Hi, I had a myomectomy last year and so my abdomen is my main problem area. Because the muscles were cut I'm struggling tone up (even when I try to tense my abdomen it feels like putty!!). I've tried sit-ups but can only manage a few before my scar area hurts so I have bought an exercise bike and cycle 30min a day but was hoping that you could advise me on some additional exercises that will help as I doubt the bike will tone that area. Thanks
As a result of any kind of back pain, pregnancy or abdominal-directed surgery, the deep abdominal muscles are seriously weakened and inactivated and need to be retrained to allow reduction/ceasing of back pain and activation and tone of the stomach area. Following a myomectomy, the resultant scar tissue will mean that a progressively graded approach is necessary to prevent the scar tissue hardening while simultaneously allowing it the adequate amount of time to fully heal. The best way to address this first and foremost is to train the muscles from a static (non-moving) method. This is called ‘isometric’ training and involves the muscles working without changing length.
On a DAILY basis you need to be training your deepest abdominal muscles (transverse abdominals and pelvic floor) so practice the 'drawing-in manoeuvre' as often as you remember. You can do this anywhere (nobody will know!) and it is great to do when you're in a car or at a desk (i.e. any sedentary position), simply start by taking a breath in and as you do, draw your belly button in towards spine. You should feel a tension develop in your midrift (like you have put a belt on!), then as you breathe out, keep your belly button drawn towards your spine and breathe normally. Hold the tension for as long as you remember, although it won’t be long to start with.
The more you practice this manoeuvre the more automatic it will become. By strengthening your TVA and retraining it to automatically activate and stay where it should, you can visibly reduce the size of your waist as well as protect your lumbar spine in the long-term.
An exercise called the plank is an excellent example of an isometric exercise that is a progression once you have established your ability to do the drawing in manoeuvre. Here is how you do it:
- Firstly lying in a prone position with your elbows underneath your shoulders. Ensure you activate your core using the drawing-in manoeuvre, (as described above) then lift your bum up off the floor till it sits at the same height as your shoulders. You should resemble a plank-type position with a straight back with your elbows, forearms and knees in contact with the floor.
- If you have your belly button pulled in towards your spine and have lifted your bum high enough off the floor you should feel a tension and demand placed on the abdominals but not the lower back. When you have this position than simply try to hold it for as long as you can. This exercise trains your core muscles to stabilize your spine and strengthen to protect against the overuse of the lower back muscles.
NOTE: if you have a very weak core - which is very likely with chronic lower back pain - then you may well feel your lower back muscles help to hold your body in the plank position to start with. Do not work through it and focus on the abdominals and lifting the bum up towards the ceiling.
This is NOT an exercise for your back it is an exercise for your core muscles! When you reach a point during the exercise where you can feel the lower back helping and can’t get the abdominal muscles to work any harder than that is the time to stop and rest!
The plank can be performed on a daily basis with two sets of up to a 1 minute hold (work up to it!) being performed with 30seconds rest in between sets. You will notice a significant difference in the size of your waist as well as lengthen and encourage healing of your scar tissue through this exercise. It is phenomenal!
Apart from the above two suggestions, it is difficult for me to provide detailed programs/exercises for specifics in written format, especially without even a visual aid, i.e. photos. What you really need is a 1-2-1 with a fitness professional where you have visual, verbal cues and feedback on your technique, as well as to monitor the improvement of your core strength and adapt and progress it for you long-term. Therefore I would recommend that for optimum results you get support from a well-qualified fitness professional (a minimum of level 3 with the register of Exercise Professionals).
With any exercise you do for your abdominals in the future, bear the following points in mind:
- do the drawing-in manoeuvre before starting the sitting-up part of the movement and aim to keep this activated throughout the exercise.
- As you curl up, try to pull your chest down into your stomach to encourage maximum contraction of your abdominals as opposed to the hip flexors.
- If doing a crunch/sit-up type movement - ensure it takes you 2 seconds to sit up fully and at LEAST 2 seconds to return to the floor. The faster you go with this technique the more likely you will use and strain your back.
- Keep consciously trying to squeeze your stomach muscles on the way DOWN! If they relax on the way down your back will have to get involved! Try not to let your stomach muscles relax for the WHOLE set!
Hope this helps,
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