel to you, right? Because it's actually pretty close to being normal, for most people Say you could bring it down by another finger. So another centimeter over the course of I don't know the next three months.
Speaker 1:You can do that by doing the existing exercises you're currently doing or indeed and this is my much, much preferred option by just going about your daily life and doing daily exercises. The point of the Healthy Positonatal Body Program is not to keep you on the program for as long as possible. The point is very much for you, after three months, to be able to go and do whatever you want to do. Almost every exercise and this is something Anthony Lowe and I, for instance, agree on almost every exercise, as long as you're performing them correctly, will help heal your diastasis. Recti Squats, bent over rows, kettlebell swings, running cross trainers, all that sort of stuff, if you perform them correctly and your body is functioning correctly, will help strengthen up your core One way or another. In an ideal world, you'd do some core-specific stuff as well, right? But even if you look at tennis, training for tennis and all that sort of stuff and I've mentioned tennis players before because I think they're a wonderful example and have some experience with this.
Speaker 1:It's the rotational movement. Basically, when they hit the ball, they hit through the ball and their body rotates. That moves, that if they exhale on that point and the muscles work correctly, that movement alone will help heal diastasis recti and make the core stronger. Now, in an ideal world, of course, you'd add a bit of resistance to that right, which is why we do things like bootchoppers, downward bootchoppers, core presses and all that sort of stuff. But just the movement and exhaling and engaging your core through that movement will help heal your diastasis recti. It just takes a little bit longer.
Speaker 1:I don't need people to stay on the postpartum program for more than three months, and I really don't. And if you look at the Healthy Postnatal Body Program after four months, I think it is because you get the first, say, four months free, right, because you get the first three months for the 12 weeks and then I give you 13 weeks. So there's another week, another four-week program that gets sent out to you even if you cancel. So you have essentially four months worth of programming completely free. Just after the 13 weeks you don't have access to the site anymore. If you can't tell, of course, if you stay with me, god love you. But yeah, four months, after that four months you can do whatever you want.
Speaker 1:And that's why the program splits up after four months, because there are other issues that most post-partum women might want to work on. There are more issues that they have back pain, neck pain, glute instability and all that sort of stuff. Glute instability should be massively improved at the end of three to four months. But you might want to work on legs and all that sort of stuff. I give you the option to do some Legs and posture and back pain, neck pain, all that sort of stuff, and even core strength still. But I'm more than happy for you to go your merry way after three months, because everything you do at that stage will help heal, help close that gap a little bit back to where it should be, as long as you perform the exercises properly.
Speaker 1:The first three months is your base, education, if you will, and that basis is really powerful if you take that on board. If you learn how to breathe properly, you learn how your body should feel and all that sort of stuff, how your body should feel whilst you perform an exercise, what feels right, what feels wrong, what you're good at, what you're not so great at All, that sort of thing. That first three months is your education and we strengthen things up a lot so that everything works properly, and then you go do your own thing and then, yeah, if you fall pregnant again, don't worry about it, right? It's Diastasis recti. Second time round isn't worse because the gap isn't fully healed. Diastasis recti is a little bit worse from a core functionality perspective if your core doesn't function well after your first pregnancy and I'll get into this a little bit Right? So this comes back to.
Speaker 1:This comes down to the definition of Diastasis recti, and this is, for instance, where Anthony Lo and I massively disagree, right, or at least we used to. I'm not sure where he stands on this now and other people Right. Many physios and I completely disagree on this. The definition of Diastasis recti for them is the width of the gap, just separation of the muscles. That is all they care about, and I don't think that's particularly interesting and I don't think that's useful. This is why some people talk about like a functional Diastasis and all that sort of stuff. I think that is nonsense, people, and poppycock, I really do. There's no such thing as a functional Diastasis. But you know, there we go. I think it's part of the same package. I get why they do it. I just don't agree with them, right? So the narrow definition of Diastasis recti is separation of the stomach muscles and the width of that and the depth of that is now part of that as well, and why that matters, and all that sort of stuff. I've gone over that before, right.
Speaker 1:For me, what should be included in that is the functionality of the muscles. Are the muscles doing what they're supposed to be doing at any given time? Right, I have come across many women, many, many, many women that have technically have no Diastasis. There's no gap. Their stomach is flat. There is no. They have a bit of resistance along the linea alba, so there's no issue there. And yet they have no core stability. They have no stability overall. Their stomach feels weak, nothing is working right. They have back pain, they have neck pain and all that sort of stuff, and it's because the right muscles aren't doing the right things at the right time. And that's what I talk about when it comes to muscle functionality.
