These unexpected causes of hip issues may surprise you but, once identified, can help you correct and address ongoing hip issues.
9 Unexpected Causes of Hip Issues
1. A weak core.
The core stabilizes the pelvis from above. If the core isn’t doing its job, this can destabilize the pelvis resulting in hip pain and discomfort.
2. Tight back muscles.
When your core is weak, your back will overwork to try to “pick up the slack”, resulting in tight back muscles. Overworked back muscles can pull on the back of the pelvis and create hip issues.
3. Weak glutes.
The glutes are key to stabilize the pelvis from below. But many postpartum women have trouble activating their glutes. If this area isn’t working effectively, it can create pelvis instability and hip issues.
If your hamstrings are working harder than your glutes, your hips can be adversely affected.
5. Pelvic floor tightness.
The pelvic floor is another set of muscles that stabilize the hips from below (along with the glutes). If you have an overactive pelvic floor, or one side of your pelvic floor that is tighter than the other, it will impact the way your hips feel and function.
6. Improper Alignment.
The pelvis is the relay station between the upper and lower body. If parts of your body are out of alignment, simple acts like walking, standing, or sitting can have a negative effect on your overall hip health.
7. Glute clenching.
A lot of women have at least some level of ongoing glute squeezing. Squeezing the glutes is a way for the body to compensate for a weak core BUT it can create more glute and pelvic floor weakness leading to even worse hip issues.
8. Deep hip rotator issues.
The muscles deep inside your leg that rotate your leg outward (like the piriformis) can get overactive and tight, particularly in a postpartum body, and cause hip discomfort.
9. Tight adductor muscles.
The adductor muscles, in our inner thigh, can become overactive and tight. These muscles can lock down and become tight as a means of keeping things steady when other muscles aren’t working properly. If one side is working harder than the other, or if both sides are very tight, that can pull the pelvis out of alignment and hurt your hips!
But most of us haven’t been taught to Kegel properly.
Typically, you are taught to squeeze the muscles as if you are shutting off the flow of urine.
But, if you only shut off the flow of urine, you are doing an incomplete Kegel!
The pelvic floor is a set of big, broad muscles that go from the pubic bone all the way to the tailbone. If you’re only thinking of shutting off urine flow, you’re missing some big parts of that muscle.
So how do we do a proper Kegel?
Step 1: Engage Properly
Pelvic floor muscles are responsible for squeezing AND lifting the pelvic floor. We want to find both these actions when doing a kegel.
As you Kegel, think about squeezing to shut off the flow of urine.
Now also visualize a diamond underneath your vagina. As you squeeze, imagine pulling that diamond up within you to lift the pelvic floor. Done correctly, you might feel the engagement deep inside the lower abdomen.
Step 2: Engage the entirety of the pelvic floor
We can access the full set of muscles by changing our pelvis position.
To begin, find the muscles in the front of the pelvic floor.
Start by untucking the pelvis and coming to sit more in the front of the pelvic floor (more toward the vaginal opening). From this position, take a deep breath in, then as you exhale engage, squeeze (like you are shutting off the flow of urine) and imagine drawing the diamond up inside of your vagina.
You just engaged the front of the pelvic floor!
Next, find the muscles in the back of the pelvic floor.
To access the back of the pelvic floor, tuck your pelvis under you so you are sitting more toward your tailbone. Inhale, let the muscles relax. As you exhale, squeeze the muscles like you are shutting off the flow of gas from your anus. Also, imagine drawing a diamond up inside your anus to find the lift of those muscles.
That’s the back of the pelvic floor!
Now come to a neutral pelvis position, sitting directly on the sit bones.
Inhale, let the muscles relax. Exhale and squeeze like you are shutting off the flow of urine AND gas, while also imagine drawing diamonds up within you.
You’ve found your entire pelvic floor!
You may find that either the back or front is weaker. This is totally normal. The more work you do on this, the more you can create balance through your entire pelvic floor.
Strengthen Abdominal Muscles
Our pelvic floor and our core are designed to work together.
And sometimes it can be easier to get the pelvic floor muscles to turn on by also contracting the muscles of the abdominals.
The inhale naturally relaxes the core and the pelvic floor. The exhale naturally engages the core and the pelvic floor.
So to begin, we will use the breath and inhale to allow everything to relax. As you exhale, imagine that you are engaging the pelvic floor like I just described in the kegel section.
Next, think about bringing that engagement into your belly. Engaging your low belly, mid-belly, and upper belly. You can use your hands as a guide to move the engagement up the body.
Remember, engagement is a subtle action. You shouldn’t be clenching or crunching, simply allow the engagement to move up. If you’re having trouble, try taking the hands and wrapping them around from the back to the front to help your body find the action (see the video for an example).
As you do this, you should feel tall and long if the correct muscles are firing. Remember to use the exhale whenever you are exerting yourself to help this engagement when you pick up your kids, sneeze, or cough.
Strengthen With A Pelvic Floor Trainer
A pelvic floor trainer is a piece of smart technology. Inserted into your vagina, it gives feedback to your phone or computer on how your muscles are working as you practice engaging.
The trainer will give you cues to engage your pelvic floor and it will help you work on overall strength (e.g. how strong the muscles are) and the muscles’ ability to work quickly (e.g. to protect you as you are about to sneeze). We will be releasing a more detailed post about pelvic floor trainers very soon. Stay tuned!
These are three simple ways to help increase strength in an underactive pelvic floor. By doing so, you can improve pelvic floor function which will allow you to get back to your active lifestyle without limitation!
Want to learn more about strengthening your post-baby core/pelvic floor with yoga? Click below to join my free masterclass.
The common advice for women struggling with pelvic floor issues is to “do Kegels”.
BUT…this assumes that all women with PF issues have underactive pelvic floor muscles (a.k.a muscles on permanent vacay).
