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- Are you breathing correctly?
Part of our guest blog take over with Niamh Morrin, Baby and I@babyandi.herts Is there a correct way to breathe? Surely if air is entering and exiting then that’s all we need to worry about? Well – yes for sustaining life – but maybe not for aiding optimal function of the musculoskeletal system! Can we assume all postnatal dancers have a disrupted breathing pattern? Yes, most probably! Good breathing patterns are our foundation – they affect our entire body. Our diaphragm, pelvic floor and core muscles should move together with each breath – the co-ordination of these muscles is essential in regulating intra-abdominal pressure – poor pressure management within our core canister can lead to pressure leaking out of a “weak area” – leading to the risk of hernias, prolapse and a persisting diastasis recti. In addition, poor breathing patterns can lead to excessive holding of tension in our pelvic floor, core and neck and shoulders. Tension holding is not a sign of strength and will eventually lead to a weakening of a muscle as it is not being stimulated correctly. Pregnancy can alter and disrupt optimal breathing patterns. During pregnancy the rib cage widens and the diaphragm gets pushed up (LoMauro and Aliverti, 2005) – the diaphragm struggles to contract and flatten and rib cage movement reduces – this make it difficult to get a deep inhale or exhale. These changes can throw us into shallow breathing pattern (all neck and shoulders) or belly breathing (where the inhale pushes the belly out). Can we assume all postnatal dancers have a disrupted breathing pattern? Yes, most probably! And as a side note, I haven’t worked with one dancer, young or old, male or female, prenatal or postnatal with a good breathing pattern! This begs the question – do dancers have poor breathing patterns? To be honest, I can’t answer that with any scientific back up, but in my experience, neck and upper abdominal tension is a very common “habit” in dancers. I believe every dancer needs training in correct breathing patterns. I’m pregnant/postnatal – why care about my breathing? If we don’t re-establish and train correct breathing mechanics, we will miss out on strengthening and connecting with our core and pelvic floor in a natural way. A correct breathing pattern should naturally lengthen (inhale) and contract (exhale) our entire pelvic floor and abdominal wall. When diastasis recti, weakened abdominal and pelvic floor dysfunction are almost part and parcel of the maternal journey, correct breathing will be the first step in retraining your system correctly. Re-establishing correct breathing Correct breathing is not as simple as letting your belly rise and fall (this actually shows pressure leaking of a weakened area). Read the 4 steps below to see how you can improve your breathing pattern and work your core and pelvic floor correctly. #1 – Develop an awareness of your breath Position yourself in a comfortable kneeling position with attention to posture, shoulders over pelvis and pelvis in neutral (Figure 2). Wrap your fingers around each side of your rib cage (fingers on the front, thumb wrapped around to the back). Take a 5 second inhale and exhale. What happened on the inhale? 1) Did your neck get tense? 2) Did your shoulders move up? 3) Did your tummy expand? 4) Did you widen and lengthen your lateral abdominal muscles? 5) Did your rib cage expand in 360 degrees? (i.e. did it widen, expand out to the front and out to the back) 6) Did you notice any movement in your pelvic floor? #2 – Let’s get your ribs expanding in 360 degrees Now repeat your inhale and exhale and let’s get your ribs expanding in 360 degrees. Wrap your fingers around each side of your rib cage. On the inhale concentrate on keeping your neck and shoulders relaxed and instead “blow your rib cage up”! It should expand out to the side, front and back. To help with rib expansion we need good eccentric length in our lateral abdominal muscles (transverse abdominals and obliques). If you lack this strength you will notice very little expansion of the rib cage and your tummy will expand out (belly breathing!). To practice lateral expansion of the abdominals, drop your fingers down so they rest on your sides and under your rib cage. Breath into your fingers – you should feel your sides expand out into your fingers. Your tummy will expand a little but not a lot! Missing out on good rib expansion and eccentric lengthening in our lateral abdominal muscles will essentially mean we are missing out on a good opportunity to use our core muscles effectively. A muscle must first lengthen to get a good contraction; this is why dancers work their plie before they take off from the ground – this will give them better jump height because the calf muscles have been lengthened first. If we take this principle to the core we need to ensure that our breathing allows our core muscles to lengthen before they contract. In a nutshell, good rib expansion and lengthening of the core muscles gives opportunity for the muscles to contract well – thus providing lots of lumbopelvic stability. This is especially important when you are dancing – if your breathing patterns aren’t allowing good lengthening and therefore good contracting, then you will never be able to sustain correct core tension when performing exercises that require lumbopelvic stability! Video 1: Exercise to assist with rib mobility #3 Time to take note of your pelvic floor If you are starting to find good movement in your ribs and lateral abdominals then focus now on allowing your pelvic floor to relax and spread on the inhale. As you exhale you should notice a natural contraction or recoil. #4 The exhale If the inhale has done its job at lengthening the abdominals and pelvic floor then they are in a perfect position to naturally recoil (at rest) or contract more fully if required for exertion (i.e. dance, general exercise, lifting kids!). On the exhale allow your pelvic floor to gather together and lift whilst concentrating on contracting your tummy muscles evenly –contraction of your abdominal should start at your lower transverse abdominals (as low as hip bones and pubic bone) all the way up to your ribs. In a nutshell Co-ordinating the movement of your ribs, lateral abdominals and pelvic floor on your inhale and exhale will be key to retraining the muscles of your core and pelvic floor whilst teaching them to contract effectively for optimal function. If you are postnatal and are looking to retrain your core, heal diastasis recti, address pelvic floor dysfunction, improve overall strength for return to dance or even address pain and discomfort breathing patterns should be addressed first and foremost. Reference LoMauro A, Aliverti A. Respiratory physiology of pregnancy: Physiology masterclass. Breathe (Sheff). 2015 Dec;11(4):297-301. doi: 10.1183/20734735.008615. PMID: 27066123; PMCID: PMC4818213. Also see Niamh's other blogs on Diastasis Recti and Pelvic Floor
- Your Pelvic floor: is it taking the hit?
