Transcript: Diastasis Recti: Abdominal Separation After Twins

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Twin Talks
Diastasis Recti: Abdominal Separation after Twins
Episode 32, July 15th, 2014

[00:00:00]

Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
[Theme Music]

CINDEY FUREY: Do you complain of postpartum muffin top or maybe even jelly belly? These maybe signs of a physical condition that is common for moms of multiples called diastasis recti. I’m Cindey Furey, physical therapists and founder of comprehensive therapy services, here to talk about recovering from diastasis recti. This is Twin Talks.

[Theme Music/Intro]

CHRISTINE STEWART-FITZGERALD: Well welcome to Twin Talks, broadcasting from the birth education center of San Diego. Twin Talks is your weekly online on the go support group for expecting and new parents of twins. I’m your host Christine Stewart-Fitzgerald. Now have you heard about the Twin Talks club? Our members get bonus content after each new show plus special giveaways and discounts.

You can subscribed to our monthly Twin Talk newsletter and learn about the latest episodes available. Another way for you to stay connected is by downloading our free Twin Talks app. It’s available from most smart phones. So before we get started let’s talk to our panelists in the room and introduce ourselves.

I’ll start and say I’ve got identical twin girls who are 5 years old almost and a singleton who is 20 months old and you know I’ll say that I had no idea what a diastasis recti was until I had them and I remember that the doctor and midwife you know basically said yeah you got some separation and I did a lot of research and I still have some even today. There’s a little bit of a space and gaps going so yeah we’ll talk about that a little bit.

SUNNY GAULT: Yeah. Hey guys I’m Sunny. I am the owner of New Mommy Media which produces this show as well as Parent Savers, Preggie Pals and The Boob Group. I have four children. My oldest are boys. I have a 4 year old and a 2 year old boys and then I have identical twin girls who are seven months and I had never heard of this Christine until you brought it up as an episode topic.

I’m actually very, very curious about this now because after I had my girls, I noticed that my belly just overall look different. Now granted okay you just had twins whatever but I feel like I have a little girl belly now where it sticks out more at the top because you always kind of have your gut or whatever you know after you have a kid it’s that your gut. Right?

But like now I feel like when I was a little girl it was more of like a you know 3 month when you’re pregnant at around 3 or 4 months you kind of have that little roundness and I feel like I’ve got a little girl belly now. So I’m wondering if that up here sticking out more because of this. So we can talk about that later…

CHRISTINE STEWART-FITZGERALD: Yes.

SUNNY GAULT: Yeah. Anyway.

CHRISTINE STEWART-FITZGERALD: And Shelly.

SHELLY STEELY: I’m Shelly. I’m the producer here at Twin Talks. I’m also a high school history teacher. I have two children. They’re boys and they will be 2 in a couple of weeks. My goodness. And I’m currently pregnant with my third so I have no idea what my stomach looks like because I just been pregnant or postpartum or pregnant again for so long but eventually I think I’ll find it again and definitely interested to see if this affected me. I want to let you guys know also about our virtual panelist program.

So you can follow us on Facebook or Twitter at Twin Talks but if you want to participate in the conversation you can use the #twintalksvp to be kind of a virtual panelist where you can answer questions, ask questions on the comfort of your own home.

[Theme Music]

SUNNY GAULT: Alright we have a special Twin Oops story for you. These are the funny stories that you guys love to share with us about your amazing parenting adventures parenting twins and this one is kind of funny. This one comes from Leslie of Louisiana and she writes my in-laws were visiting over the holidays and we put them in our five year old twin’s room where there’s a queen size bed for the first time and the twins slept on an air mattress in our room.

They stay for one week and on the last night one of the twins, Ella, was sitting by her grandma looking kind of sad and asked “are you staying one more night”? And the grandma replied “no tonight is the last night” and Ella suddenly said “good I want my bed back”. Amazing things that are twins say right? So if you have a funny twin parenting story or you want to share something funny that your twins did, please do so we’ve love that. You can send us an email or you can reach out to us through our voicemail which is 619-866-4775.

[Theme Music]

CHRISTINE STEWART-FITZGERALD: Well today’s topic is recovering from diastasis recti also known as diastasis recti and I’m so we’re probably going to hear a lot of different variations of that so please correct me.

SHELLY STEELY: Tomato.

CINDEY FUREY: It’s pronounced either way, diastasis rectis or diastasis rectis or short DR.

CHRISTINE STEWART-FITZGERALD: DR.

CINDEY FUREY: DR for short.

CHRISTINE STEWART-FITZGERALD: And maybe we’ll use DR just to keep it simple and in today we’re talking with Cindey Furey who’s here to help us understand what an expectant twin mom need to know in if she may have diastasis recti and also for the moms who have been diagnosed postpartum. So thanks for joining us.

CINDEY FUREY: Oh thanks for having me.

CHRISTINE STEWART-FITZGERALD: First of all before we talk about diastasis recti, I know postpartum you know there’s so many different complaints that women have after giving birth. I mean really it’s like how much the body has had to adapt to carry those babies and I’m just always amaze that you know how much it from every system within the body. What maybe just touch on what are some of the different types of dysfunctions or conditions that you see in your practice?

