I Like Big Butts And I Cannot Lie

Seriously... a nice healthy butt is something I’ve always admired. Even in 5th grade, when my mom asked me why I liked the boy I had a crush on (along with my best friend at the time, and every other 5th grade girl), my answer was that I liked his hair and his butt was nice too (It was). This fun throwback fact says 2 things about me: 

• I might have been a tad bit superficial in my preferences in men AND

• I was way ahead of my time in realizing the power of the gluteal muscles!!

So, let’s talk about the glutes and how they relate to pregnancy. As a physical therapist, the most common problems I see in a pregnant woman include, back pain, diastasis recti, prolapse, and incontinence. 

In back pain, we look at all parts of the spine, the lumbar spine which is the low back, the thoracic spine which is the mid back near your shoulder blades, your cervical spine which is your neck, and your sacrum which is the flat part of your spine below your low back that connects your spine to your pelvis. 

So, what the heck is diastasis recti? Diastasis recti is the separation of the right and left rectus abdominis muscle which is your 6-pack muscle. The structure that actually creates that rad 6-pack feature is called fascia. Fascia is just connective tissue, the very same type of tissue that the famous IT band is made up of. It’s very stiff but can become more loose and flexible with the hormones of pregnancy. This is actually a good thing because when it stretches it helps make room for an expanding belly and growing baby. It’s also what helps your pelvis widen during labor. A diastasis recti is completely normal during pregnancy, but should start to close up and heal after pregnancy. It becomes a problem when it doesn’t heal properly after pregnancy and can lead to back pain, abdominal hernia, and can worsen things like prolapse and the function of the pelvic floor.

So, what about prolapse, what’s that? Pelvic organ prolapse is the downward displacement of one of your pelvic organs which could be your uterus, bladder, rectum, or even your intestines. The ligaments and other connective tissue that should be supporting them in place become loose and stretched causing them to drop down, which can be seen during a pelvic floor physical therapy examination when the patient is asked to “bear down” (like pushing out a bowel movement on the toilet). 

Speaking of using the toilet, is incontinence just peeing your pants when you jump on the trampoline? Sort of. Incontinence is the lack of voluntary control of urine, feces, or gas. The most common type of incontinence we see in pregnancy and the postpartum period is urinary stress incontinence which is the leaking of urine during high abdominal pressure activities, like running, jumping, sneezing, and weightlifting. 

The good news is that all of these problems have a solution! A big part of the solution for ALL of these problems is strengthening the glutes.

Strengthening the core is the obvious part since it provides stability for the spine, helps with abdominal pressure regulation, provides postural control, and helps with force transfer from lower body to upper body- all good things. But often it’s the glutes that are overlooked and are the missing piece of the puzzle. I actually consider the glutes to be part of the core.

There are actually three pairs of glutes, the gluteus maximus, gluteus medius, and gluteus minimus, all doing slightly different jobs while working together to support the pelvis. Since the glutes support the pelvis and the pelvis supports the spine, now you can see why the glutes are a part of the core!

Let’s talk more about this awesome group of muscles. Glutes are the main driver of power for hip extension, which is super important in walking, running, jumping, and squatting. Strong glutes provide good force absorption which is important for preventing all the “itis”es of the lower body. Think patellar tendonitis, achilles tendonitis, plantar fasciitis, etc. When glutes are not strong enough (or not turned on 100%) to absorb the ground reaction forces that go up your body from running, walking and jumping, it forces those forces to be absorbed into the passive tissues of the body like bones, tendons, and fascia, leading to injury. Glutes also help you bend over in a way that is protective of the spine, called the hip hinge. With all of these cardinal functions, the glutes are literally the foundation of the spine and provide a strong foundation for the core to work. Oh and a good set of glutes also make you look fierce!

So, how do we pull this all together to relate to pregnancy?

Strengthening the glutes is a key aspect in helping to prevent all those common problems experienced during pregnancy and postpartum that we talked about earlier: back pain, diastasis recti, prolapse, and incontinence. Strong glutes and proper activation of them help to decrease back pain by providing a strong foundation for the core, pelvis, and spine as well as serving as an active structure for force absorption so that forces are not absorbed into the spine. Wonder Woman glutes help to prevent and treat diastasis recti symptoms by supporting and optimizing the core, which is paramount in decreasing a diastasis. Strong glutes are an important part in getting rid of prolapse symptoms because they are intimately tied to function of the pelvic floor muscles. So glutes are like back up support to the pelvic floor, whose main job is to support all the organs within the pelvis and keep them where they are supposed to be! Since we already talked about the glutes acting as reinforcements to the pelvic floor, this is why strengthening them is integral to treating and preventing incontinence too. Talk about shooting 4 birds with 1 stone (the stone is strong glutes if you didn’t get that by now).

So please, ladies, do as Sir Mix A Lot instructs and shake that healthy butt- Baby Got Back

Dr. Mel out….mic drop