Part of our new blog take over from Niamh Morrin, Baby and I@babyandi.herts Introduction Although the pelvic floor can be troublesome for anyone no matter their age or sex it can become a particularly troublesome part of the body for athletic females (Rebuildo, Faigenbaum and Chulvi-Medrana, 2021), dancers (Thyssen et al. 2002) and maternal women (Faubion et al. 2012). Evidence suggests that female athletes are three times more likely to experience pelvic floor dysfunction as compared to their male counterparts – throw the pre and postnatal journey on top of that; the maternal female dancer, is most certainly at risk of encountering pelvic floor dysfunction (PFD). The pelvic floor can be particularly vulnerable during the journey to motherhood. Reasons that pregnancy and childbirth can influence pelvic floor function include: 1) A growing bump and widening pelvis will put stress and strain onto the pelvic floor muscles. 2) A long pushing phase or experiencing a tear can directly affect pelvic floor function 3) The overall postural changes and muscle imbalances that can occur during pregnancy can affect the function of the pelvic floor. Pelvic floor dysfunction is NOT normal and should not be brushed under the carpet as a postnatal issue that’s part and parcel of becoming a mum. Understanding the basic anatomy and function of pelvic floor, training it in the right way and getting support if needed should be part of every female dancers pre and postnatal journey. What’s frustrating, is that despite its very important functions, the pelvic floor isn’t an area of our body that we can readily see or even feel entirely comfortable talking about. Important functions include: 1) Spine and pelvis stability and support 2) Breathing and posture 3) Pelvic organ support 4) Continence (Urinary and faecal) 5) Sexual activity Anatomy Basics The pelvic floor muscles are a group of muscles that together form a hammock at the base of the pelvis (Figure 1). If we were able to look down into the bowl of our pelvis (Figure 1) we would see that the pelvic floor muscles span the entire pelvis cavity – muscles attach to the pubic bone at the front, the coccyx and sacrum at the back and the ischial tuberosities/sitz bones at the sides. There are a number of muscles that make up the entire pelvic floor, some superficial and some deep. The superficial muscles provide the squeeze which help with continence and the deep layer supports our pelvic organs (bladder, bowel, uterus). There is also a right and left side and a front and back to the pelvic floor. The right or left side can function or become dysfunctional independent of the other side, the same goes for the front and back and deep and superficial layers. In theory when contracting our pelvic floor we want our pelvic floor muscles to fire as a cohesive unit – just like our primary core muscles (internal and external obliques, transverse abdominus and rectus abdominal muscles). Also, similar to our core muscles, whilst we can consciously contract them, the pelvic floor should fire automatically to provide stability to the pelvis during movement. Signs of dysfunction Pelvic floor dysfunction (PFD) is a non-specific term that can encompass a wide variety of conditions. If a pre or postnatal dancer is experiencing PFD they might notice one or more of the following symptoms. Urinary or faecal leakage; this could occur with jumps, coughing, sneezing, or lifting (stress incontinence) Experiencing a very strong and uncontrollable urge to go (urge incontinence). Pelvic pressure or the sensation of something falling out of your vagina Urinary or bowel frequency/urgency (Having to “go” more often than every 2-4 hours during the day or getting up more than once in the night Pain with urination or bowel movements Incomplete bladder emptying (having to “go” again or dribbling a few minutes after urinating) Pelvic pain (pain in the pelvic floor, lower abdominal, coccyx, pelvic region including urethral, bladder and anal pain) Constipation Painful menstruation Painful intercourse Training the pelvic floor Kegals – what are they and do they help? A kegal or pelvic floor contraction is an exercise that isolates and contracts the pelvic floor muscles. A bit like a bicep curl – the exercise is targeting one specific area of the body. The idea of a kegal is to get someone to connect with their pelvic floor muscles and increase muscle volume and strength. Different versions of the kegal are designed to increase the responsiveness (i.e. exercises would include quick contractions and relaxations) and endurance of the pelvic floor (i.e. exercises would include holding a contraction for a period of time like 10 seconds). Kegals are often thrown around as the solution to all pelvic floor dysfunction – the reality is that it will usually only be effective if the pelvic floor is hypotonic and lacks muscular tone. Sometimes Kegals quite simply might not help the PFD or in some cases (for example when the pelvic floor is tight or hypertonic) they might be making the issue worse. This is where the pelvic floor issue is NOT a pelvic floor issue and the pelvic floor is simply taking the hit for an issue somewhere else in the body. Because the lower extremity, hip, abdomen, pelvis, and spine are a connected kinetic chain, any dysfunction along this chain may cause overcompensation and dysfunction of other associated muscles, including the pelvic floor (Fabion et al. 2012). Some of the major contributors of pelvic floor dysfunction might include 1. Incorrect response to increases in intra-abdominal pressure 2. Hip muscle imbalance 3. Function and strength of external rotators / turnout muscles Incorrect response to increases in intra-abdominal pressure. When it comes to PFD we often need to retrain the natural function of the pelvic floor (Zivkovic et al. 2012). With each inhale the pelvic floor should relax and spread and with each exhale the pelvic floor should gather and contract (Bartelink, 1952). The pelvic floor, should, in theory work in synchrony with the respiratory diaphragm and the muscles within the abdominal cavity (Figure 2). Training