CINDEY FUREY: Well let me start with this, once your pregnant everything changes; everything in your body changes. The hormones change, digestion changes, posture changes, everything changes. That being said, some of the biggest conditions we treat at the clinic are incontinence, both urinary incontinence and fecal incontinence.

We certainly treat just difficulty recovering especially with conditions of pain so low back pain, sacroiliac pain, hip pain are very common let alone all the conditions of pelvic pain. Pelvic pain may go along with just how the baby was delivered and it may also go along with things like episiotomies or tares or pelvic organ prolapse or something like a disruption in the pubic symphysis and that can lead to difficulty even with walking.

CHRISTINE STEWART-FITZGERALD: Ooh.

CINDEY FUREY: So we treat all kinds of things. We treat low libido and dyspareunia, pain with intercourse. We also treat fractures which twin moms are much more susceptible to. So we see [inaudible] fractures, pelvic fractures even just stress fractures. Those little babies are just leeching the calcium right out of your bones. So if you go back to exercise too soon or you’re actual labor and delivery was tougher than expected or you had been on bed rest you have a higher risk of fractures.

So we’re working on getting those moms back in shape as well. So the list is long plus it’s just orthopedic conditions postpartum lots of shoulder pain, elbow pain, risk pain, even thumb pain and a lot of that comes from lifting the baby or how you are actually breastfeeding the baby. So posture has a lot to do with it. So we do a lot of education on all these topics for all of our moms.

CHRISTINE STEWART-FITZGERALD: And do most of your patients, do they come in referred from either their doctor or midwife or how do they get in to see you?

CINDEY FUREY: Well here in California, you can actually just a lot of people just find us on Google. So we’re out there. You can Google a physical therapist but here in California you can actually just come in for the first 45 days or 12 visits. You can actually go get treated by a physical therapist. There’s no prescription needed.

CHRISTINE STEWART-FITZGERALD: Oh that’s a great to know.

CINDEY FUREY: However so in order for it to be if reimbursed by insurance companies, it’s about 50/50 who reimburses with the prescription or who actually requires a prescription. In my clinic we call and verify on all insurance so there’s no surprises but you can be referred from your physician. We know a lot of midwives, we know a lot of doulas, we know chiropractors and acupuncturers. We get referrals from all resources and of course your BFF girlfriends, best referral source ever right especially if they’ve been through it. So that’s how they find us. Yeah.

CHRISTINE STEWART-FITZGERALD: Oh that’s great. Now I know one of the most common complaints after giving birth I mean I know fraction excuse me fractures maybe aren’t as common but I know a lot of I hear cons and complaints about okay you know I got this muffin top or the jelly belly or the twin skin and you know looking pregnant. So is that a function of you know losing you know losing weight. You just need to lose more weight or are there other components that we’re not aware of?

CINDEY FUREY: There are other components. Unfortunately, one of them is genetics so what you’re mom look like or at least you could I supposed you could blame your mom you know you have the same body type. But a lot of it has to do with genetics in relationship to how you carried how much weight you gained and what is the elasticity of your tissue. How much collagen do you have? How much elastin do you have? So what is that skin and that connective tissue going to do? Is it going to split and separate and if does can it repair itself or is that skin just really loose? Is it having a hard time coming back? So that’s the genetic factors. Other things are history of obesity prior. Smoking plays a huge role prior history of smoking.

CHRISTINE STEWART-FITZGERALD: Really.

CINDEY FUREY: These days you know.

CHRISTINE STEWART-FITZGERALD: For your skin.

CINDEY FUREY: We’re not smoking during pregnancy right but so those days are hopefully long gone however if you have a history of smoking, some of the damage may already be done and so you lose the oxygenation of that tissue and so it can be slower in recovery or just have a difficult time.

When it comes to actual diastasis rectus though, the studies are still being done on why it’s actually happening so again it might be genetics, it might be a loss of collagen or elastin but some people relate it specifically to twin moms because their bigger right? I mean you’re carrying two so you would expect that wall to split. But I have some tinny tiny moms even with singletons and they’ve only gain 20 pounds and they still split.

CHRISTINE STEWART-FITZGERALD: Wow.

CINDEY FUREY: So sometimes it’s also a dysfunction related to two body mechanics. How you are breathing, how you’re lifting, how you developed but even things like chronic constipation.

CHRISTINE STEWART-FITZGERALD: What? Really?

CINDEY FUREY: I know, I know and it isn’t that just a bummer that kind of goes along with pregnancy sometimes but with constipation comes a lot of bearing down and the more you push the more risk you run of things splitting.

CHRISTINE STEWART-FITZGERALD: Oh my god.

CINDEY FUREY: Whether it’s your pelvic floor, I hate to say it or the abdominal wall.

CHRISTINE STEWART-FITZGERALD: But I mean I’ve heard you know when you’re you know going that you shouldn’t strain yourself too much.

CINDEY FUREY: Right.

CHRISTINE STEWART-FITZGERALD: So I would have no idea that it would be related to that.