This is simply untrue.
Many women who struggle with pelvic floor issues have the opposite issue – overactive muscles.
Traditionally, women with overactive muscles would have to seek the help of a physical therapist to release those muscles. But today, there are a number of Pelvic Floor Massagers available so you can release your pelvic floor muscles from the comfort of your own home.
We’ve rounded up the best pelvic floor massagers on the market and include our top pick.
Here are the pelvic floor massage tools we reviewed:
When trying to kegel, they don’t feel much engagement (because the muscle is already engaged!),
Difficulty taking a deep, full breath,
Peeing with exertion (a.k.a. pee-sneezes),
Pelvic pain or tailbone pain,
Pain with intercourse, or
Trouble emptying bladder fully.
These individuals may also be more of a “type A” personality.
WHAT IS INTERNAL PELVIC FLOOR MASSAGE?
Women struggling with hyperactive pelvic floors, often have trigger points in their pelvic floor. These trigger points are areas of muscular tension or fascia constriction that prevent the muscles from working properly. They often feel tender to the touch and result in muscles that don’t work effectively.
Internal pelvic floor massage relaxes and lengthens the muscles and fascia of the pelvic floor to change how they work and reduce pain. This is done internally through either the vagina or rectum.
It can be done manually with a finger (as is typically done at a pelvic floor physiotherapist) or with the use of a tool, like a pelvic floor massager.
Pelvic Floor Massage helps the muscles relax and the body feel better in two ways:
By lengthening the muscles through physical manipulation, and
By changing the way that the brain is interacting with the muscle (similar to when you have a headache and distract yourself from the pain by pinching your arm).
The end result: Better working muscles and less pain and discomfort.
We share additional ways to release overactive pelvic floor muscles in this blog post.
HOW DOES A PELVIC FLOOR MASSAGER WORK?
Most pelvic floor massage tools are small, curved wands. They come in a variety of materials.
Image Source: Intimate Rose
These wands are inserted into the vagina or anus, about an inch deep, with the help of lubricant.
Once inserted, you gently press the wand into the internal muscles of the pelvic floor.
HOW TO USE A PELVIC FLOOR MASSAGE TOOL
For vaginal insertion, you will want to be lying on your back, with your knees bent.
Visualize the pelvic floor like a clock, with the pubic bone at 12:00 and the tailbone at 6:00. Once inserted gently massage the areas from 6:00 to 1:00 (Starting from the anus, along the right side of the pelvic floor, ending to the right of the urethra). And then return to 6:00 and massage from 6:00 to 11:00 (along the left side of the pelvic floor).
Avoid the area from 11:00 to 1:00 (the area directly behind the urethra). Direct pressure on that area is uncomfortable and can cause injury.
This video gives a nice explanation of the pelvic floor and how to use a pelvic floor massage tool.
Once you are finished, wash the tool with soap and water and store it in a clean location.
WHO CAN BENEFIT FROM PELVIC FLOOR MASSAGE
A wide range of women (and men…but that’s another post for another day) can benefit from pelvic floor massage.
You may benefit from pelvic floor massage If you:
Experience the signs of overactive pelvic floors, mentioned above.
Experience unexplained pelvic pain that is unrelated to infection or gynecologic conditions like endometriosis or fibroids, or
Hold chronic tension in your deep hip rotator muscles (e.g. piriformis and obturator internus).
If you suspect that you have overactive pelvic floor muscles, it’s always a good idea to get confirmation from a pelvic floor physiotherapist before beginning any treatment.
PRECAUTIONS TO TAKE WHEN USING A PELVIC FLOOR MASSAGE TOOL
When using a Pelvic Floor Massage Tool make sure you follow all usage instructions from the manufacturer.
WHAT TO EXPECT WHEN USING A PELVIC FLOOR MASSAGE TOOL
When using a PF massage tool, it is common for it to feel very intense at the beginning. These muscles can hold large amounts of tension. Releasing that tension can feel similar to foam rolling tight muscles.
You may also experience MORE incontinence issues at first. As the muscles release, they must re-learn how to engage properly. In the interim, you may find that you are leaking more often. This should resolve over time.
WHAT IS THE BEST PELVIC FLOOR MASSAGER?
We’ve reviewed the majority of the available pelvic floor massage tools on the market (there aren’t that many!). Take a look through the pros/cons of each to find your best Pelvic Floor Massage Tool.
The Intimate Rose Pelvic Wand is a beautiful product designed by a doctor of physical therapy and a certified pelvic floor rehabilitation specialist.
A strong feature of this product is its design. Its unique shape allows you to reach both superficial and deep pelvic floor muscles. Many users noted that they could tell the tool was designed by someone with a good knowledge of pelvic floor muscles. And many reported that the tool reduced their pelvic floor tightness symptoms quickly.
One user indicated that they could not reach the piriformis muscle with the tool, but others did not report that issue.
This product also has the lowest price of the tools we reviewed, making it a great value for the money.
Designed with BPA-free, medical-grade silicone, so that it feels soft and smooth
Designed with a unique shape that helps the tool reach both superficial and deep pelvic floor muscles. This helps to better relieve pelvic pain deep within the pelvis.
It has two different sized/shaped ends, to suit your particular anatomy.
Both ends can be used vaginally or rectally to reach many of the pelvic floor muscles.
Easily cleaned with soap and water.
Most affordable of the tools reviewed (at the time of this writing).
Silicone coating can be damaged if left in a heated environment
Must avoid using silicone-based lubricants. Water-based lubricant is recommended to ensure the silicone doesn’t get damaged.
Like the original wand, the vibrating pelvic wand is a beautiful product designed by a doctor of physical therapy and certified pelvic floor rehabilitation specialist. It has the same unique design so that you can reach both superficial and deep pelvic floor muscles.