Speaker 1:This is why I spend so much time on focusing on glutes and all that sort of stuff, because that is part of the problem. In fact, I would argue it is much more of a problem than whether you have a two-finger gap or not. Right, if muscles aren't functioning the way they should, if muscles aren't working properly, you can't do the things you're supposed to do without at some stage ending up with a bit of a problem Usually back pain, right, by overcompensating by your lower back, overcompensating for your core muscles and all that sort of stuff. Or you end up with some posture or alignment issues because your glutes are just not doing what they're supposed to be doing at the right time. Right, you're not functioning optimally and you feel it Every single time. Every single woman I've ever spoken to knows when things don't quite feel right, and it's never, ever a problem with the width of the gap. It never is. It's always down to the muscles aren't doing the right thing at the right time.
Speaker 1:And that should be part of this discussion about diastasis recti, because if you go to your GP and you say, which you still need to do in the UK, you go to your GP and you say I think I have diastasis recti because stuff doesn't work properly and the doctor measures it and they say, no, you do not have diastasis recti because the gap is only one and a half centimeters. Then he's not going to give you a physio referral for diastasis recti and you really should get a physio referral for diastasis recti. And again, I disagree with some physios on this, physios. On this I think you need to work with a specialist and therefore it matters what physio you are referred to. I know loads of nice physios that are amazing as individual bits and pieces, but they're not necessarily great with things like diastasis recti. Because it's such a complex issue they don't specialize in it and therefore you know they're a jack of all trades, which is awesome. But if you're a year or two postpartum and stuff doesn't feel right, you don't want jack of all trades, you know. You want the master of one. You want the person that really knows what they're doing with this, because stuff is going to be a little bit complicated to fix and you don't need a back pain physio if your core doesn't do what it's supposed to be doing Right. You need a women's health physio, fundamentally Women's health physio or PT or whatever it is, but you don't want to start work with, for instance, a normal personal trainer either. That's it a jack of all trades. Pt. Now there's just on a weekend course on on diastasis and now things. They know what they're talking about. Now you want to work with somebody who just is all the time for a living Right, in the same way that I don't always I don't train athletes to get faster and stronger and better at, like NFL football or something like that.
Speaker 1:I can train the tennis players post-partum, oh yes, and then they go their merry way again. I can't make them better at. I'll make them better at tennis, but that is because I repair what they're, how, how, whatever this function they have in their core. Then that's what we work on. When I say repair, I don't mean that to sound mechanical, but we do exercises for that stuff. I can make football players a little bit quicker on the turn. I can't make them. I'm not a strength and conditioning specialist for for for football players. I'm nowhere near that level when it comes to strength and conditioning for football players, but most strength and conditioning coaches are nowhere near my level when it comes to diastasis, recti stuff. So work with someone who specializes in this stuff, right, we can all help each other, help someone get better, but not necessarily as efficiently and as quickly as a specialist can, and that's that's why I always say work with a specialist.
Speaker 1:Now an interesting question that was posed to me on the back of someone sent me an email a while ago and she said do you think pink the singer, pink, use the MOTU system and that is why her diastasis recti was better and why don't we do more research into diastasis recti? I get asked that a lot. Right About researching to diastasis recti, but the issue with diastasis recti programs and all of them this goes for every single one of them is that again, measuring the, using the narrow definition of diastasis recti as just being the gap, it will heal in about 80% of all cases. Diastasis recti will heal anyways at some stage, as in the gap will go back to some semblance of normality 70 to 80%. I think it was the last. The last study I saw had it at roughly 80, but an earlier study I saw had it at 30. I had it at 30%. Still have issues a year later, right, and that is just looking at the gap. That is not nothing to do with muscle functionality but it matters. So I should.
Speaker 1:Pink worked. The story is Pink worked with her existing personal trainer and that personal trainer, like, bought a copy of the MUTU system which is a good system, by the way and incorporated some of those exercises into pink's recovery program, postpartum recovery program. And Pink said thanks very much, mutu, for it really helps. And I then did another person's podcast where I was asked why there wasn't more research done into the efficacy of postpartum programs and I said because it's impossible.
Speaker 1:You can't. I can't prove to you that healthy postnatal body that the HPNB program helped heal your diastasis recti. You can't measure that in scientific terms. I know it works, don't get me wrong. I've a lot of experience with this. But I can't prove to you that it works If we just look at the gap and most of these studies are designed and they say I don't have a gap anymore and therefore the program helps. Not necessarily Pink's PT personal trainer, I'm sure, is an excellent personal trainer and almost any exercise, as long as your muscles are functioning properly, will help heal the gap. Like I said earlier, as long as your muscles are functioning properly, any exercise you do, whether that's kettlebell, swings or butter ropes or whatever, lunges and figure eights to a halt and all that sort of stuff, everything that way will help heal your diastasis recti, will help close that gap and give you abs of steel again. Right, you can't prove that. It's that. It's that that gap only closed because of the postpartum exercise program.