the co-ordination of this is essential for good pelvic floor function. Without training this natural synchrony we might hold a constant level of tension or tone in the pelvic floor – our inhales might not be accompanied by a relaxation or lengthening of the pelvic floor. Holding tension in a muscle will introduce fatigue, hypertonicity (tightness), weakness and ultimately poor function. Another consequence of poor synchrony is that an exhale, in particular a forced exhale (i.e. during a cough or laugh) which rapidly increases intra-abdominal pressure could cause a bearing down on the pelvic floor, instead of it gathering and contracting. This puts the dancer at risk of stress incontinence (i.e. leaking) or pelvic organ prolapse. Training good synchrony in breathing patterns is essential so that when it comes to effort we can increase abdominal pressure without pelvic floor failure. Dance can be a high impact, high intensity activity and dancers need to put effort into movement – they need to leap, jump, pirouette, run, lift and transition in and out of the floor. Dancers are therefore constantly increasing intra-abdominal pressure in response to effort – having good natural function of the pelvic floor means that it will be ready to gather and contract during these moments of increased effort. Hip muscle weakness / muscle imbalance The hip muscles are often used as a window into the pelvic floor. Hip muscles include the adductors, the hip flexors and extensors and the internal and external rotators (Figure 3). Many of these muscles have been found to work synergistically with the pelvic floor (Halski et al. 2017). They work together to provide pelvic stability. Imbalances and weaknesses within the hip complex can therefore contribute to changes in the orientation of the pelvis and the musculoskeletal balance of the hip, this can therefore directly affect the function of the pelvic floor muscles. Specifically, research findings have revealed a relationship between pelvic floor tightness, dysfunction and abnormal pelvic alignment (Tu, Holt, Gonzales and Fitzgerald, 2008). In addition, research has shown that hip muscle strengthening benefited the pelvic floor in individuals with stress urinary incontinence (Marques et al. 2020). Function and strength of external rotators / turnout muscles When it comes to dancers, a very important consideration in the hip and pelvic floor relationship are the hip external rotators. The obturator internus, a turnout muscle is a pelvic floor muscle and the remaining external rotators are fascially connected to it – the dancers’ turnout muscles are their pelvic floor and therefore the function of these muscles are directly important for good pelvic floor function (Tuttle et al. 2020, Baba et al. 2014). Foster and colleagues (2021) found weaker hip external rotators and abductors in women with increased urinary urgency and frequency (signs of pelvic floor tightness). But can we not assume that all dancers who use turnout have strong, functioning external rotators?Personally I’m not convinced and research has recently found that many dancers rely on floor friction to hold external rotation (Duncan et al. 2020) – this finding suggests that the function and strength of these muscles might not be what we need it to be and better training and understanding of the external rotators themselves is required. For good functioning external rotators (ones that can contract and relax) we need correct positioning of the hip socket, good pelvic alignment and balanced strength between the internal and external rotators – these very specific things can be altered during pregnancy and therefore might need attention postnatally – especially if PFD is present. If a postnatal dancer, with PFD is suddenly (or has always been) more comfortable standing in external rotation – the chances are that their external rotators and therefore their pelvic floor could be overworked, tight and weakened. Organising the strength and balance within the hip will be an important factor in improving pelvic floor function. Getting support Pelvic floor dysfunction is NOT normal and should not be brushed under the carpet as a postnatal issue that’s part and parcel of becoming a mum. Pelvic health physiotherapist A pelvic health physiotherapist is best placed to provide you with a clear picture of why you might be experiencing pelvic floor dysfunction. Through internal examination, they can gain a full understanding of your pelvic floor and what is and isn’t functioning as it should. Understanding whether it’s a prescribed programme of kegals that is required or whether the problem could be stemming from another part of your kinetic chain is key. Pelvic health physiotherapists can also administer manual therapy (trigger point massage and myofascial release) to the pelvic floor – this is a very effective treatment for a hypertonic (tight) pelvic floor (Faubion et al. 2012). Postnatal corrective exercise specialist A postnatal corrective exercise specialist is well placed to train the function, strength and balance of your body whilst considering and integrating the correct function of the pelvic floor. Whilst returning to dance and intense physical activity it is key to understand, train and strengthen the body in a way that targets the postural changes and muscles weaknesses that can occur during pregnancy and ultimately affect the function of the pelvic floor. ____ Want to be pro-active at re-entering the dance workspace after birth? Sign up for Dance Mama Live! - our flagship professional development membership programme - and get 30% off our specialist dance class programme for dancing parents, suitable for general and professional levels (code will be sent with your Welcome Pack). References Baba T, Homma Y, Takazawa N, Kobayashi H, Matsumoto M, Aritomi K, Yuasa T, Kaneko K. Is urinary incontinence the hidden secret complications after total hip arthroplasty? Eur J Orthop Surg Traumatol. 