The vibration feature is designed to improve circulation in the pelvic floor, vaginal, and vulvar area. This makes this tool particularly useful for women who can benefit from increased blood flow to the area. This includes women who:
Experience chronic long-standing pelvic pain,
Are recovering from vaginal surgery,
Are post-cancer treatment (both pelvic and breast cancer)
Experienced a significant tailbone injury
Designed with BPA-free, medical-grade silicone so that it is soft and smooth to the touch
10 speeds of vibration
Designed with a unique shape that helps the tool reach both superficial and deep pelvic floor muscles. This helps to better relieve pelvic pain deep within the pelvis.
Has two different shaped ends, to suit your particular anatomy
Both ends can be used vaginally or rectally to reach many of the pelvic floor muscles.
Easily cleaned with soap and water.
Rechargeable with a USB wall charger
Silicone can be damaged if left in a heated environment
Must avoid silicone-based lubricants. A water-based lubricant is recommended to ensure the silicone doesn’t get damaged.
The TheraWand V-Wand was created with direct input from leading pelvic floor therapists. Made from high-quality acrylic, the wand includes two different shaped ends so that you can massage both broad areas and more targeted trigger points.
Although this wand can be used both vaginally and rectally, the manufacturers recommend their LA Wand for rectal massage.
This product seems to work well for pelvic floor massage, with a few users indicating they no longer need to see a physical therapist for manual treatment. One user mentioned that the acrylic material is quite hard, so it is important to use gentle pressure while using it. A few users mentioned that they did not receive instructions with the tool.
Designed with input from pelvic floor therapists.
Two different sized ends so that you can massage a broad area or more targeted trigger points.
Easily cleaned with soap and water.
Designed to allow you to control the exact amount of pressure and location of the massage
Some may find it too large for rectal usage (the company recommends their LA Wand for this).
Can not clean with alcohol.
Harder material (acrylic) might provide too much pressure for some.
If your pelvic floor is overactive, your goal is to find ways to release and relax those muscles.
(If your asking…how do I know if my pelvic floor is overactive? Head over to this post for our guide. If your symptoms sound more like an underactive pelvic floor, stay tuned!)
In an overactive pelvic floor, the muscles are chronically active. Often, they are overworking to create stability in your pelvis. This can lead to dysfunction that includes pain, poorly functioning muscles, leaking urine and a variety of other issues.
These four simple exercises can relax and release those pelvic floor muscles to create balance and reduce discomfort.
Happy Baby Breathing.
This simple breathing exercise starts by laying on your back in happy baby yoga position. Take your feet up and grab the outside of your feet with your hands, if possible.
If this position is challenging for you, just bend your knees and grab behind your thighs. This position naturally stretches the pelvic floor muscles.
From your desired position, allow your back and the back of the pelvis to settle down into the floor. Focus on the breath, particularly the inhale, which naturally expands the pelvic floor.
Begin deepening the breath and try to feel the inhale expand and stretch the pelvic floor. Let the exhale be passive (don’t worry about anything happening in your pelvic floor). Don’t worry if you can’t feel the breath in your pelvic floor at first. It can take some practice to get it to work!
Try to do 5-10 of these breaths per day to naturally relax those muscles.
Myofascial Release With A Ball.
Using a ball for myofascial release is another way you can begin to relax and release these muscles. Using a racquetball, tennis ball, or another small ball you have around the house (play with the size and firmness to find what’s comfortable for you), place the ball to the inside of one of your sitting bones.
(Not sure where your sitting bones are? bend over slightly and you will feel two bony protrusions in the center of your butt. That’s them!!)
In this position, the ball will be on one side of your pelvic floor.
If this feels too intense, place a towel or pillow underneath you to reduce the sensation.
With the ball under you, begin to take deep breaths, imagining you are breathing your pelvic floor into the ball. This will massage the muscles, breaking up some of the tension in the pelvic floor.
Stay there for a few breaths, then move the ball slightly forward, still on one side of the pelvic floor, to just behind your vagina.
Repeat the deep breaths.
Repeat on the second side to get into all the deep muscles in this area.
Internal Massage with a Pelvic Floor Massager
An internal pelvic floor massage toolis a device that you insert into your vagina to release both the superficial and deep muscles of the pelvic floor and deep hip.
It simulates the manual release that occurs when a pelvic floor physiotherapist manually releases your PF.
This is a very direct, and effective way to release tension that is chronically held, and difficult to access, in your pelvic floor.
We have a complete guide for Pelvic Floor Massage, including a review of the top pelvic floor massage tools.Click here to read!
Meditationis also an effective way to address pelvic floor overactivity. Typically, women with overactive pelvic floors tend to be more type-A, in general.
Implementing a regular, 10-15 minute daily meditation practice in your day can help reduce the level of tension in your body in general, including the tension in your pelvic floor.
These are four simple ways to help reduce activity in an overactive pelvic floor. By doing so, you can improve pelvic floor function which will allow you to get back to your active lifestyle without fear of pain or incontinence!
So many painful and uncomfortable postpartum body issues are considered normal.
They are chronic issues. And society tells women they are a normal part of “becoming a mom.”
Well I call BS.
There is a difference between issues that are common, meaning many women experience them, and issues that are normal, meaning they are a necessary byproduct of the birth and delivery process.
Many of the COMMON issues women are experiencing CAN and SHOULD be corrected by proper rebalancing of the postpartum body.
Check out our list of postpartum issues that are COMMON..but not normal.
Pelvic floor dysfunction… in other words, you are leaking pee:
We hear this all. the. time. This has become a joke in our culture. Many moms will say it’s just a ‘normal’ part of postpartum life. “Oh, you had a baby? Well…have fun on the trampoline!” Leaking urine during the course of daily life isn’t a joke. In fact, it is a sign that your body isn’t working properly. It’s a sign that your body is not handling the load you are putting on it and is in fact a warning that your pelvic floor is not working properly. So while this is a common issue, it should not be a normal way of living once you are out of the immediate postpartum, healing, phase. Learn more about this issue (and ways to minimize leaking) right here.
