Response to the ‘Mummy Tummy’

 

It’s been a few days since NPR’s article (link) “Flattening the ‘Mummy Tummy’ With 1 Exercise, 10 Minutes a Day” came out and as you can imagine, its everywhere with that catchy title. It’s being discussed in all of my women’s health circles and I wanted to write down my response to it because I’ve been asked to do so by many friends and clients.

  • Yay for publicity that exercise is a great way to address the issues that many women experience after having babies. We need these issues to be seen and we need women to know that they can find people to help them achieve their goals.
  • Yay for the great consumer education on what a diastasis is.
  • But this article went about it the wrong way, and in my opinion, a harmful way. The summary of the article is that pulling your stomach in “tighter and tighter” will melt inches off your waist. And guess what? You only have to do this one exercise! That’s it!

Not So Fast.

  • First and foremost. Pulling your tummy in “tighter and tighter” is not a safe way to address postpartum strengthening because our muscles do not function like this! Pulling your belly in this tight will also create pressure downward onto your pelvic floor so if you already have a pelvic floor dysfunction (leaking urine/gas/stool, prolapse, pelvic floor pain and tension) than method this will make that dysfunction worse, or create a dysfunction where there was none before.
  • Pelvic Floor. There is no mention of the pelvic floor in this article. The pelvic floor and the abdominals work together and you cannot address one without addressing the other. Doing so is irresponsible for someone who specializes in postpartum women. Without attention to the pelvic floor, a diastasis may improve immediately, but what I have seen over the years is that women who have tried this type of technique (pulling in tighter and tighter, over and over) come to me because their immediate results did not last. This can be explained because the pelvic floor is necessary to stabilize the abdominals. As someone who actually puts my fingers on the pelvic floor and the abdominals at the same time, I can tell you that MANY women lose their pelvic floor control when they engage their abdominals, and especially when they engage them with the type of cues mentioned in this article. And if this continues, a woman might get a flat tummy immediately but what about the long term effects on the pelvic floor……we know there is an increased risk of leaking and prolapse once a woman goes through menopause. Shouldn’t we focus on healing women so that they have long term pelvic health instead of immediate aesthetic benefits?
  • Flat back. There is a mention of flat back in the article, which in my opinion, is not the position of the spine that we want to train these women in. Flat back biases the brain to use the six-pack muscle instead of the deeper layers and that deeper layer is what is responsible for holding the spine and pelvis together as well as flatten the stomach without spinal compensation.  Flat back also is considered to increase pelvic pressure so someone with a pelvic floor dysfunction would not want to be in this position as they engage their abdominals at maximum force.  I want women to train their deep core layer in a neutral spine to optimize pelvic pressure, breathing pressures and enhance the ability to connect to the desired muscles.
  • The research. The article states that the research found that “100 percent of women achieved full resolution” and “all the women had fixed their diastasis”. This sounds like everyone fully closed their separation, right? Looking at the research, “full resolution” is defined as a separation <2cm, so the article needed to be transparent on what the definition of “full resolution” is so that women do not think that every separation will fully close. Anyone who works with this population intimately will tell you that not all separations close fully and the final size of a gap is not the only thing to focus on. And I’d like to see the long term results of this method. How do these muscles respond in the long run when they have to do more than contract harder and harder in a stationary position?
  • Abdominal gripping. The cues in the article and the cues I heard in the Dia Method videos I could find on YouTube are to pull the belly in as hard as you can: this can and will lead many women to become abdominal grippers, which is not how the muscle is designed to work and is not going to train for muscle strength. If you walked around with your bicep muscle pulled up tight all day, would that muscle be ready to receive a heavy load?
  • The exercise described in the article is not enough. What mother stands or sits still? Training a muscle to activate in stationary will not prepare a mother to live in her real life where she is dynamically moving. Clinically I see many women who can perform their core connection lying down but once I ask them to do it standing and with movement, it falls apart…so that’s where we work, to improve her ability to use her core while she is bending, lifting, carrying, running, etc.  It looks like the Dia Method does include more than this one exercise in her online material but the article did not mention that there is more to the story. 
  • Measuring tape. This part made me the most upset….as a woman with a body image disorder history and as someone who hears my clients express their concerns with their physical bodies on a daily basis. Are we really going to measure a woman’s waist in front of other women and give her a number that means what exactly? This article supports that skinnier equals more fit, which is absolutely not true. I’ve had clients who have healed their separations and are dynamically very strong but have not lost their baby weight. I’ve had clients who have no inches to lose yet have a wide separation and no core control. This gives me flashbacks to when I had my fat tested with those pinchers in high school PE class, giving me a number to memorize, to compare to my friends, a number to measure my fitness, not the number of miles I could run. In a world that already pressures women to “get their body back” and look like they never had a baby, this method of measuring one’s results is feeding into a body image disorder culture. 
  • Losing inches does not mean you are stronger. She isn’t measuring a woman’s strength or her ability to lift her kids with better body mechanics or  run without leaking.  We need to move the fitness industry away from targeting mothers with the goal of being skinny and towards the goal of strength and confidence in one’s ability.  This article was a big step away from that goal. I get it, the fitness industry uses the promise of being skinnier to sell, but as women who take care of women, we have a responsibility to fight that message whenever we can….to teach our daughters and our sons that the size of a woman’s waist is not a measure of her worth or her strength.