2014 Dec;24(8):1455-60. doi: 10.1007/s00590-014-1413-4. Epub 2014 Jan 10. PMID: 24408744. Bartelink DL. The role of abdominal pressure in relieving the pressure on the lumbar intervertebral discs. J Bone Joint Surg Br. 1957 Nov;39-B(4):718-25. doi: 10.1302/0301-620X.39B4.718. PMID: 13491636. Duncan R, Wild C, Ng L, Hendry D, Carter S, Hopper L, Campbell A. Dancers' Joint Strategies for Achieving Turnout in Low and High Friction Conditions. Med Probl Perform Art. 2020 Jun;35(2):96-102. doi: 10.21091/mppa.2020.2015. PMID: 32479585. Faubion SS, Shuster LT, Bharucha AE. Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clin Proc. 2012 Feb;87(2):187-93. doi: 10.1016/j.mayocp.2011.09.004. PMID: 22305030; PMCID: PMC3498251. Foster SN, Spitznagle TM, Tuttle LJ, Sutcliffe S, Steger-May K, Lowder JL, Meister MR, Ghetti C, Wang J, Mueller MJ, Harris-Hayes M. Hip and Pelvic Floor Muscle Strength in Women with and without Urgency and Frequency Predominant Lower Urinary Tract Symptoms. J Womens Health Phys Therap. 2021 Jul-Sep;45(3):126-134. doi: 10.1097/jwh.0000000000000209. PMID: 34366727; PMCID: PMC8345818. Halski T, Ptaszkowski K, Słupska L, Dymarek R, Paprocka-Borowicz M. Relationship between lower limb position and pelvic floor muscle surface electromyography activity in menopausal women: a prospective observational study. Clin Interv Aging. 2017 Jan 4;12:75-83. doi: 10.2147/CIA.S121467. PMID: 28115836; PMCID: PMC5221554. Marques SAA, Silveira SRBD, Pássaro AC, Haddad JM, Baracat EC, Ferreira EAG. Effect of Pelvic Floor and Hip Muscle Strengthening in the Treatment of Stress Urinary Incontinence: A Randomized Clinical Trial. J Manipulative Physiol Ther. 2020 Mar-Apr;43(3):247-256. doi: 10.1016/j.jmpt.2019.01.007. Epub 2020 Jul 21. PMID: 32703614. Rebullido TR, Gómez-Tomás C, Faigenbaum AD, Chulvi-Medrano I. The Prevalence of Urinary Incontinence among Adolescent Female Athletes: A Systematic Review. J Funct Morphol Kinesiol. 2021 Jan 28;6(1):12. doi: 10.3390/jfmk6010012. PMID: 33525502; PMCID: PMC7931053. Thyssen HH, Clevin L, Olesen S, Lose G. Urinary incontinence in elite female athletes and dancers. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(1):15-7. doi: 10.1007/s001920200003. PMID: 11999199. Tu FF, Holt J, Gonzales J, Fitzgerald CM. Physical therapy evaluation of patients with chronic pelvic pain: a controlled study. Am J Obstet Gynecol. 2008 Mar;198(3):272.e1-7. doi: 10.1016/j.ajog.2007.09.002. PMID: 18313447. Tuttle LJ, Autry T, Kemp C, Lassaga-Bishop M, Mettenleiter M, Shetter H, Zukowski J. Hip exercises improve intravaginal squeeze pressure in older women. Physiother Theory Pract. 2020 Dec;36(12):1340-1347. doi: 10.1080/09593985.2019.1571142. Epub 2019 Feb 1. PMID: 30704364. Zivkovic V, Lazovic M, Vlajkovic M, Slavkovic A, Dimitrijevic L, Stankovic I, Vacic N. Diaphragmatic breathing exercises and pelvic floor retraining in children with dysfunctional voiding. Eur J Phys Rehabil Med. 2012 Sep;48(3):413-21. Epub 2012 Jun 5. PMID: 22669134.
- Diastasis Recti – unravelling the myths
Part of our new Blog Take Over! series from Niamh Morrin, Baby and I @babyandi.herts See Lucy and Niamh talk about this new development on Dance Mama on IGTV “It’s all about the gap” “Once my gap has closed I am safe to do any exercise” “My rectus abdominal muscles tore during pregnancy” “I can’t do any front-loaded exercises with my diastasis” “I must do x,y,z to heal my diastasis” “I am too long postnatal to heal now” “A diastasis recti always looks like a distended tummy” “A diastasis recti is only related to the rectus abdominal muscles” There are many myths and misunderstandings surrounding the diastasis recti (DR). Myths can instil fear of movement and delay healing. The following article will hopefully disperse these myths and provide a fuller understanding of a DR. What is Diastasis Recti? Diastasis recti is the term used to describe the stretching and thinning of the connective tissue that runs down the middle of the abdomen between the two sides of the rectus abdominal or 6 pack muscles. Diastasis recti is a natural process and according to Mota et al., (2015) 100% of pregnant women will have it at their due date – some womens’ diastasis will heal on their own whilst many others will need specific exercises to help it heal. The connective tissue involved in a DR is called the linea alba. There are a number of abdominal muscles that contribute to the formation of this connective tissue. Most obviously the linea alba connects the two sides of our rectus abdominal muscles. In addition, tendon like extensions of our lateral abdominal muscles feed into and contribute to the make-up of the linea alba – these muscles include the external obliques, the internal obliques and transverse abdominals. The linea alba therefore acts as a midline anchor for all the abdominal wall muscles and it is therefore all these muscles that pull and generate force at the linea alba. What is most important here is an understanding that all our core muscles need to be involved in the postnatal rehabilitation of the core and successful healing of a DR. Figure 1: Core muscles to work on if you have a diastasis. Reference: Hudani, M (2020). Diastasis Rectus Abdominis: Start here (Part 1). Available at: https://www.munirahudanipt.com/single-post/diastasis-rectus-abdominis-start-here-part-1 What does a Diastasis Recti look like? As a dancer, aesthetics and how we feel about our body can be a big part of what we do and who we are. We can assume that all DR’s look like a distended tummy or pooch but understanding that it can look and feel very different from person to person is very important. You might have a “mummy tummy” or “mummy pooch” where the lower and/or middle part of the abdomen is loose and distended out. ·Your whole abdomen could look like it is still rounded out or distended. You might not have any abdominal distension but you might notice a vertical “gap” down the midline of your abdomen. You might not notice anything too different aesthetically, but you just feel much weaker and disconnected to your core. How do you check for a Diastasis Recti? It is usually best to have a postnatal exercise specialist, a pelvic health or women’s health physiotherapist check this for you – however, you might want to check it