Weak Vaginal Wall Muscles…aka your tampons are falling out:
If you have the sensation that your vagina can’t hold tampons or your menstrual cup in, or if they feel unstable or just ‘not right’, this is a sign that the musculature in this part of your body is weak and needs to be strengthened. Pelvic floor physiotherapy is commonplace in some counties (bonjour, France!) as a way of retraining these muscles to work properly so these annoying issues go away.
Unstable core making you feel like Raggedy Ann or a limp noodle:
When I first went back to work after having a baby, my boss, and friend, noticed that I was always collapsed in my chair, leaning over the office table. I looked and FELT like Raggedy Ann because I was incredibly weak in my core. If you just had a baby, this is normal. Those muscles will take some time to recover. But if you are a few months or even years out from baby being born and still feel like a limp noodle when sitting upright or have a hard time staying upright for any length of time, this is a sign that that you haven’t recovered your deep core strength. The Heal Your Core With Yoga program can help you with this!
Tight back muscles…feeling old before your time:
Nothing like a chronically achy back to make you feel old and creaky. The paraspinals, back muscles that line the spine, become overworked and tight when the core is weak. The back muscles start doing the work for the core when it slacks off. Retraining and strengthening the core lets those back muscles relax a bit and release their iron grip. Back tightness and the sense that you always need to stretch those tense muscles will ease as we bring the core back into balance. P.S. If you wake up every morning with back pain, check out this quick video tip.
Neck and shoulder discomfort:
The tightness and discomfort you feel in your neck and shoulders may not seem related to the changes of pregnancy, but there are chain reactions occuring your body that creep all the way up to the top. Think about nursing, rocking and holding a baby in the post-partum period. Now, add to this the fact that most women are not breathing properly after having a baby, and have muscles compensating for the weakness in their noodly core. Together, these lead to tension and tightness. For three simple ways to reduce neck and shoulder tension, head here.
If you are struggling with any of these issues, know that you are NOT alone. We work with women everyday to help them strengthen and rebalance their postpartum body.
An extremely common issue for postpartum women is pelvic floor weakness. This is a main contributor to the common postpartum complaint of leaking pee.
Jumping on the trampoline, sneezing, or even laughing can all cause urine leakage with a weak pelvic floor.
So how do we correct this?
Unfortunately, the solution that gets the most press is…kegels.
However, kegels are NOT always the solution. And, for some women, kegels can actually make the situation worse.
So let’s dive a little deeper and uncover the root cause of your pelvic floor weakness.
WEAKNESS DOES NOT ALWAYS MEAN UNDERACTIVE MUSCLES!
This first point can be a little hard to understand, but it’s important!
Pelvic floor weakness does not necessarily mean that your muscles are underactive (a.k.a. On permanent vacation).
For many women, pelvic floor weakness is caused by OVERactive pelvic floor muscles (a.k.a. Muscles that are working really hard all day long).
What you need to remember: Whether the muscles are not engaging enough, or are holding on for dear life, both of these scenarios cause weakness in the pelvic floor.
What happens in an underactive pelvic floor?
Underactive pelvic floor muscles are weak in the same way a muscle that never gets exercised is weak. If you never strengthen your bicep, that muscle will be weak. If I place a 10 lb weight in your bent arm, that arm is going to immediately drop to your side. Your muscle doesn’t have the strength to contract against the load of that 10 lb weight.
The same thing can happen with your pelvic floor. If your pelvic floor muscles are underactive, they have trouble contracting fully and/or holding that contraction. So when you sneeze, and put a large amount of pressure on the pelvic floor, the muscles can’t hold the contraction and you likely end up pee-ing yourself.
Underactive pelvic floor muscles do not have the strength to contract fully. This means that when you sneeze, they don’t have the strength to protect you from leaking.
What happens in an overactive pelvic floor?
Overactive pelvic floor muscles are weak because they are trying to contract all the time.
Imagine your bicep again. If I ask you to bend your arm and squeeze your bicep for the entire day, that muscle is going to get TIRED because it is working so hard.
Then when I place a 10 lb weight in your hand, the arm will, again, drop to your side. In this case, it will happen because the muscle is so worn out from the work it has been doing that it has become weak. Weak from overactivity.
This is similar to what happens in an overactive pelvic floor. Overactive pelvic floor muscles are weak because they are being held in a constantly contracted position. So, when you sneeze, those pelvic floor muscles can’t contract fully because they are worn out from being in a constant state of contraction. The end result…you pee yourself!
Do You Have An Underactive or Overactive Pelvic Floor?
How do you know what is happening in your pelvic floor?
First, it’s helpful to see a physiotherapist who specializes in pelvic floors. They will be able to assess you internally and tell you exactly what is happening in your muscles.
However, that isn’t always accessible or possible. Luckily, there are some other ways you can get a sense of what is happening in your muscles.
Signs of an underactive pelvic floor
If you have an underactive pelvic floor, you likely feel that, when you kegel, it is hard to hold that engagement. You likely feel quivering in the muscles and that the muscles stop engaging relatively quickly.
You may also feel like tampons don’t stay in as well as they once did. Or you may feel that you have less sensation during sexual intercourse.
Also, the muscles often reflect the personality of a person. So, if you are more of a relaxed, Type B, person in general, it’s likely your pelvic floor muscles are underactive.
If you’ve suffered from pelvic floor issues or a lack of core strength, you may have already ditched your 3-mile run. But you shouldn’t give up on lacing up your shoes and getting out the door.
Instead of running, try walking. Walking your former running route is a great full body, cardio activity. It also helps create conditions for a healthier core. You read that right.
Walking in proper alignment can help you create a stronger, healthier core. How? Let’s dive in!