CINDEY FUREY: You know once in a while not a big deal.

CHRISTINE STEWART-FITZGERALD: Yeah.

CINDEY FUREY: But if it’s a chronic condition you’ve always had it or you push and push and push. It can be tough and now just it’s not necessarily a DR thing but it can be a pelvic organ prolapse thing.

CHRISTINE STEWART-FITZGERALD: Wow.

CINDEY FUREY: Yeah.

CHRISTINE STEWART-FITZGERALD: Now let’s take a step back I mean just can we explain for you know the average person I know lot of us just the concept of diastasis recti it’s you know it’s a big word but I mean what is it exactly and how does it happen?

CINDEY FUREY: So diastasis on rectus is a split on the abdominal wall right down what we call the connective tissue called the linea alba so it just tends to separate. It tends to separate more right at the belly button or umbilicus or umbilicus [inaudible] but it can also happen above that or below that. It can happen all the way up to your rib cage or as far down as your pubic bone.

CHRISTINE STEWART-FITZGERALD: So this is the right on the midline of your abdominals.

CINDEY FUREY: The midline of your abdominal.

CHRISTINE STEWART-FITZGERALD: Okay.

CINDEY FUREY: It just tends to separate on some people.

CHRISTINE STEWART-FITZGERALD: And when we say so when we say separate like kind of just you know visual here that we’re have oh like that we have like literally if you can imagine like a kind of felt the wall is sort of just opening a little bit.

CINDEY FUREY: It opens.

CHRISTINE STEWART-FITZGERALD: Yeah.

CINDEY FUREY: It opens and splits and the problem lies is that if it’s big enough one your organs can actually come through it…

CHRISTINE STEWART-FITZGERALD: Ooh yes.

CINDEY FUREY: So that can be very problematic for GI dysfunction and it can also be very painful but two is the bigger quality of life issue of low back pain. So your core, core is a very fancy popular term this days in exercise but including your entire abdominal wall and your back and your pelvic floor and your diaphragm, they all work together to keep things contained and solid.

When there is a split in the core whether it’s diastasis or condition of the pelvic floor or low back injury, the whole core kind of crumbles. Picture a soda can. If the soda can is close and the top is on and it’s close, you can’t squish that soda can if you jump on it, if you threw it, it just doesn’t budge. Right? That can is solid. The minute you pop the top, even if the liquid is inside, now it’s crushable even with your hands.

So that would that’s kind of an analogy if what happens in our system. So the diastasis occurs the low back pain may not happen immediately but what we’re seeing is years down the road that’s really high correlation between low back pain, [inaudible 00:14:48] disease, sacroiliac dysfunction, all of that low back pain in the occurrence of diastasis.

CHRISTINE STEWART-FITZGERALD: Well so are you saying then that women might experience pain in some form with low back pain and it might be years I mean their kids are you know 4 to 5 years old and then they go in and it could be related to child birth years earlier.

CINDEY FUREY: Right. So that’s what we’re trying to figure out now in studies. So right here in San Diego there are two studies currently going on. So the navy is actually doing a study on elective surgical repair of a diastasis and then how does it improve the quality of life. Does it improve the pelvic floor? Does it improve their low back pain? Can they come more active? So that’s one study.

The other study we’re doing here part of my clinic and part of San Diego state university were now recruiting moms either while they are pregnant or recently postpartum and measuring they’re diastasis either finger width task calipers or ultrasound. We can actually do a real time ultrasound. It measure the actual separation and then teaching them.

Teaching them body mechanics, teaching them the proper exercises and using some other techniques one specifically called kinesio tape to pull those muscles back together because we really we see clinically that conservative care really works well. We have to prove it scientifically though. But the numbers are out there the statistics are very high 60% chance of diastasis rectuses in our lifetime.

CHRISTINE STEWART-FITZGERALD: Really?

CINDEY FUREY: 60% chance.

CHRISTINE STEWART-FITZGERALD: 60%.

CINDEY FUREY: 60%

CHRISTINE STEWART-FITZGERALD: And in women only or in men and women?

CINDEY FUREY: Men and women…

CHRISTINE STEWART-FITZGERALD: Oh my gosh.

CINDEY FUREY: Included in that statistics.

SUNNY GAULT: Wow.

CINDEY FUREY: But Jill [inaudible] did a study at an OB/GYN office where she just measured everyone coming in, you’re prenatal, you’re postpartum, we’re going to measure and her statistics were in second term 27% of women had DR. That’s just second term. Third term the numbers increase just 66%. Postpartum the numbers were 53% of women had diastasis and that’s in an OB/GYN office. Now fast forward, Tracy [inaudible] another physical therapist work with her urogynecologist. So urogynecology you see everything I mean [inaudible] a lot of incontinence and prolapse and all those kind of things. She measured women coming in of all ages and the incident was 53% so over 50% of women just in urogyne so that’s the connection that we are trying to figure out.

So as the diastasis contributing to all this other dysfunctions because we got to think it is. So we are it’s always treatable as far as we’re concerned and we always check for it and I teach all my PT students they have to check for it.