I think this article had a huge responsibility to expose the issue of healing postpartum women but it did not do this important topic justice. I do not know the Dia Method other than this article and what I could find online and I do think there is more to the story of this method that was not represented here. I hope that we find out more of the story and that the attention this article has gotten gives us a platform to discuss the bigger picture here. The real story of what it means to heal women fully and integratively and unfortunately, it takes more than 1 exercise, 10 minutes a day……..because aren’t we worth more than that?

9 replies
  1. Jessica Dufault
    Jessica Dufault says:

    Alicia Willoughby Yes, yes, yes! Thank you so very much. I am also a pelvic health PT and we have very similar views on this! And I wrote a very similar blog post. I hope we can just keep putting out the good word with solid education…but when this is then promoted on GMA it overwhelms me with concern.
    Jessica

    https://www.mindfulmotionphysicaltherapy.com/blog/2017/8/7/response-to-npr-article-flattening-mummy-tummy-with-one-exercise-10-minutes-per-day

    Reply
  2. Michelle
    Michelle says:

    Thank you! I was so confused after seeing that story, 9 months ppd (unplanned c section) and literally have no idea where my abs are, struggle with this new body and how to start a SAFE, HEALTHY and supported path back to some semblance of strength (beyond the kick ass current mom feeding baby strength). THANK you for reminding people, just because it’s on TV doesn’t make it … right

    Reply
  3. Karen
    Karen says:

    Alicia. I just finished a 5 day pelvic floor teacher training with Leslie Howard. I also have to say I went to a yoga class this morning after my teacher training and was not happy with the ques or what they were having their students do. I am so extremely happy as a woman, doula, and yoga teacher that you wrote this article. Thank you thank you.

    Reply
  4. Janna
    Janna says:

    Alicia I so appreciate your approach.
    We must engage from the bottom up… thank you for helping me find my rhythm after many years of “mismanagement.” I now include the cues we explored when teaching my yoga classes.

    Reply
  5. Brooke Lewis
    Brooke Lewis says:

    Yes, I completely agree. I also work with women to help them heal their diatasis and PF dysfunction. I shared the article to help spread the word about the positive effects of exercise. But have also been explaining the article’s short falls. Thanks for this post, I will share it as well.

    Reply
  6. Nina
    Nina says:

    Thank you for writing this article in response to bad information. Clients come to me after seeing not so great personal trainers, doctors or people with Facebook ads. It’s so disappointing to see pelvic floor issues exacerbated by people trying to “fix” mummy tummy and diastasis recti with horrible suggestions like NPR’s article. So a woman that had a little belly pooch is not leaking pee when she wasn’t before or she has crappy posture from listening to so called experts who don’t understand the female pelvis. I’m sharing your article everywhere I can!

    Reply
  7. Emm
    Emm says:

    I was a Dia Method member for a few months. There are some things I liked about the program: a decent nutritional guide, good help and support in the Facebook group (Leah responds to most questions with practical tips and advice), it’s an affordable and flexible program that’s easy to access.

    But right from the get-go I felt there was a lack of concentration on the pelvic floor. I have a stage 2 prolapse, so that’s a big area of concern for me. The instructor does mention pelvic floor here and there in the videos and suggests you can do kegals with some of the moves, but doesn’t really incorporate them into the exercises. The exercises also just don’t feel like they were developed with a whole core (including pelvic floor) approach, and prolapse is never given a mention. I was doing the core compressions for a while, but the more I tried to engage the softest area of my belly where my muscles are the weakest, the more I felt pressure on my pelvic floor. And I quickly stopped doing the other workouts because too many of the moves felt like they were exacerbating my prolapse.

    Now I’m on the hunt for a good workout routine that will help my strengthen my whole body and burn calories so I can lose a lot if my baby weight (I gained 70 pounds between my two kids) which will help reduce the load on my pelvic floor, as well.

    Just like it’s a good thing to get the word out about diastasis, I think it’s great you’re getting the word out about pelvic floor health, too. I’m sure I’m not alone in what having kids did to me “down there.”

    Reply

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