Why Walk Consistently?
How does walking impact core strength and healing?
Stronger Glutes and Happy Hips
Walking strengthens the glutes and stretches the hip muscles. (And stronger glutes contribute to a health pelvic floor.) Both of these actions help bring your body into proper alignment. Proper alignment is the key for a healthy core.
Increased Circulation and Healing
Walking regularly increases circulation. Increased circulation can speed the healing of connective tissue and muscles. This is good for both pelvic floor issues and diastasis recti (abdominal separation).
If you aren’t sure if your walk is aligned correctly, pay attention to the next part of this post.
How to Walk With Good Alignment
I can already hear you protesting. “But, Catherine, I already know how to walk. I learned that ages ago.”
Yes, you know how to walk. What you probably don’t know is how to walk properly. All the time we spend sitting has weakened our walking muscles. Those weakened muscles don’t perform as well as they should, leading to walking with suboptimal alignment.
The good news is that you can fix your walk by becoming more aware of it. After that, you set about adjusting your stride to encourage proper body alignment. Here are four things to look for when you’re walking:
Roll the Foot Heel to Toe
The heel of your foot should hit the ground before any other part of your foot. When you walk, you want there to be a smooth rolling motion from the heel to the ball of the foot and then on to the toes. When you walk, try to notice which part of your foot hits the ground first. If it’s not your heel, make a conscious effort to change your stride and focus on having your heel hit the ground first. The rest of the stride should follow after that.
Use the Foot to Push Off the Ground
In an ideal walk, your foot should push off the ground, not slide along it or shuffle. To achieve this walk, first hit the ground with your heel. From your heel, roll the all the way to the toes. As the ball of the foot and the toes are rolling onto the ground, you should start to push the ground away from you.
Does that sound like what happens when you walk? You may need spend some time noticing how you walk to identify areas that need improvement.
Keep Legs Hip-Width Apart
For proper alignment to happen, your legs need to remain hip-width apart when you walk. But how can you tell how wide apart your legs are? Try this test: Place your feet on each side of a sidewalk crack. Take a few steps forward and notice where your feet go.
If they move towards the crack when you walk, you need to work on keeping your legs at hip-width. If your feet stay an even distance from the crack (or other line), you’re fine.
When you’re testing your stride, be mindful of your foot alignment. Are you turning your toes outward, away from the crack? Your feet should be pointed straight forward and should be parallel to the crack.
Once you’ve determined how you normally walk, find what hip-width looks like for you. Start becoming mindful of what your legs feel like when you walk with them hip-width apart. It may feel strange at first, but keep practicing it.
Move From the Hip (Straight)
In a proper walk, you shouldn’t use your knee to move your leg. Instead, your movement should come from your hip. This is going to sound counterintuitive, but trust me.
Don’t bend your knee and lift your leg when you walk. You should push off the foot and send the leg back behind you from the hip. When you start walking from the hip, you’ll notice a difference. Your knee will feel kind of spongy. There will be a soft bend to it, but there shouldn’t be much force behind the bend.
Pelvis Stays Straight
Once you start walking from the hip, be sure to keep your pelvis from moving. When you move from the hip, you might find that your pelvis rotates with your steps. You end up moving your right hip forward for your right step. And the left hip moves forward for the left step.
The movement in your pelvis isn’t ideal. It doesn’t help open your hip muscles. You want your pelvis to stay straight and allow the legs to extend within the hip.
Eyes on the Horizon
When you walk, look ahead of you. Too often, we get wrapped up in what we’re doing. We tend to look down at our phones, our kids, etc. What we really need to do is look to the horizon. That helps ensure that your body is upright and not leaning forward.
The next time you find yourself looking down when you walk, look at the horizon. You may see something you’ve never noticed on your normal walking route.
Get a Core-Strong Walk
Developing a core-strong walk is all about technique and consistency. It will likely take you some time to identify how to improve your walk. Once you have the problem areas noted, you’ll need regular practice to make your new walk feel natural.
Even with pelvic floor issues, cardio isn’t out of your reach, especially if you develop a core-strong walk.
One key to healing your core after pregnancy is your alignment. I often discuss how three key alignment changes (hips over heels, neutral pelvis, and neutral ribs) minimize intra-abdominal pressure and turn on the deep core muscles.
But for many new moms, a common question arises: how can I maintain alignment and healing while baby-carrying or baby-wearing?
Holding a squirming bundle in our arms, or in a carrier, throws off our posture and strains our core.
So let’s discuss how to do this in the most core-safe way.
How to Baby Carry In a Core-Safe Way
The Newborn days
In those first few weeks, when your newborn has no head control, you’re likely using your hips to support the weight, and rounding over to keep them secure. It’s very hard to maintain good alignment in this newborn stage!
The good news…This only lasts a couple months. Don’t put extra pressure on yourself in those early days.
Once Your Baby Has Head Control
However, once baby has a little more head control and is getting heavier, it’s time to become more mindful of your body position.
Holding in Arms
Our tendency is to throw one hip out to one side (usually the same hip every time) and let the baby rest on the shelf of our hip bone. This position is less than ideal.
It makes it hard to engage our deep core muscles and increases outward pressure on the abdominal connective tissue. This increase in pressure is particularly harmful if you have diastasis- recti or a prolapsed pelvic floor.
We can ease that pressure by keeping the hips square. When you pick the baby up, use your arm to hold the baby (as much as possible) rather than the hips. When one arm gets tired, switch to the other side. You can also take them in front with both arms as support. At first, this feels hard and strange. With time, you will build arm strength and it will become easier.
As your baby becomes a toddler, try to use the piggy-back method when they need to be carried. This allows you to keep alignment and squared hips while giving tired toddler legs a break.
For those of you using a baby carrier, here are a few tips that will help you maintain alignment and minimize intra-abdominal pressure.