CHRISTINE STEWART-FITZGERALD: Wow.

CINDEY FUREY: Yeah.

CHRISTINE STEWART-FITZGERALD: And we talk about you know these different studies I mean these are generally measuring you know women with I mean any kind of pregnancy so probably majority are going to be singleton pregnancy. Now I would imagine in having a twin or multiple pregnancy…

CINDEY FUREY: Right.

CHRISTINE STEWART-FITZGERALD: The incident is much higher.

CINDEY FUREY: It’s worst. I’m sorry to say at ladies but everything is tougher with twins as far as physically on your body…

CHRISTINE STEWART-FITZGERALD: Yes.

CINDEY FUREY: You know whether we go back to talking about stress fractures or we talk about diastasis, your body is just going through a lot you know. It’s a bigger stretch.

CHRISTINE STEWART-FITZGERALD: So it’s to be more important…

CINDEY FUREY: To get check.

CHRISTINE STEWART-FITZGERALD: To get check. Now I have to say…

CINDEY FUREY: And not every OB/GYN offers checks.

CHRISTINE STEWART-FITZGERALD: Yes.

CINDEY FUREY: In fact they rarely check so that’s why you really do want to pop in to physical therapist and say hey I’m pregnant with my first second fourth you know whatever pregnancy. I really want to get this check or even postpartum recovery, just get check. It only takes a second.

CHRISTINE STEWART-FITZGERALD: That is a really great point because I think I didn’t know what diastasis recti was until afterwards and there wasn’t a whole lot of information out there and I would’ve loved to had more proactive treatment…

CINDEY FUREY: Sure.

CHRISTINE STEWART-FITZGERALD: You know during the pregnancy.

CINDEY FUREY: Sure.

CHRISTINE STEWART-FITZGERALD: And I think you’re right. I know in my experience I mean you know my provider didn’t ever talk about it so I don’t know how much awareness was there…

CINDEY FUREY: Probably none. Yeah and I’m trying, I’m trying to get to those meds to do this [inaudible 00:19:04]

SHELLY STEELY: Yeah. So hopefully that’s why it we’re doing here too so what you’re saying is I mean twin moms once the babies come there’s not a whole lot on their minds except for sleeping and feeding for quite a few months right? So you’re saying that a mom who’s currently pregnant with twins could come see you and say…

CINDEY FUREY: Absolutely.

SHELLY STEELY: How are things looking? Maybe get a referral while she’s still pregnant. Setup those appointments ahead of time and make sure you know kind of get it on the calendar. Get it on the priority list and so that she knows to take care of postpartum.

CINDEY FUREY: Exactly. I mean really the best treatment for this and what I teach my PT student, the best treatment is prevention. It shouldn’t get this bad. You know we need to do more research. We also just need to get out there and educate women. You can actually test yourself. So the test is actually quite simple. So if you lay down on your back.

CHRISTINE STEWART-FITZGERALD: Okay.

CINDEY FUREY: And you take three fingers and push them down on your belly button.

CHRISTINE STEWART-FITZGERALD: Okay.

CINDEY FUREY: Your head must be flat. Your knees should be bent but your flat on the floor.

CHRISTINE STEWART-FITZGERALD: Okay.

CINDEY FUREY: You put your three fingers in your belly button and you kind of wiggle them side to side. You’re really feeling for the muscles on either side. Okay so you just kind of get an idea what that feels like and then you lift your head off the floor. Once you lift your head again you retest side to side. Hopefully you’re at two fingers or less fit between the walls of the abdomen. Okay the muscles there. If you are two fingers or more then that’s it. Then you have the diastasis.

CHRISTINE STEWART-FITZGERALD: Oh.

CINDEY FUREY: Then it split. And then once you’ve done that you really do you want to rest your head again and then scooch up a little bit and palpate about half way between your ribcage and your belly button and test there. And then rest your head again, palpate again. Maybe go up to your ribcage and test if it split there. And then test again both low belly button and down towards the pubic symphysis as well.

So you really want to get an idea of is it the whole linia alba that separated and split or is it really contain just on the umbilicus or is it a little bit above a little below because the severity does predict how well you are going to recover from this. But the sooner you find out, the more you can do.

CHRISTINE STEWART-FITZGERALD: Now let’s say I mean a twin mom you know [inaudible] She’s pregnant or maybe even postpartum and she says you know what I can feel there seems like there’s a gap right there…

CINDEY FUREY: There’s a gap.

CHRISTINE STEWART-FITZGERALD: And I think I need, I need some treatment. What would she do to you know to find someone who can help her get treatment? I mean in her area I mean I know she can’t come to you directly.

CINDEY FUREY: [inaudible] not everyone can come to sunny San Diego but if you’re in the area that’s great. You can certainly hunt us down but if not you want to look for a physical therapist. Go online and the easiest thing to do is type in physical therapy pelvic medicine or pelvic physical therapy because 99% of the pelvic floor physical therapist out there do treat this.

You can look for other physical therapist but there is no guarantee that all of them treat diastasis rectis. So you really want to look those pelvic PTs. There’s also the American Physical Therapy Association, they have a website section on women’s health and you can kind of hunt your way through their directory and see if someone is in your area. That I really think just searching online is probably your best bet. Yeah.

