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Deep Core Rehabilitation – Dr. Katie Sellars

So you had a baby.  Or maybe you had two babies, or maybe more!  Maybe you’re about to have one.  In any of these cases, you’re going to want to read this.

It is pretty likely that you’ve heard the word “core” before.  Your core by most definitions is made up of the musculature of your torso that stabilizes your body.  A “strong core” is extremely helpful in providing you with the proper base from which to perform exercises without damaging your back.  The problem here is that your “core” and your “deep core” are not the same thing.

Your core consists of muscles which are more superficial on your person.  They are often referred to as “big movers” because they tend to be larger, built for strength, or to move you.  Your deep core (shockingly enough), consists of muscles that are layers deeper on your torso.  Four muscle groups, to be exact.  They are: your breathing diaphragm, your pelvic diaphragm, also known as pelvic floor, a deep oblique abdominal muscle known as your transversus abdominus, and a group of deep back muscles, collectively known as your multifidus.  These four muscles make up essentially a deep cylinder of support for your body.  They are less built for brute strength, and more for their ability to anticipate your body’s movements.  They function together as a unit to support your pelvic organs (like your bladder, your uterus, and your rectum), much like a sling or a hammock.  They help hold your abdominal contents in tight so that they don’t protrude out.  They help you take big, deep, effective breaths in and out.  They prevent you from having to use phrases like “pee happens”.

The problem is: in a lot of women who have had babies, they don’t do these jobs anymore.  They don’t function harmoniously, and they don’t function in an anticipatory manner.  When this happens, a lot of problems happen: we pee when we laugh, we get what everyone lovingly refers to as a “mommy tummy” due to our abdominal muscles splitting apart during pregnancy and not closing back up postpartum, and/or we wind up with hip or back pain that will just not go away.

So why does our deep core stop working?

Well, the reasons are many, but let’s take the most common one, pregnancy, as an example.  When you are pregnant, your abdomen fills right up with your baby.  Your diaphragm, which was once able to descend freely into your abdominal cavity as you filled your lungs full of air, gets stopped by all of that baby in there.  Your pelvic floor goes from supporting a few pounds of abdominal organs to supporting 20-50lbs worth of baby-related weight gain!  That hammock gets seriously strained and stretched out… not to mention the process of expelling that baby.  Your pelvic floor does not come out in good shape.

Then we have your transverse abdominus which basically undergoes the same stretching as your pelvic floor only outward, and your multifidus which, in one way or another, gets tugged at and used differently depending on whether you are one of those pregnant women who wind up sticking her bum way out while her belly protrudes forward, or tucking it under to try to help support your new centre of gravity using your hips more.

Another reason your deep core stops working properly beyond the biomechanics of pregnancy is what happens postpartum.  This notion of just going back to whatever exercise you were doing before you got pregnant starting six weeks postpartum has GOT to stop!  I get it, I’m a gym rat, too.  But in most cases, six weeks postpartum is just too soon for your body to start up high-intensity, especially high-impact activity.  Your body isn’t done recovering!  For some women, it has barely started.  Having a baby is a major event!  If you went in for knee surgery, would you just pick up where you left off and go play a hearty game of soccer 6 weeks later? No – you would properly rehabilitate your knee, and gradually increase your physical activity level once you were confident that your knee was stable and functional.

So the golden question is: How do we fix the deep core?

How do we stop those pesky leaks and help our abs re-approximate, or come back together, so that we can have our bodies back? Well, since deep core dysfunction is partially a result of a lack of synergy of the musculature that makes it up, we need to regain that synergy.  In other words, we need to retrain our body’s ability to fire all four of the deep core muscle groups together, and eventually, without us having to cue it first.  In a perfect world, this rehabilitative process should be considered the “re-training” of your core before you “train”, aka workout – much like the knee surgery example I gave earlier.  In a perfect world, women would undergo 6-8 weeks of re-training their deep core postpartum before they began any strenuous exercise program.

The task begins with learning how to do core breath

Which is a conscious way of breathing while purposefully engaging your pelvic floor.  This is where I come in.  I teach core breath.  From there, a progressive series of rehabilitative exercises are often given which are designed to teach your body to activate functionally while using the core breath to stabilize your deep core (I teach that, too!).  This system is a great start, and for many women, it is all that is needed to correct the deep-core dysfunction they are experiencing.  I always recommend seeing a pelvic floor physiotherapist postpartum at least once as well to assess the actual physical condition of the pelvic floor, as they do internal work.

The goal, as I have mentioned, is to get to the point where you can perform your normal exercise regimen, or whatever other activity you need to be doing, without having to constantly cue the core breath because your deep core is functioning in an anticipatory manner on its’ own.  So it just becomes a part of your day, without having to think about it.  Once that happens, pee doesn’t happen.  Nor does “Mommy Tummy”.

Dr. Katie Sellars is a Licensed Chiropractor and the owner of Sellars Chiropractic & Wellness Centre in Waterloo.  She works with patients of all ages, with a special focus on prenatal, postnatal and pediatric care. In addition to her Chiropractic training, Dr. Sellars is also fully certified in Webster Technique, as well as Contemporary Medical Acupuncture. She specializes in the diagnosis and treatment of a wide variety of conditions and disorders relating to the skeletal, nervous, and muscular systems. 

To learn more about her Deep Core Rehabilitation program please contact Sellars Chiropractic & Wellness Centre via phone: (519)208-6900 or email:

You can also visit her website

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