As soon as baby is big enough, move them to the back instead of carrying on the front. This allows you to use the natural protection of the bones in the back, the ribcage and spine, to avoid straining the core.
If your baby isn’t big enough or isn’t ready to be on the back, make sure that while you front carry you don’t shift your hips forward as you get tired. Instead, lean forward slightly and take breaks often.
Regardless of whether you wear your baby in front or back, makes sure that the straps are fitted properly. You want the baby nice and snug against your body and the waistband snug around the hips. When the straps are too loose, we tend to move into poor alignment to compensate.
In general, make sure you take breaks as often as possible to avoid fatigue in your muscles.
Even though it feels like you will be carrying that heavy child around forever, I promise you, those days will be behind you soon enough! Your core (and entire body) will appreciate the time and attention you put into proper baby carrying during this season of your life.
As moms, it has become normal to joke about peeing our pants. I get it. We use humor when talking about difficult topics.
While incontinence may be common in postpartum women, it is not normal. In fact, leaking is a sign of dysfunction in the core/pelvic floor system.
Today I’ve got two tips to share for those of you struggling with leaking. These are actions you can take right now to work on improving this.
Tip #1: Find Pelvic Floor Balance
First, a little anatomy. Your pelvic floor is a huge set of muscles that connect from the pubic bone at the front of your pelvis, to the tailbone at the back of your pelvis. We should be able to engage the entire set of muscles. But, often, women who leak are instructed to “do more kegels” by just squeezing the muscles that shut off the flow of urine. That cue engages only a small portion of the pelvic floor muscles.
You want to make sure you are engaging the entirety of your pelvic floor – both the front and back. We do this by playing with our pelvis positioning.
To test out your balance, try this. Sit on a chair with your feet flat on the ground.
1. First, engage the muscles at the front of the pelvic floor.
a) Tilt your hip bones forward to move your pelvis into an anterior pelvic tilt position.
b) Then engage your pelvic floor by squeezing the muscles that shut off the flow of urine.
c) Try to hold that engagement for 10 seconds and observe what happens.
2. Then engage the muscles at the back of the pelvic floor.
a) Tilt your hip bones back and tuck your pelvis under you (Posterior Pelvic Tilt Position).
b) Now engage the back of your pelvic floor by squeezing the muscles that shut off the flow of gas.
c) Again try and hold that engagement for 10 seconds.
3. Now engage the entire pelvic floor.
a) Bring your pelvis back to a neutral position (sitting on your sit bones)
b)Now engage the entire pelvic floor by engaging the muscles that shut off the flow of urine AND the muscles that shut off the flow of gas.
c) Now you have all your pelvic floor muscles firing. What happens when you try to hold for 10 seconds?
While doing this, ask yourself: how is your balance? Does one part feel stronger or weaker? If so, you would benefit from creating balance in those muscles.
You might be asking…but what does this have to do with leaking?
The muscles that are responsible for holding urine are in the front of your pelvis.
By positioning your upper body in a slightly forward position, you encourage the muscles at the front of the pelvic floor to engage more readily…which helps prevent leaking! (Watch the video above for a clear visual of how this works!)
Tip #2: Work the Fast and Slow Twitch Muscles
So now that we’ve got the body positioned to help these muscles fire more efficiently, the second step is to work both muscle types. Your pelvic floor has two types of muscles, fast-twitch and slow-twitch.
The slow-twitch muscles help hold your internal organs in. They are designed for holding a low level of engagement over a long period of time. When you hold a kegel for 10 seconds, you are engaging your slow-twitch muscles. If they are weak, you may find them getting shaky as you hold them. However, these are NOT the muscles that stop the flow of urine.
Fast twitch muscles turn on with sudden demand (like when you sneeze or hit the ground in a jumping jack). These are the primary muscles that help you prevent leaking. These muscles engage quickly, for just a moment, and then they relax.
For this reason, it’s important that your pelvic floor training works both types of muscles. You want to engage your pelvic floor with long holds (e.g. 10 seconds) and multiple reps of quick pulses (squeeze, release, squeeze, release). This will train your pelvic floor to respond to the demands of daily life and those sudden moments of intense pressure (like a sneeze).
The unpleasant leaking that many moms experience does not have to be a fact of life. Body positioning AND training both fast- and slow-twitch muscles can help reduce leaking once and for all.
Connecting to your deep core muscles, particularly your transverse abdominals.
From a seated position (or while nursing), first take a breath in and let the belly relax. Imagine a corset around your midsection. As you exhale, feel the corset draw in gently. This should create a feeling of length in the torso. This action helps bring your core muscles back on-line.
If you are desperate for some movement, walk!
Walking is low impact and increases circulation (which aids healing). In a perfect world, this walking would happen without holding or wearing your baby. For some of us (like me!) that isn’t possible with a newborn, and that’s ok! But, if you can manage it, walking freely helps bring your body back into proper alignment after pregnancy.
To recap: as you begin to heal in those first six weeks focus on: REST, breathing, core engagement, and walking (if you feel up for it!).
6-Weeks to 4-Months Postpartum
At this point, you’ve had six weeks to heal (and possibly a few weeks longer in the case of a C-section), and your care provider has cleared you for activity. We now enter the six-week to four-month period of recovery.
This period is critical to your post-baby core health. I encourage my students to approach this stage with care and caution.
Elevated hormone levels and muscular imbalances from pregnancy leave your body, particularly your core, in a compromised state. And doing too much too soon can lead to postpartum issues like diastasis, prolapse, and hernias.This is especially true for a woman who was active during her pregnancy. Her arms and legs are strong. She feels like she can do everything. But her core is weak and cannot support that effort. My recommendations for this period include:
Continue working on the basics.
Engage your deep core muscles regularly and get the breath down. Pregnancy alters the core muscles and breathing system and it takes time to get them working well again!