SUNNY GAULT: What triggers where it separate as far as the top or the bottom like I was explaining earlier I feel like mine if I do have this I’m really eager to know. I feel like it could be at the top because that’s why it feel like it’s more a pooch that I never had before like that little girl belly I keep talking about. So I’m just wondering could have anything to do with how you are carrying your twins or you know how high or low you’re carrying them or anything like that?

CINDEY FUREY: It can. We see the split above and below certainly right at umbilicus. It’s a soft spot and you can even see in your own little babies when their little I don’t know if you remembered that they had a little space in their belly. It’s the last thing that kind of knits together even embryo logically you know even developed mentally in little kids and so it’s always a soft spot even on us as adults so right at belly button is where people typically split and then above and below nobody knows why some people split above or some below.

You know we suspect that it’s body mechanics. It’s how you hold your breath. It’s your everyday lifestyle habits because those are some things that really play a role on whether or not you’re going to split. So yeah that’s part of the education process too.

SUNNY GAULT: Right.

CHRISTINE STEWART-FITZGERALD: Oh awesome. Well when we come back we’re going to talk about some different types of non-surgical treatments and how you can help patients deal with DR.

[Theme Music]

CHRISTINE STEWART-FITZGERALD: Well welcome back. Today we’re talking with Cindey Furey who helps twin moms recover from diastasis recti without surgery. Can you tell us about some of the different treatments that you do in your office as well as maybe some exercises that they can do at home.

CINDEY FUREY: Sure. Certainly the first thing we do is educate. Educate. Educate. Educate. Educate on how to lift. Lift with exhalation. Tighten your core. Really strengthen those abdominal muscles but we teach people how to do something called and abdominal brace meaning that we get their spine on neutral. We teach them how to contract not just their rectus but really their other obliques and transversus abdominis muscles and we get them stable on that position and then teach them how to lift their baby or babies. How to lift the car seats, how to push the stroller, how to lift the diaper bag, how to get your kids in and out of the car.

CHRISTINE STEWART-FITZGERALD: Oh yes.

CINDEY FUREY: That’s probably the most awkward thing ever right is getting the kids in and out of the car seat. So we physically take moms out to the car and say look this we have to show you how to do this so you don’t split further. We even have to teach them things as simple as getting on and off the table. And I think this could be why we see this so often during pregnancy as well. How many times you go on and off an exam table.

SUNNY GAULT: Oh yeah.

CINDEY FUREY: While you’re pregnant. Often right?

SUNNY GAULT: Right.

CINDEY FUREY: And when you are pregnant, doesn’t that sweet nurse or medical assistant want to give you a hand right they reach out and they said oh honey I’ll help you.

CHRISTINE STEWART-FITZGERALD: Yes.

CINDEY FUREY: And they hold you up off the table.

CHRISTINE STEWART-FITZGERALD: Yes.

CINDEY FUREY: So when they pull you off the table, it’s a full rectus abdominis contraction…

CHRISTINE STEWART-FITZGERALD: Oh my gosh.

CINDEY FUREY: And if your connective tissue isn’t strong enough, it could give. So we teach all of our moms wait-wait-wait, it’s okay I can handle this myself. Even though the tables are tinny tiny especially in the OB/GYN office you want to roll on to your side and then push yourself up with your arms.

So your legs go down as you push with your arms and you have to get in and out of bed the same way so we call it log rolling, you lay on your side first and then roll on to your back but that roll is really, really important because if anyone whether it’s your husband, your partner or the nice nurse in the doctor’s office, if they pull you off the table it’s a huge contraction and that’s where we see kind of this crowning that occurs.

It crowns through the abdominal wall and it really stresses it and we see a lot of DR that way. So…

CHRISTINE STEWART-FITZGERALD: Wow. So we should avoid kind of moving or like leaning and crunch [inaudible] crunching but we should avoid…

CINDEY FUREY: Yes.

CHRISTINE STEWART-FITZGERALD: This forward you know motion with your abdominal.

CINDEY FUREY: Yeah so if you’re lying on your back, you really do want to roll on to your side bottom line you don’t just sit right up with your abdominal wall. You don’t want to use those muscles. We’d rather have you roll on your side.

CHRISTINE STEWART-FITZGERALD: Wow I never would have thought of something so simple…

SUNNY GAULT: Right.

CHRISTINE STEWART-FITZGERALD: You know getting off a table would make a difference.

CINDEY FUREY: Yeah. So as far as treatment goes, education goes a long, long way. I mean that’s first and foremost. We can teach women exercises and how to close diastasis whether they’re pregnant or their postpartum is really important to teach them how to close and so mechanically actually if you do a very force exhalations so breath out every last bit of air you can, your abdominal wall actually does come together.

If the fault is that big, three, four, five centimeters, we’ve seen that the fault is really big we have women physically hold it together. So we would have them put their hands on their belly and push their abdominal wall back together as their exhaling so those muscles can learn to shorten again because that’s the other thing the abdominal wall it’s just the whole thing is over stretched so we really want to shorten that and then we progress them from there. So then we might have them do that and maybe some heel slides.