yourself also so let’s make sure you have a few pointers to get an accurate finding. What we are looking for when checking for a DR is any gapping between the two sides of the rectus abdominal muscles and any squishiness or sinking feeling in the linea alba. Traditionally a DR was only assessed by the “gap” however a DR is now more commonly assessed by width and depth. A DR is confirmed as having a gap of more than 2 finger widths and/or a sinking feeling down into the linea alba. A healed diastasis is firm or trampoline feeling for depth, and a gap that is under 2 fingers. You can do a self-check for DR by following these simple steps: Lie down on your back – it is best to get into this position by rolling from your side and over onto your back. Halfway between belly button and rib cage: Find a place in the middle between your belly button and your rib cage. Pick your head up a very small bit off the ground. With two fingers laid horizontally, feel the gap between the two sides of your rectus abdominal muscle. How wide is this gap? Do your fingers squish/sink in? Relax your head and note down what you felt. Above your belly button: Place your fingers right above your belly button. Pick up your head a very small bit off the ground. Feel the gap between your rectus abdominal muscles. How wide is is? Do your fingers squish/sink in? Relax your head and note down what you felt. Below your belly button: Place your fingers right above your belly button. Pick up your head a very small bit off the ground. Is there any gapping here? How wide is it? Do your fingers squish/sink in? Relax your head and note down what you felt. Adding in the breath: Now check your DR whilst adding in a breath. This tells us what your breathing system is like and what your pelvic floor is doing. Take an inhale and on the exhale lift your head, think about drawing your pelvic floor up, drawing your hip bones together and bringing ribs in and down. What’s your gap (in all three areas) like now? Does it get more squishy or more firm? Do your rectus abdominal muscles pop up? Do you get doming out of the linea alba? We’re looking for the changes that happen here when you exhale and how well your system handles pressure. Figure 2: Location of a diastasis recti. Reference: Core exercise solutions, how to check for a Diastasis Recti. Available at: https://www.coreexercisesolutions.com/how-to-check-for-diastasis-recti/ Is your Diastasis Recti…Wide? Squishy? Below belly button? Above belly button? A DR can be noted anywhere along the linea alba. A DR can appear in different places on different people (Figure 2). Some will be wide but firm, some narrow but squishy and others wide and squishy. Some will just have a DR below the belly button and others will have it closer to the ribs – others might have it the entire length of the linea alba. Everyone’s DR can be different. It is because of these variations that individualised approaches to healing will be most beneficial – especially if you have tried a general exercise programme for DR healing and it is not working. In general, the depth or squishiness of a DR is affected by the function of your deep core (Transverse Abdominals and Pelvic Floor) and the width is affected by the function of your more superficial core (Rectus Abdominals and Obliques). Traditionally it was gap closure that was deemed most important in the healing of a DR – however, current thinking is less to do with the gap and more to do with firmness in the linea alba and the core’s ability to manage and regulate loads, pressures, and forces. I have a diastasis, can I plank / do front loaded core exercises as part of my training or choreography? Maybe! As mentioned above its important to know how well your core is managing and regulating pressure. Take for example, two different dancers, both with a 3-finger width diastasis – these two dancers might handle loads differently and therefore a plank type of movement could be good for one and poor for the other. What we are looking for is for the core to fire as a cohesive unit – if it is not firing cohesively we might get increased squishiness in the linea alba, doming of the rectus abdominal muscles or doming out of the linea alba (Figure 3a). If it is firing cohesively (Figure 3b) we should get a firmness in a linea alba and flattening across the abdomen – this is a sign that we are getting a more even core contraction. No matter the “gap” some women will be able to recruit the core well and do front loaded exercises whilst others might need to work more on establishing good core recruitment in easier positions first – regardless, each dancer will need to progress at their own pace depending on how the core is handling load and managing pressure. Figure 3: A) the rectus abdominal muscles are over recruited whilst the transverse abdominal muscles are under recruited. The abdominal wall appears domed out. Figure 3: B) The core is firing as a cohesive unit. The transverse abdominal muscles are recruited together with the rectus abdominal muscles. The abdominal wall has a flatter profile. Healing a Diastasis Recti – building the foundations first #1 Breathing Correct breathing is the foundation stone for correct core (and pelvic floor) function and therefore DR healing. For our core to function well we need our inhales and exhales to lengthen and shorten our entire core system respectively. Faulty breathing mechanics will disrupt this natural muscle function and prevent the core muscles getting the stimulus needed for adaptation. Example of faulty breathing mechanics: 1) Our inhale is all neck and shoulders 2) We maintain a constant level of tension in our abdomen (i.e. suck in our belly button, grip with our upper abs) 3) Our inhale is all belly 4) Our rib cage motion is limited and only moves up on an inhale (with very little back and side expansion) When we take an inhale we are looking for a 360 degree rib cage expansion – this encourages lengthening in the entire abdominal wall (and pelvic floor). Following the inhale, the exhale should provide 360 degree compression where the whole abdominal wall shortens – just