Speaker 1:The reason I say it does, the reason I say it does work, is because I work with a lot of women who are two to three years postpartum, or even five or ten, and that is never going to heal by itself. That gap is never going to get narrower, more narrow by itself. That just doesn't happen, right, that needs a bit of help and needs a bit of guidance. And I see, in every single one of those cases I see results because what we do works. Right. But what I mean is you can't prove, you can't put a study together At least it's really difficult with decent numbers that says I don't know.
Speaker 1:We took 500 women who were five years postpartum. They all had diastasis recti and we'd give them these exercises and see this works. And that doesn't you. It's almost impossible. That is the only way you will be able to put a study together, the only way I can think of. And I might be wrong, so, peterathalfiposnatalbuddycom, if I am, you can point it out to me if I'm missing something, but that is only way I can see you design a study that proves the efficacy of exercise programs. Right, I did a thing for Masik, the charity to get this. We're on their website and all that sort of stuff. Right, we do some stuff with Masik, giving free access and all that sort of stuff. And we did a thing what did we do Of the peterathalfiposnatalbuddy, right? So we did a survey.
Speaker 1:Over 80% of women suffer from, probably from the results we surveyed and yeah. So here's the survey 200 members and four more members 90% reported the distinct improvement in diastasis recti and core strength. All that after two months. 95% of members who followed 15 to three plus months reported diastasis had recovered to the point they no longer had issues. Also, true, 85% reported less back pain within 13 weeks. Well, and that is the measurement right Whether something works, not the gap the 85% is a better number than the 95% is of members who don't have diastasis recti anymore after three plus months of following the routines 85% with less back pain. Because that is what we're doing we're making sure everything functions well.
Speaker 1:You know when I say 90% of members reported the distinct improvement in diastasis and core strength after two months. The core strength is the best that the program worked. On the diastasis. I can't prove that that was caused by us. You would think that there's a link, but it's the same.
Speaker 1:Mutu did a similar thing, which is why we did the survey for us. They said 91% of diastasis rectaim improvements. If you measure that only in people that are 6 weeks postpartum to 3 months postpartum, then that's about right. That's only 11% higher than the actual number of people, even if they do nothing. That is not crapping on the Mutu system. That is just explaining to you that it's almost impossible to say that it's the program that you paid for that caused your improvement. This is why I'm not a big fan of telling people the program gives you magical results. No, it doesn't. You put a bit of work in and you will get results. That is how it works on every single level for every single strength and fitness program. If it's well designed, it'll help people for a long time with a lot of issues. But I can't prove to anyone that postpartum exercise programs work.
Speaker 1:This is the pickle, because when I talk about getting funding for when I say this stuff should be available on the NHS or any other health services right. The other shitty health services are available. Often it comes from women's care. The NHS isn't great. I've said this before. You really want as dinky snorries in the background rather loudly, so apologies for that. So it's difficult to have to say this definitely works for women, because we can't prove it. So this is why we can't put a scientific study together easily that says see, women who have a three month postpartum to six months postpartum, if they get an extra amount of access to programs and they do an extra amount of exercises, they will feel X percent better. And that is the only way you get funding. This is the only way you get into the NHS and it simply can't be proven. It can't be done. It really can't Because, like I said, in 80% of cases it heals.
Speaker 1:The gap narrows by itself in the first year. This is why I always say the gap is the least important thing about diastasis recta. For me it's borderline, irrelevant. I never focus on the gap. I show you how to measure it, of course, and I do that as part of the program as well, because people like to measure results. But the proof is in the tasting of the pudding. It's the taste. And the taste is do you feel stronger, does everything work better, do you have less pain and all that sort of stuff? That is where the gold sits. Don't get caught up in this talking about the width of the gap and all that sort of stuff. It is the least interesting thing about diastasis recta and this is why the rest should be included in diastasis recta.
Speaker 1:If we ever want to get women the proper care they need, we have to move away from the idea that diastasis recta is an aesthetic issue and that it is only the gap that is the issue. There is so much more to it, and muscle functionality is everything, and this is why you have to do I might say have to, I mean, I'm pointing a finger a little bit you have to do some specific exercises to make sure everything starts up again properly. This is why I disagree with some health and fitness physios that are not diastasis specialists that say, yeah, it's not really much of an issue, you don't have to do specific issues. If you do not do specific issues, you will never fix a specific issue Right. I can do all the bicep curls in the world. If my problem is my leg, the bicep curls won't do me any good. Over simplifying a little bit, but I hope that drives the point home a little bit. Anyways, anywho, that's me done for another week. We're going to see how the transcription and all that works.
Speaker 1:Peter at healthypostnatalbodycom, if you have any questions or comments or want to complain, want to come here, jackass, want to say thank you? I've had it happen before. People say thank you. You didn't just send me an email, right? That's what I'm here for. You take care of yourself. You have a tremendous week and next week we're talking body and body confidence and all that sort of stuff. You're gonna love that chat. We've got right until then. Bye now.
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