Maybe if their abdominal wall holds they can now raise their arms over head. We can progress them to a four point positions. So just on hands and knees and if your babies are there you put the babies on the floor and get a good gaze out of them right? So we’re trying to incorporate the babies into the exercises to make it easier.

CHRISTINE STEWART-FITZGERALD: That’s great.

CINDEY FUREY: Yeah you got to multi task right?

CHRISTINE STEWART-FITZGERALD: Yeah.

CINDEY FUREY: Every second counts so babies on the floor you make that good eye contact but while you’re on all fours again you can brace that abdominal wall, you can work on knitting it together mechanically and then start weight shifting. Okay can I hold that abdominal wall in that shorten position as I shift forward and shift back? Can I hold it when I raise an arm, when I raise a leg, when I raise one arm and one leg? So we kind of progress on the way and then we progress to other exercises maybe girly push ups, maybe wall push ups, maybe girl push ups and then to more aggressive things like planks.

CHRISTINE STEWART-FITZGERALD: Planks.

CINDEY FUREY: Planks. So holding you’re propping yourself up on your elbows and your toes. So it’s kind of a modified push up position…

CHRISTINE STEWART-FITZGERALD: Oh yes.

CINDEY FUREY: But it’s more intense and so in crazy workouts they’re holding planks for a minute for two minutes or five minutes. We just want you to be able to hold your wall okay and that’s really the difference between going to like a PT who is looking at this nitty gritty mechanics making sure things are knitting together, they’re approximating, they’re holding and going to a gym with a trainer who’s really can motivate you but may not know how to check these little things that make that can make a big difference down the road. So…

CHRISTINE STEWART-FITZGERALD: And I know in my experience I have had PT for DR and I use a lot of acronyms…

SUNNY GAULT: Yes [inaudible] absolutely.

CINDEY FUREY: Love the letters.

CHRISTINE STEWART-FITZGERALD: Yes and I think one of the things that I got so much out of it is it seem like it wasn’t so much about we’re doing this rigorous exercise or it’s strenuous in anyway but so much about just the body consciousness.

CINDEY FUREY: Sure and it’s about your posture and it’s about the awareness of what am I doing with those muscles right now? Am I kind of just letting it all go and let my belly hang out or can I actually actively stand up tall, contract a little bit, do that abdominal brace and then get through you know a series of exercises or just a series of household tasks. So the exercises don’t necessarily have to be that intense but they do have to be accurate. You know someone’s got to be picky with you on how you do it.

CHRISTINE STEWART-FITZGERALD: It sound like you can have a number of these exercises you can incorporate throughout your routine. I mean twin mom we’re all busy crazy.

CINDEY FUREY: Exactly.

CHRISTINE STEWART-FITZGERALD: The first months you know after giving birth is just insane but I mean if you’re doing breathing exercises…

CINDEY FUREY: Exactly.

CHRISTINE STEWART-FITZGERALD: You can do that any time when you’re bus feeding…

CINDEY FUREY: Exactly as well as your kiggles because you can twist those anywhere too. So yeah I’m all about multitasking so I really do try to incorporate kids in and you know use your time wisely. So yeah but teaching moms abdominal brace is key but there are some other things we can do too.

I’ve had great success with kinesio taping so I loved this tape and I’ve been using it on my patients for years and years and years and that’s the fancy tape everyone saw on the Olympics with the volleyball players and all the divers. They had this black tape all over themselves. It comes with different colors. But we use it on moms and I used it on moms for a long time because it gives you a little bit more support. It’s not bulky.

You can wear it for days. You need to be taught how to put it on because postpartum skin can be very sensitive. Postpartum skin on twin moms can even be more sensitive because the skin has been so stretched…

CHRISTINE STEWART-FITZGERALD: Yes.

CINDEY FUREY: Right? So the tape is very sticky. It’s very adhesive. It’s hypo allergenic but there are some techniques to it so we call it a band aid technique as you lay it on but then you have to make sure that your hands are very free so that it doesn’t pull on the skin but kinesio tape works well. So one of those studies that I talked about earlier is actually trying to incorporate kinesio tape because we see clinically that it works but we want to prove medically you know to the rest of the world that it really works.

CHRISTINE STEWART-FITZGERALD: And isn’t it I mean I haven’t used it for DR. I’ve used it for other forms and I think what I understand it to be it sort of helps the body remember that this is the proper position it supposed to be in.

CINDEY FUREY: Exactly.

CHRISTINE STEWART-FITZGERALD: Yeah.

CINDEY FUREY: Exactly. In a way it kind of be like if someone was slumping in a chair and someone came from behind they kind of brush your back and kind of gave you that huh maybe you should sit up straight it could be very light touch but that was the tape is doing. It’s light touch but it’s all of the time. So that tape kind of queue those muscles into saying hey hello turn on again let’s knit this together. Plus it’s a really good reminder because you kind of you’ll get used to it but if you do something you’re not supposed to do the tape will remind you that you’re not supposed to be doing that.