like pulling a corset tight. #2 Core firing For good core muscle recruitment, we are looking for balanced muscle activity from the bottom to the top of your abdomen. This balance needs to be maintained so that pressure within the core system is maintained and stability is provided for your body (Figure 3b). So, for example, allowing the rectus muscle to become more dominant over the deep transverse abdominus will result in doming and pressure leaking out on the front of the core (Figure 3b). This is a sign that the deep core stabilisers aren’t fully on board – thus leaving you vulnerable to injury and stalling or regressing your DR healing. #3 Progressive overload There are many core exercises and there is unfortunately not one set of magic exercises to heal a DR – everyone’s DR could be slightly different and therefore different exercises would often be chosen based on the individual, their stage of healing and location of the DR. However, once good breathing mechanics and core firing have been checked and established, challenging the core in a progressive and varied manner is important. Progressing exercises based on achieving solid technique and good pressure management strategies would be advised. #4 Address the entire body Diastasis recti is a whole-body issue. Strengthening the abdominal wall without addressing poor movement habits and muscle weaknesses above and below the core could halt your DR healing. Working on good movement patterns and strengthening weaknesses whilst applying them to workouts (i.e. dance) as well as to day to day life and activities (lifting children, heavy shopping etc) can go a long way. So, for example if you are unable to move your hips and shoulders from a stable foundation (i.e. core) and independently from your rib cage then every time you perform an upper (e.g. port de bras, partner lifts) or lower body (e.g. plie, jumping) exercise or movement you might be failing to recruit your core appropriately and/or continually put pressure out on your DR. Diastasis Recti – myths unravelled Diastasis recti is a diagnosis that can be treated, no matter how new or old the diastasis is. Understanding that a diastasis is not just to do with the gap between the rectus abdominal muscles and entirely to do with our deep and superficial core muscles, our breathing systems, our core firing patterns and our whole kinetic chain is the first step to progressively healing a DR and improving the function of the core system. References Dufour et al., (2019). Pregnancy-related diastasis rectus abdominis: Impact of a multi-component group-based intervention. International journal of Gynecology and Obstetrics, 10(2). Dufour et al., (2019). Establishing Expert-Based Recommendations for the Conservative Management of Pregnancy-Related Diastasis Rectus Abdominis: A Delphi Consensus Study. Journal of Womenʼs Health Physical Therapy. 43(1). Mota, P., Pascoal, A.G., Carita, A.I., & Bø, K. (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy, 20(1), 200-205. About Niamh Niamh is a graduate from a BSc in Sport Science and Health (Dublin City University) and MSc in Dance Science (TrinityLaban). Throughout her years working as a performance enhancement practitioner at the Centre for Advanced Training (TrinityLaban) and as a visiting lecturer in Dance Science (University of Bedfordshire) she continued her professional development and qualified as a Sports Massage Practitioner with Sports Therapy UK and completed a PhD in Exercise Physiology (Buckinghamshire New University). Her most recent stop along the professional development road was at a Pre and Postnatal Corrective Exercise Specialist course (Core Exercise Solutions) which has culminated in the development of her own business "Baby&I" - a business designed to coach, educate and inspire women to maintain strength and function and therefore participation in sport and dance during and after their child bearing years. https://www.babyandi.org.uk Niamh is passionate about the use of the right exercise prescription to increase strength, reduce pain and improve function in the pre and postnatal body. Niamh believes that pregnant and postnatal dancers should not be left to navigate the complexities of prehab, rehab and their return to dance without being given the tools to do so safely and effectively. Niamh is also a member of Dance Mama's Research Advisory Group
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Want to join them in being supported and inspired? FREE registration open to our unique online professional development programme made for dancing parents with busy schedules! WATCH & GET A TASTE INFO & JOIN DANCE MAMA LIVE! Welcome! How I can help you? STORIES Be Inspired Our unique collection of 50+ stories from Dance Mamas across the industry and beyond. LEARN Be Involved Flagship online programme for Professional Dance Parents to one-off workshops MENTOR MAMA Be Motivated One-to-one, group and organisational mentoring sessions - COVID offer available BLOG Be In The Know Straight from the horse's mouth, follow Dance Mama Founder, Lucy's adventures RESOURCES Be Informed Sign-posting you to the latest information and people who can support you Community Be Connected Join our community of dancing families to share, connect and be inspired Curated CLASS PROGRAMME TRAIN ONLINE