Add in activities that rebalance your post-baby musculature.
Rebuild mobility in the mid-back. When your back and chest are tight, simple activities, like reaching or lifting, strain an already weak core.
Balance the muscles of the hips. By rebalancing the muscles of the hips, you create a healthier pelvic floor.
In the next few weeks, I’ll be sharing some of my favorite yoga postures for this critical postpartum period. Stay tuned!
High-intensity impact activities. No running, burpees, HIIT, Crossfit. These activities put excessive demand and load on your core and it’s not ready for that yet!
Front-loading ab activities. Planks, crunches and all the ‘typical’ ab exercises will do more harm than good.
Excessive back bending postures and deep twist positions like you find in many yoga classes.
Remember, this is a critical period for your body and recovery. You have the chance to create a solid foundation that will allow you to begin incorporating more intense activities in the near future. If you overexert yourself during this period you could end up weaker at six-months postpartum than you were at six-weeks.
4-Months Postpartum and Beyond
Recommendations become less cut and dry after 4 months.
Some who’ve spent the first 4 months building the foundation can safely introduce high-intensity activity at this point. Others would benefit from continuing with lower-intensity activities for longer. This would include anyone who falls into the following categories:
Breastfeeding extends the critical period for your body. The hormones associated with breastfeeding create laxity in your ligaments. In other words, they make you loosey-goosey and create instability in your body. If you are an extended breastfeeder (like I was!) you should approach high-intensity activities with caution until you finish nursing or are down to 2 or 3 feedings a day. After that, the hormones shift and allow more stability in your ligaments.
If you tend to be a very flexible person, you are likely genetically predisposed to instability. You’re super flexible because your joints are looser. If this is the case for you, you also want to be more conservative in your post-baby movement. You would benefit from giving your body more time to rebuild core stability.
Family History of Postpartum Issues:
If you have a family history of things like hernias or prolapses it likely means you are genetically predisposed to these issues. Again, this is an indication that you may want to give your body more time to build a foundation of stability and strength before jumping into high-intensity activities.
How to Begin Increasing Intensity of Your Exercise
You’re done nursing (or are down to 1-2 times a day), you’ve mastered deep breathing, and have a solid connection to your deep core muscles.Awesome! Let’s increase that intensity!Here’s how to do it in a mindful, core-safe way.
Start With Lower Intensity.
Your body has gone through a huge transition and you should not jump into any activity at your pre-pregnancy intensity. Start at 50% of your “usual” and see how it feels. If you feel back pain, hip pain, if you leak, or feel like your core isn’t supporting you, those are all signs that you are working beyond your ability.
Short Intervals Are Best.
If you’re getting back to running, don’t start by heading out and knocking out two miles. Instead, try five minutes and then check in. If you’re doing a yoga class, take a break every 5-10 minutes and see how everything is feeling.Again….Does your back hurt? Do your hips hurt? Did you leak any urine? Do you feel unsupported in your core?
If you answer yes to any of those questions, your body hit its limit. You’ll want to move to even shorter intervals and spend more time building that foundation.
If, after five minutes, you are feeling good and aren’t having any of those symptoms. Awesome! Next time, try 7 minutes and see how that goes. You want to build your intervals slowly.
Check In Frequently!
It’s likely there will be a point at which you will reach the limit of what your body can do in a strong, safe way. And once you hit that limit, stop! That’s your limit, but just for now. You build from there.
Remember: Start back to your activity of choice with less intensity, shorter durations, and continual check-ins with yourself. The moment you see any signs of disfunction, back off or stop. From there, we continue to build! By respecting your body’s limits rather than pushing through them, you give your core the chance to rebuild it’s pre-baby strength.
A weak core and pelvic floor creates a whole host of compensations in other parts of the body…weak glutes, tight hips, and a tight back, to name a few. (If you haven’t already, you might want to check out last week’s post on exactly what happens in your body during pregnancy)
In the words of some of my students, it’s easy to feel like “Pregnancy trashed my body.”
And easy to feel overwhelmed at where to begin fixing the issues.
With the core? With the back? With the hips?
But I’m here with some good news.
The answer is pretty simple.
You start with your breathing.
Getting your breath working properly restores much needed muscular balance to your postpartum body. Restoring this balance is a HUGE first step in preventing (or healing) postpartum issues like abdominal separation (diastasis recti), leaking pee (incontinence,) and pelvic organ prolapse.
Let’s dive in (Plus, I’ve got a great free resource for you to help get your breath system working).
The Relationship Between the Breath and Core
Our breath system is extremely sophisticated and has a huge impact on our muscular balance.
The system includes our:
And pelvic floor
Take a look at that diaphragm! It’s huge! Not only does it span our entire chest but it attaches to the ribs and the spine.
When the breath is working properly, every inhale expands the ribs and drops the diaphragm down. When the diaphragm drops down, the belly expands and relaxes, and the pelvic floor expands and relaxes. The movement of the diaphragm and ribs also relaxes the mid-back muscles and the psoas (a hip flexor that attaches at the ribs!). Basically, every inhale allows a whole lot of tight muscles in the body to relax fully.
On an exhale, the diaphragm lifts up, the core naturally engages, and the pelvic floor engages and lifts. This natural action of breathing creates a healthy resting muscle tone in the core and the pelvic floor.
As you can see the core and the breath are DESIGNED to work together.
Healthy breathing = healthy core. Funky breathing = Really hard to have a healthy core.
Breathing in a Postpartum Body
But what happens in a postpartum body?
Well, to be blunt. For many women, pregnancy jacks up the breathing system.
Plain and simple, the diaphragm stops working effectively. Which means the core isn’t working effectively either.
This loss of diaphragm functioning can’t be helped. There is just no room for it to drop down into the body because the baby is taking up that space.
