We met with Mary-Lou Richards Nilsson the co-founder of Hela Kvinnans Klinik, to talk about the female body post pregnancy. Specifically about ab separation and pelvic floor after having given birth.
After Mary-Lou's second child she found the information was very scarce on how to start exercising postpartum, and especially when you are used to being a very active person. That served as inspiration to open up Hela Kvinnans Klinik. Hela Kvinnans Klinik, is a clinic founded by Katarina Woxnerud and Mary-Lou Richards, located in Scandinavia. Their ambition and focus is on the women's health with a holistic approach. They combine treatments, consultations with ultrasound and biofeedback and are specalising in hernia and rectus diastasis (RD) operation.
Mary-Lou is concerned there has been so little research and information about rehabilitation after having given birth. She would like to compare the initial postpartum phase to the rehab you would receive after a sports injury.
Read the full interview with Mary-Lou Richards Nilsson below. Why her two children inspired her to open up the clinic, and her aim to make it more accessible for women to get help with pelvic pain and treatment of the pelvic floor:
I am a a certified naprapath, certified at the Scandinavian College of Naprapathy located in Stockholm. I have had continuous education with Diane Lee PT and Jenny Wickford PT for increased learning in the field of women's health.
As a naprapath, it has always been important for me to combine manual therapy with physical activity. Working together with personal trainers and other professions are therefore very important to me.
I have 2 children myself, ( 18 + 15 ) and its actually after my second child that I noticed more prominent issues with my pelvic floor. I found it hard to find any help. I have always been a very active person so it was natural to exercise during my pregnancies but also postpartum. I however found the information was very scarce on how to start exercising postpartum, on how to progress with more loading and when to start.
A true revelation was when I took the Mammamage course ( by Katarina Woxnerud - who is a pioneer in womens health ) many years ago. It is together with Katarina, I have founded Hela Kvinnans Klinik.
I think that we all agree that we need to promote physical activity before, during and after pregnancy. I think that a misconception about exercising postpartum is that there is no rehab program to follow and that sometimes women are told to just listen to their bodies and rely on that their bodies will tell them if something is not good. This may be true for some but not all women.
You would never tell a person after a muscle tear just to listen to their
body as they rehab.
An individual assessment needs to be done. We are all different, some women have a long background of exercising and could exercise throughout their pregnancy whereas other women couldn’t exercise due to pain, nausea, fatigue etc. Many thinks affect how you start your postpartum journey.
About 30% of all women that contract their PFM for the
first time do not perform it correctly. Initially you need an assessment of the PFM to ensure that you are doing the contraction correctly.
(PFM) or pelvic diaphragm it is a group of muscles and connective tissue that support the organs. During childbirth the pelvic floor stretches about 300x its length. As a consequence of vaginal delivery structural and neurogenic damage to the PFM and sphincter muscles have been observed. As a result of this the PFM would become weak.
To this date there is no data that shows that there is a specific way of exercising after giving birth. However most professionals are united in their thoughts that the body needs time to heal. Healing is promoted however through physical activity. The PFM (pelvic floor muscle) has an intimate relationship with the diaphragm, the deep abdominal and deep back muscles. Its all connected and there is an importance of assessing not only the pelvic floor but also its synergistic muscles. The abdominal muscles and its fascia have also seen biomechanical changes.
I would like to compare the initial postpartum phase to the rehab you
would receive after a sports injury.
would receive after a sports injury.
0-3 days: Acute phase
the first few days of initial healing
0-6 weeks: Remodelling and healing
1-12 months: returning to activity
Days: inflammation phase
Weeks: reparation phase
Months: remodelling phase
Months to Years: maturing phase
(source: Svensk Idrottsforskning )
Provide time for healing and time to regain strength and resilience of
Then we have the RD (rectus diastasis). RD is a separation of the abdominal muscles. It is the distance between your abdominal muscles ( rectus abdominis ). It is however important to know that we all have a distance between our muscles since there is a tendon in the midline. It is common however that clients are told they have a RD if the distance is more than 3 cm above the navel. It should be acknowledged though that this measurement says nothing about function of the abdominal muscles.
Due to the hormonell and biomechanical changes during pregnancy, the linea alba may become soft and therefore you will note a seperation postpartum. But there is always a distance between the abdominal muscles since anatomically you have a tendon there. Since the tendon is tense you will usually not feel the seperation. The question is at what width will you have issues? Maybe we need to assess an overall function.
A common misconception about RD is that there is a separation of the abdominal muscles. The whole abdominal wall stretches out during pregnancy which is normal to give space for the growing baby. The linea alba that is a tendon that runs in the midline of your abdomen, we all have this tendon meaning that we all have a distance between our abdominal muscles. The tendon is tense therefore you may not feel a separation or depth prior to having a baby.
Great read! Inspiring.
Emma September 21, 2020