Am I even doing this right?

by Bryn Zolty, PT

I hear this constantly. “Check my muscles, are they on?” The struggle is real. I’ve been there postpartum. Women feel hopeless at times trying to reconnect with muscles that have stretched or torn. The deep core muscles, including the transversus abdominis (TA) is one of them. 

The TA muscle is part of the deep core muscles. It wraps around your trunk like a girdle. If a girdle sounds supportive to you, you are right. One of the main functions of this muscle is trunk and pelvic stability.  

The TA was a big part of my postpartum rehabilitation and I would like to share some of that journey in case any part of it could help another woman find her way. My daughter was born via c-section. I knew at that time my abdomen felt weak and the middle of my muscles felt different.  I waited for physician clearance and began exercising, slowly building strength and intensity. I noticed my side abdominal muscles, the obliques, looked chiseled! I was proud. However, I realized after having my c-section that a muscle tore in that area and soon found out that it had led to an inguinal hernia. I needed another open abdominal surgery. I again waited for clearance and started back up exercise and had the same results.  

I noticed that I had very little strength or tension in the middle of my abdomen again. This time the separation (diastasis) was more obvious. Like many of my patients, I was guided to start trying to “find my TA.” This made me very sympathetic to my patients trying to tension their TA.  It took me forever to activate it despite being a physical therapist. Two open abdominal surgeries left me with poor ability to connect to the lower deep abdominal muscles.  

I tried feeling for the muscle. I tried laying on my back, side, and cat/cow. I tried using sheets, taping and bracing. I used all the breathing techniques. I also knew that a c-section doesn’t mean you can’t have pelvic organ prolapse (pelvic laxity). I was relying heavily on other muscles to compensate for my abdominal muscle weakness and it was becoming painful in my hips and tailbone. I finally found it! It took a long time. But I had motivation, not just for how the abdomen looks. I wanted to be strong. 

I share this story because now there are more tools to help our patients and postpartum women learn how to start using those deep core muscles. Ultrasound imaging makes it easier for women and men to connect to the deeper muscles. We use this at Connect PT as a type of biofeedback for turning on muscles and coordinating functional movement. Being able to see the muscles while you try different breathing patterns of movement can help you see what works for you!

Here is an ultrasound image of my abdomen with me at rest.

• D1 is the TA.
• D2 is the internal oblique.
• D3 is the external oblique.

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The top of the picture is the surface of my abdomen. The TA is deeper than the obliques.  ​

This is an ultrasound image of me turning on my TA. Compare it to the picture above. See the lower band, D1 which is the TA, widen and start to slope down, which is what we want to see. ​

Below is an ultrasound of my abdomen during a sit up/curl up. The TA should turn on for this movement. But there is no widening, nothing like the image above. The internal oblique, D2, does start to widen. The obliques help with side bending and rotating; the next picture on the right shows me doing those movements. My obliques are really widening and working now!

Finally, in this last image below, I exhale and gently start the TA turning on and do a sit up. I let my body start to take over with how much intensity is needed. I provide a gentle reminder to my deep core to turn on. D1, the TA, is widening and turning downwards.  ​

There are many online postpartum and mommy fitness programs now. Many of them are great, but for some women, you need help knowing you are doing the techniques correctly. Are you doing a TA workout and not actually turning on the TA? Are you bearing down when supposed to be pulling up/in? I recommend a visit to a pelvic physical therapist, even if it’s just a few times to make sure you are on the right track. We want you back to running, back to lifting weights, and back to the activities that make you feel good. Let us help you get your confidence back.  ​