CHRISTINE STEWART-FITZGERALD: Oh yes.

CINDEY FUREY: Because if you if I’ve taped your abdominal wall and then you just kind of let those muscles sag and hang out and your gut really hanged out well the tape is going to want to pull you back and it’s going to tug on your skin and it’s going to remind you oh no honey you should really stand up straight.

CHRISTINE STEWART-FITZGERALD: Yeah stand up straight.

CINDEY FUREY: Stand up straight, sit up straight you know so that’s a big one is the kinesio tape is a great tool that we have so education, exercise and kinesio tape are really the big ones. There are some other products out there binders, postpartum binders and even pregnancy binders.

CHRISTINE STEWART-FITZGERALD: Yes.

CINDEY FUREY: So binders are great so when you’re looking for a binder you first of all you need it to fit. It needs to be comfortable. You probably don’t want something to bulky because I don’t know about you when you were pregnant but I was my own little personal heater right?

SUNNY GAULT: Yeah.

CINDEY FUREY: So the more I put on the hotter I get and really at the end of the day you just rip those things off and you just want to get out of them. So binders are great. They can support you during your pregnancy and postpartum they’re great. They can again queue you to kind of pull in. With some of the more aggressive binders out there postpartum they’re great also because they can help you tighten your tissue because if you’re wearing a binder all of the time then your belly can’t really hang out. It’s not going to tighten your muscles but may actually have an effect on your tissue.

CHRISTINE STEWART-FITZGERALD: Really?

CINDEY FUREY: So it may help to get that elastin to kind of kick back in a little bit. So I can remember reading some stories about some Hollywood stars actually doubling up on their binders to trim their waist postpartum like how do they get back [inaudible].

CHRISTINE STEWART-FITZGERALD: Oh interesting.

CINDEY FUREY: So they may even wear two binders. Now the flip side of wearing a binder is you get really hot.

CHRISTINE STEWART-FITZGERALD: Yeah.

CINDEY FUREY: Sometimes you feel like you can’t breathe. They can be bulky so if you have a job where standing up sitting down or when you’re at home with your kids and you’re in and out of the car, you standing up sitting down, doing laundry [inaudible] the binders can kind of shift sometimes so you may have to reposition or you just get so hot you take it off. Right? So [inaudible] a binder doesn’t work so well because you’re not wearing it.

SUNNY GAULT: Yeah.

CINDEY FUREY: So it has to be something comfortable enough that you’re going to wear all the time and if you have a job or you’re on your feet all the time, it has to be really comfortable and really supportive. So you know you really just kind of want to hunt and find the perfect binder but they can work really well.

CHRISTINE STEWART-FITZGERALD: [inaudible] it is some great points. Now early you just touched on like some exercises and things to avoid, I know a lot of moms postpartum are really anxious to get back into the gym and you know get in shape overall. Are there some things that they should avoid you know that were really exacerbate?

CINDEY FUREY: That’s a very good question. So typically what we see is that everyone wants to strengthen their core back to the core right we’re going to strengthen our core so we’re are going to do tons and tons of ab exercises. Any ab exercise can actually be pretty detrimental if you do it wrong. So and the biggest one is crunches.

Crunches are and I know there are moms out there are saying but I’ve been doing them for years and I love my crunches and I do a hundred and fifty a day and but the problem is again if you kind of do them incorrectly, you’re going to wind up making your condition worse.

So what you want to look for you can really go back to how you tested for your DR and palpate that midline and do feel kind of a soft spot in between those muscles that’s get worst when you raise your head to do that crunch or if you physically look down as you’re doing your crunch and you see your belly jet out and kind of crown, stop please stop. So stop doing the crunch and reorganize because what you should be when you do any abdominal exercise is that your spine actually stays in neutral but that you can kind of [inaudible] the sides of your waist.

You can approximate the diastasis rectus and you can hold that as you lift your head maybe into that crunch position or as you raise your leg or as you do any exercise. So you really again want to go back to mechanics and make sure someone checks you. The big thing is is that if you’re doing any ab exercise your belly should come in. Your belly button should move towards your spine as you doing the exercise. If it bulges out and moves away you’re going to make your DR worst and if you’re bulging your abdominal wall, I hate to say it but you’re probably bulging other things too including your pelvic floor.

So crunches and more aggressive abdominal exercises is not great to start right away but you can go back to some of the basics doing very force exhalations and just contracting the muscles. You can start that immediately postpartum.

CHRISTINE STEWART-FITZGERALD: Oh that’s great to know.

CINDEY FUREY: So you can start some things pretty quickly and walking. Walking is a fabulous exercise. Get up and get out there as soon as you can and walk tall. That’s the big thing is you want to be as tall as you can.

CHRISTINE STEWART-FITZGERALD: I like that. Walk tall.

CINDEY FUREY: Walk tall and it’s hard right I mean our breast are a little bigger, we’re tired, we’re pushing a stroller, we get lower and lower and lower right so but if you walk tall you want to get a good supportive [inaudible] bra. You really do want to have the support behind you so to speak and walk tall as you’re pushing those kids on a stroller because as soon as you stand up straight your abs automatically come in. So you really do want to get on your walking programs as soon as you can.