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Lucy McCrudden Founder firstname.lastname@example.org LUCY's STORY aka Dance Mama, is a London-based dance entrepreneur and advocate. She is Founder of dancemama.org - a community and platform profiling significant parents in dance and the arts. Lucy has dove-tailed her own work with holding key positions in learning and participation over the last 18 years. These include: Dance Artist in Residence for DanceXchange (2004), Manager for London Contemporary Dance School, The Place, Centre for Advanced Training (2005-11), Expert Panel member of the DFE Music and Dance Scheme representing the National Dance CATs (2007-2010), Vice-Chair of Royal Borough of Kensington & Chelsea Arts Grants Panel (2006-2009), Learning & Participation Manager, Rambert (2014-16), Chair of the Board of Trustees Dance Woking (2014-16) , Head of Learning and Participation, Rambert (2016-18), Project Manager, Chance to Dance, Royal Opera House (2019-2020) and Lecturer and Mentor, DDP, ISTD (2021-). As an independent specialist she has taught over 19,000 people across the UK and has engaged with a wide variety of dance and arts organisations in many other capacities; consultant, management, choreography, and presenting/public speaking. She is Ambassador for the Parents in Performing Arts Campaign and Secretariat to the Scientific Advisory Board of the Active Pregnancy Foundation. She has an Honourable Mention as a Nominee of the inaugural AWA Dance Woman in Dance Award 2021. Pia Zicchi Projects Assistant email@example.com Pia graduated from the University of Surrey with First Class Honours in Dance and Culture. She has previously worked within the Learning and Participation teams of established dance organisations, Rambert and Akademi South Asian Dance UK, and has experience in both administration and practical event delivery. In addition to her expertise specifically in the performing arts sector, Pia has also worked for The WOW Foundation under the directorship of Jude Kelly, founder of Women of the World Festivals. Here, at the forefront of advocating for gender equality, she had the opportunity to engage with world-renowned artists, authors, activists, and work with schools and community groups. Pia is passionate about advocacy, inclusivity, diversity and accessibility in regards to creative arts, as well as looking at these from a gender-based perspective and raising important questions of equality. Katie Mason Projects Assistant firstname.lastname@example.org Katie Mason holds a BA Hons degree in Dance from the University of Chichester and a Diploma in Dance Teaching and Learning from Trinity Laban a passion for how the wellbeing of individuals can be improved through dance. Since 2013, Katie has been a freelance dance practitioner (teaching and choreographing) across the UK, South Africa and New York working for companies including Dance for All, Alvin Ailey, Rambert, English National Ballet and Step into Dance for the Royal Academy of Dance. This has involved leading workshops in a variety of contexts such as schools, day centres, theatres, community centres and hospitals, all of which has provided the opportunity for Katie to work with a widely diverse age group from 2-99 year olds. A key specialism is in leading classes, workshops and talks on working with older adults and those with specific health conditions. Across 2015-2017, Katie worked with Rambert as their Elders Programme Coordinator developing specialist classes for older adults in London and this culminated in her organising a very successful Dance and Health Symposium to celebrate and raise awareness for the health benefits of Dance. Katie runs her own independent over 60s classes in London and is also proud to lead the ENBEldersCo, a performance group for older adults with English National Ballet. Throughout the Covid Pandemic, Katie has taken her teaching online, this lead her to being appointed as the lead Dance Artist for the We Are Undefeatable Campaign; a national campaign (featured on BBC National News) to keep people with long term health conditions active. Katie is also a qualified Fitness instructor and alongside her freelance dance teaching, is the Studio Manager at F45 Ealing, a global franchise brand that focuses on fitness classes. Laura Harvey Guest Artist Dance & Health LAURA's STORY Laura began her career at Rambert teaching on the Dance for Health programme, developing the youth dance programme and touring nationally as animateur. She was Artistic Director for ten years for Quicksilver, Rambert’s youth dance company, teaching weekly classes and making work for performance. Laura has taught a range of people from young children to adults and specialises in contemporary dance, dance fitness, ballet and creative practice. In 2007 she joined English National Ballet as Learning & Participation Officer: National & International and went on to become Creative Associate choreographing and directing their flagship programmes including Swanning Around at the Royal Albert Hall and Shanghai Expo, Dance Journeys at the Barbican and Sadler’s Wells and at various locations across London including Westfield, Horse Guards Parade and Kings Cross St Pancras. She was movement director for Disney for the premiere of Saving Mr Banks and has worked for Ballet Boyz, Richard Alston Dance Company and Sadler’s Wells amongst others. Laura is currently Head of Creative Programmes at English National Ballet leading on their Dance for Health programme including their National Dance for Parkinson’s programme, Dance for Dementia and EldersCo dance strand. She has taught Dance for Dementia at both Rambert and English National Ballet and has led on a number of training days for artists around the country. Laura has a BA in Dance & Arts and Cultural Management and an MA in European Dance Theatre Practice. She continues to work as a dance artist alongside her role at ENB championing and advocating for all people to access and engage in dance at the highest possible level. Laura is a Mum to two energetic boys, age 6 and 2 and enjoys an active, outdoor lifestyle! Lucy Balfour Guest Artist Class Programme LUCY's STORY Lucy has performed and toured internationally as a leading dancer with the world renowned contemporary dance company Rambert. Lucy trained at the International Ballet Academy in Christchurch, then spent ten years with the Royal New Zealand Ballet, before joining Rambert in 2013. Career highlights include performing roles in Javier De Frutos' Milagros and Banderillero, Jorma Elo's Plan To A, David Dawson's A Million Kisses To My Skin, Queen Of The Willis in Ethan Stiefel and Johan Kobborg's Giselle, Christopher Bruce's Rooster and Ghost Dances, the Cunningham Events, and Itzik Galili's A Linha Curva. She was assistant rehearsal director on Kym Brandstrup's Life Is A Dream in 2018. In New Zealand she starred in a docco/reality T.V series "The Secret Life