So you start compensating. You start using the lift of your shoulders to bring air in. This often results in the diaphragm pulling up into the body on an inhale RATHER than dropping down.
Basically the diaphragm completely switches directions! Which makes you lose all of the natural core strengthening of the breath.
Now in a perfect world, our bodies would magically switch back to good breathing after the baby is born. But, for some reason (that I haven’t figured out yet), this just doesn’t seem to happen.
Postpartum women, particularly those that struggle with core and pelvic floor weakness, tend to continue to breath in this funky way even after the baby is out.
Let me show you an example from one of my students.
See that hollow space under her ribs. If her diaphragm were dropping down on an inhale, that space would fill up and inflate. But hers does the opposite. The space deflates and becomes almost like a vacuum! That signals to me that her diaphragm is lifting up on the inhale. And that her core isn’t receiving the benefits of the natural deep breathing system.
So the first thing to do after having a baby is to retrain the diaphragm to work effectively. The breath is the best place to start your healing.
Once the breath is functioning well, so many other things start falling into place!
How the Breath Fixes a Body After Pregnancy
Restoring the natural breath patterns brings the core and pelvic floor back online.
When the core starts working it allows the back and hip muscles to stop working so hard. (And remember that good inhale helps relax those muscles too).
Getting the breath working begins to rehabilitate the body by bringing proper balance to the muscles!!
So the answer to the question ‘where do I start?’ You start with the breath.
I know this is not always what women want to hear. They want to jump back into high intensity stuff. But if you skip over the breath piece and move into high intensity stuff before you’ve retrained the diaphragm you are building your house on a non-existent foundation.
If the breath isn’t working properly, the core isn’t working properly. And doing activities without core support is a recipe for disaster. It’s worth spending a few weeks on the breath so you can spend YEARS doing the other activities you love with a healthy core.
Start with the breath. Get the breath down. And then you can confidently move into all of these things that you love doing.
If you’d like to practice this, I’ve got a free breath training tutorial which will help you reset your breathing and get your diaphragm working again!
Free Breath Training!
Naturally engage your core and pelvic floor with breath.
Build core strength all day, every day.
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In so many ways, we send harmful and unrealistic messages to women who just had a baby.
When a new mom goes to her midwife or doctor for a six-week check-up, she often hears, “Go ahead. Go do everything you were doing before you were pregnant. You are good to go.”
Pregnancy is a massive change to the musculoskeletal system. We should treat pregnancy as an injury to the body and the postpartum period as a time of rehabilitation.
Let’s dive into this! You can watch my facebook live or read below.
What Happens with an Injury
Think about an ankle injury. If you sprain the outside of your ankle, the ankle loses stability and can’t work the way it normally does.
The body DOESN’T like instability. Other areas start taking over to support and stabilize the injured area. All sorts of compensations happen.
You stop putting weight on the outside of that foot. You shift more of the muscular work to the inside of your ankle. That creates a chain reaction up your entire body.
The knee, hip, shoulder and even neck work differently because of the ankle injury. Crazy, right?!
What Happens to Your Body During Pregnancy
This isn’t a far cry from what happens during pregnancy.
Think about it: you’re growing a giant baby in your belly.
Even if you are active during pregnancy, the core muscles get weak. They cannot support the body in the way they did before you were pregnant.
Normally, the core stabilizes both the spine and the pelvis.
When the core isn’t working, those areas become unstable. And, remember, the body doesn’t like instability.
So some compensations happen to maintain stability in your body.
The paraspinal muscles in your back start working hard to make up for the work your core was doing (They get tight!).
The psoas, the main hip flexor, starts working overtime. This huge muscle is designed to move your legs. But when the core isn’t working, it will start working to stabilize the spine. So your hip flexors get really tight!!
On the outer hip, a group of muscles called the TFL starts gripping to help keep your pelvis stable. So your outer hips are tight!!
The TFL is a bully to the glutes and make it hard for your glutes to fire. Overtime, your glutes get weak.
So not only is your core weak, but you have major compensations in your back, hips, and glutes!
If that isn’t reminiscent of an injury, I don’t know what is!
Typical Approach to an Injury
When someone injures an ankle we don’t say “You injured your ankle a few weeks ago. Your muscles are working completely differently. But go ahead and go run that half marathon. Go ahead and do that HIIT workout that you were doing before you hurt yourself. You waited 6 weeks, right? That’s cool. You’re good.”
We say “You sprained your ankle and let it rest and heal. NOW let’s rehabilitate it. Let’s balance out the muscles that were overworking to create stability. Let’s get the joint working properly again so that you can run or do HIIT again, without injuring yourself.”
After rest, you rehabilitate, THEN you move back into higher demand activities.
Typical Approach to the Postpartum Period
This is not the approach taken in the postpartum period.
We tell postpartum woman “Rest for six weeks…and then go do everything you did before you were pregnant.”
Starting into activity before rehabilitation perpetuates the imbalances created during pregnancy.
Practicing yoga or running with a weak core makes your back and hips work even harder to stabilize your spine…Which strains them further.
You are asking an injured body to do things it isn’t ready to do.
A New Model for the Postpartum Period
Let’s treat pregnancy as an injury and rehabilitate the postpartum body.
Let’s tell women “Rest and recover for 6 weeks. Then let’s correct the imbalances created by nine to ten months of pregnancy. Let’s rebuild the weak muscles and teach those overworked, overactive muscles to chill out! THEN, let’s move on to all that higher intensity stuff.”
Bring the core back online. Rebuild strength in muscles that grew weak during pregnancy. And release tension that has built up in the hip flexors and back.
Once everything is working the way it’s meant to, you can get back to the activities you love.
Hi there! I’m Catherine Middlebrooks, a yoga instructor and postpartum corrective exercise specialist.
I’m on a mission to help moms reclaim their core and pelvic floor strength so they can get back to the activities they love.