CHRISTINE STEWART-FITZGERALD: I think we underestimate walking.

SHELLY STEELY: Make sure you invest on a double stroller with a high enough handle.

CINDEY FUREY: There you go. So…

CHRISTINE STEWART-FITZGERALD: Right.

SHELLY STEELY: Because I know some of them I mean ours are I’m short so one of ours is pretty good for me and another one is adjustable for my husband but a lot of people wind up with one of those like cheaper double strollers like the double umbrella or like lower ones and they’re really low to the ground.

CHRISTINE STEWART-FITZGERALD: Very good point.

SHELLY STEELY: And so anytime you’re walking you’re just kind of hunching…

CINDEY FUREY: Exactly.

SHELLY STEELY: So it’s kind of an investment on your health really [inaudible] nicer stroller.

CHRISTINE STEWART-FITZGERALD: Oh that’s a good point.

CINDEY FUREY: And I would say by the way same thing with breastfeeding right…

CHRISTINE STEWART-FITZGERALD: Yeah.

CINDEY FUREY: I mean most people are trying to bring their breast to the baby…

CHRISTINE STEWART-FITZGERALD: Yes.

CINDEY FUREY: And you really want to get those babies up so that you can sit tall because again then it becomes now it’s an exercise right so I know you just want to go to sleep at that point but really again multitasking. You can kind of pull these exercises in anywhere. So…

CHRISTINE STEWART-FITZGERALD: That’s great you know I’m glad I mean I share your passion for you know helping everyone to get educated and get healthy. Well thanks for joining us today and for more information about recovering from diastasis recti or for more information about any of our speakers or panelists, visit our episode page on our website. This conversation continues for members of our Twin Talks club and Cindey is going to share with us some of her great success stories on recovering from DR. And for more information about the Twin Talks club, visit our website www.twintalks.com

[Theme Music]

CHRISTINE STEWART-FITZGERALD: Today we have a question about potty training from Allison in Kansas City Missouri. My fraternal girls are two and a half years old now and we just started potty training. One is really excited to be the big girl and the other one could just care less. So how can I motivate both of them to do it together?

NATALIE DIAZ: Hey everybody its Natalie Diaz author of “What to do when you are having two” and founder of Twiniversity and multiplicity magazine. So its potty training time for your twins, wow yes it’s a milestone that every parent of multiple looks forward to. Who does not want to get rid of all the diapers in the house? Think of all the storage you’re going to have. So it often comes up at one twin is ready and one twin isn’t.

So you had some options. The first options is let the twin who is ready to start potty training start potty training. You can always have a little bit of peer pressure let’s say over the twin who isn’t quite ready. So go full force you know have the twin who was totally ready take her to the store, let her take out her underwear or his underwear, let them even have to stay maybe in a potty chair if that’s something that you want and not going through right to the toilet bowl.

I would actually recommend the people try to go right to the toilet bowl if they can. I don’t know depending on the size of the child that’s starting but it would be an easier transition to go from a pot you know just to go right to the bowl from going from a potty chair to the toilet. You may want to have some reading material ready for them if they are cute little poopers that take a long time to grab them you know the catalogue that just came in the mail from you know everything from American girls to Lego has some really great catalogues.

I would keep those on handy when my twins are potty training. And for the one that is not ready you know should see that the other one is getting so much attention so she’s say I want to try it too. It’s funny how when you start the process even if you don’t think one is ready how the one would just kind of pick up the pace and start doing what the other twin is doing.

So I would say go full force with the one that is ready and wait for the other one to pick up the queues on the twin that is doing it but I really wouldn’t put the pressure on the second child. Not everybody really does potty training at the same time. People think about that often and you know the average age for a boy in the United States is four so it could actually take a really long time to potty train and what I mean by that average age is when everybody is [inaudible] and everything.

Not just starting the process but good luck with your 2 ½ year old little monkeys. I know that you’re going to have ultimate success just stay positive. Don’t you know do anything negative. You can go old school one M&M for a pee, two M&Ms for a poo. You can keep a chart on the refrigerator as well as kind of like a reward chart they can work up to something as long as they you know do well on the potty but it’s in just [inaudible] and try to keep it very positive and don’t try to force the one who isn’t ready.

In her own time she’ll be ready and I’m sure when she sees her sister going and getting all these [inaudible] M&Ms and catalogues and stuff she’ll jump right on the bowl. I wish you the best of luck. If you have more questions you can go to www.twiniversity.com there’s actually a ton of resources about potty training and multiples on there so good luck. Bye bye.

[Theme Music]

CHRISTINE STEWART-FITZGERALD: Well, that wraps up our show for today. We appreciate you listening to Twin Talks.
Don’t forget to check our sister show:
• Preggie Pals for expecting parents
• Our show The Boob Group for moms who breastfeed their babies and
• Parent Savers, your parenting resource on-the-go.

Next week we’ll going to talk about preparing for a vaginal twin birth. This is Twin Talks, parenting times two.

[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
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