Of Dancers" which ran for 3 seasons. She has recently given inspiring talks to graduates of Rambert Dance School and English National Ballet School and is currently teaching pregnant and postnatal professional dance classes for Dance Mama as well as teaching ballet at London Contemporary Dance School. Niamh Morrin Guest Blogger NIAMH's BLOG Niamh is passionate about women feeling strong and confident during both pregnancy and the postnatal period. She is a Sport and Exercise Scientist and a Pre and Postnatal Exercise Specialist, and runs her own business - Baby and I - based in Hertfordshire. For the last 13 years she has worked with young, inspiring and talented adolescent dancers at the Centre for Advanced Training (Trinity Laban, London), rehabilitating and prescribing exercise programmes to improve dance technique, strengthen the musculoskeletal system and alleviate pain. She is fascinated by how the body works, how dysfunction can cause significant pain and how the right training and exercise prescription can make it better. Research Advisory Group In our commitment to furthering progress in evidence-based dance-science research, Dance Mama has its own Research Advisory Group. The group assists Dance Mama in delivering high-quality experiences and is comprised of a wonderful group of renowned specialists in their own fields. Some of which have contributed their stories to Dance Mama (links): Verity Blackman Helen Laws Niamh Morrin PhD Prof. Emma Redding Erin Sanchez MSc Dr Marlize de Vivo Dr Edel Quin Research Advisory Group Dance Mama has its own Research Advisory Group, including the brightest minds in dance science, sports and exercise science and medicine to support our work as we strive to deliver the highest quality in all our endeavour. We are privileged to say that this group includes: Edel Quin, MSc Professor Emma Redding Erin Sanchez MSc Helen Laws Dr Marlize de Vivo Niamh Morrin MSc Verity Blackman Karen Palmer Voluntary Dance Science Researcher Karen has danced since the age of 4 years old and has been involved in the dance industry most of her life. After training at Northern Ballet School achieving qualifications in both performance and teaching, Karen went on to dance professionally in Italy and Germany where she gained invaluable performance experience. Since then she taught ballet, tap and modern in both the public and private sector for a number of years adding to her qualifications along the way. Karen undertook a BA (hons) degree in Dance Education with the Royal Academy of Dance which led to the development of Access Dance, a Social Enterprise committed to providing young people with access to high quality dance activities and performance experiences they might not otherwise have. She has also collaborated with other dance organisations producing charity dance projects that link both dance and science together, specifically raising awareness for Cancer and MND research. Building on her existing experience and qualifications, Karen is currently studying MSc Dance Science at Trinity Laban with aspirations to further her career in this area. Ana Ramos Voluntary Dance Science Researcher Ana graduated with a Bachelor in Business Administration. She developed a career as a Marketing Manager in other industries, and later became a freelance marketer in order to include her lifelong passion for dance. She has collaborated as Marketing Adviser for the Mexican Society of Teachers of Dance, as well as developed and executed marketing campaigns for ballet schools such as Victoria Academy of Ballet in Canada, and for the dance performances of the Festival Koinzidenz 2018 in Hamburg, Germany. Ana is also a ballet teacher with 17 years of experience, and a former professional dancer. She has taught internationally across Mexico, Japan and the UK. An aspiring dance researcher, she is currently studying an MSc in Dance Science at Trinity Laban, so that in the future, she can blend her knowledge and passion for dance with her marketing skills, to contribute in the dissemination of science in way that can be engaging and practical for different populations.
- RESOURCES | dancemama
Resources RESEARCH Science & more Research papers, articles and projects from leading scientists and organisations Read More ARTICLES Response Publish articles in the media by Dance Mamas and for Dance Mamas Read More BOOKS Great Next Reads Book recommendations for help on being a parent working in dance Read More Organisations ADVOCACY One Dance UK The UK body for dance, and the sectors leading support organisation. Dance Mama Founder, Lucy McCrudden, is a member. VISIT CAMPAIGN PIPA Campaign Conducting extensive research across theatre, dance and music to support working parents. Dance Mama Founder, Lucy is an Ambassador VISIT CAREERS Dancers Career Development Supporting dancers to successfully transition into alternative careers. DCD have supported the Dance Mama Live! event VISIT Active Pregnancy Foundation The Active Pregnancy Foundation aims to remove traditional barriers and social stigmas, ensuring there is easily accessible provision in expertise, information and support for women who choose to be active throughout pregnancy and motherhood. As a charity the Active Pregnancy Foundation intends to normalise active pregnancies, and have been instrumental in the development of Chief Medical Officer approved guidelines for pre and postnatal activity in the UK. They have the latest guidance on COVID-19 advice for pre and postnatal women, an online directory of activity and more brilliant research. In 2021 they are guest on both the professional development and general public strands of Dance Mama Live! Dance Mama Founder, Lucy McCrudden, is also Secretariat to the charities Scientific Advisory Board. ACTIVITY GUIDLINES DANCE MAMA LIVE! APF SITE counselling for dancers Terry Hyde MA MBACP is a Psychotherapist/Counsellor who founded Counselling for Dancers recognising that the dance population needs specific mental health support. Terry is a retired performer and a #dancepapa - you can read his story here, and visit his site. TERRY'S STORY VISIT SITE