Episode 14 – Dr. Sarah Duvall – Pelvic Floor & Diastasis – Coming Back Stronger Than Ever Before!

Dr. Sarah Duvall

Dr. Sarah Duvall is a leading professional in the field of Postpartum fitness. In todays episode we talk about return to triathlon and running after Diastasis or prolapse, and how triathletes can come back STRONGER than ever before!

We also talk about a topic all cyclists, runners, and triathletes should practice: Breathwork, and learning how to breathe properly can not only boost performance, but also improve your recovery, and general well being.

Make sure to check out her many various programs and resources at www.CoreExerciseSoloutions.com



In this Episode:

  • Introduction: Dr. Sarah Duvall
  • Common Fears Among Women Returning to Running Postpartum
  • Common Considerations for Diastasis
  • Pelvic Floor Connections
  • Common Red Flags in Running Pictures
  • Anterior/Posterior Tilt
  • Stress
  • Breathing Exercises to Destress
  • Accessory Muscles for Breathing
  • Conclusion

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Show Notes:

0:42 –

Introduction: Dr. Sarah Duvall

  • Today we will talk about diastasis to prolapse, breathwork, and more
  • Postpartum Corrective Exercise course – Dr. Duvall
  • Pelvic floor is important!
  • Like, subscribe, give us a review, and please share!
  • Pick up a copy of Strength Training for Triathlon Success
    • An entire chapter on breathing there
    • On TrainingPeaks University
  • Dr. Duvall is a leader in postpartum corrective exercise
  • More triathlon-based than cycling-based episode
  • Core Exercise Solutions
    • Blogs posts and videos
  • “My passion is to get women their bodies back – for whatever that looks like for them” – Dr. Duvall


7:31 –

Common Fears Among Women Returning to Running Postpartum

  • Leaking
  • Prolapse
    • “Most women can run with prolapse – if you do the work it takes to get there” – Dr. Duvall
    • “It’s not easy – you gotta put the work in” – Dr. Duvall
  • Diastasis: when the mid-abdominal wall stretches to make room for the baby and the tissue thins out
    • “100% of women when they go into that delivery room have some form of diastasis… it’s a really cool, natural way for the body to make room” – Dr. Duvall
    • “It’s not just women who have diastasis – it can also be men” – Menachem


11:11 –

Common Considerations for Diastasis

  • Usually your deep inner core is not coordinating as it should
    • Looking for how the deep abdominals are giving with the inhale
      • Nice TA expansion or just belly breath?
      • What kind of bracing are they using?
      • How is the pelvic floor co-contracting?
      • How is their posture?
    • “Everything is connected” – Dr. Duvall


13:12 –

Pelvic Floor Connections

  • “The way we react to the ground is our foundation for movement” – Dr. Duvall
    • It affects how the rest of your body reacts
    • “What’s going on with your feet is a window into what’s going on with your hips… and then your hips are a window into your pelvic floor, and your pelvic floor is a window into your respiratory diaphragm” – Dr. Duvall


15:06 –

Common Red Flags in Running Pictures

  • Posture and pelvis
    • Is your bottom tucked under and your head forward?
    • Are you hunched forward?
    • Is your pelvis anteriorly tilted?
      • Could be a compensation for hip impingement


17:26 –

Anterior/Posterior Tilt

  • Both can contribute to diastasis and prevent a diastasis from healing
    • If you’re pelvis is tilted it’s not lined up with your diaphragm, which prevents the deep abdominals from working as they should
  • “When you have the tilt either way it ends up stressing that midline by creating abnormal or excessive pressure in the abdomen” – Dr. Duvall
  • Pelvic floor/prolapse (pressure issue of the pelvic floor) and diastasis (pressure issue of the front) are closely related just on opposite sides
    • Check in with external obliques, serratus
      • Serratus: “I like to think of it as your transition muscle between your abdominal wall and your shoulders” – Dr. Duvall
  • Generally safe test:
    • Take a sideways selfie in the mirror with minimal clothing and analyze your pelvis
      • Is it tucked forward or backward?
      • Do you have an arch in your back? Where?
    • Can you come out of that posture or does it feel really restricted?
  • “I am not a fan of stretching – I am a fan of moving through ranges of motion” – Dr. Duvall
  • The psoas is the primary vertical stabilizer for the spine


25:38 –


  • “I have seen so many injuries in people because they were stressed out” – Dr. Duvall
  • Stress is a huge player in injury
  • 4 pillars for athletics progression: hormonal, metabolic, neuromuscular, cardiorespiratory
    • “We all forget the hormonal” – Menachem
    • There’s a general trend for the neuromuscular
  • “There are days to train hard and there are days to take a bubble bath” – Dr. Duvall
  • How Dr. Duvall manages stress as a mom:
    • “I recognize there are seasons for things” – Dr. Duvall
      • Sometimes I’ll work a little less and train a little harder and vice versa
      • “I have to pick – I can’t do both at the same time” – Dr. Duvall
    • “Something has to give – you cannot have it all to the same level all the time” – Dr. Duvall
  • Similar to running the last leg in a relay race that’s how Dr. Duvall does her job – she never wants to let anyone down and wants to be the best for her clients
    • “Then I realized I can’t run this race forever there’s no finish line” – Dr. Duvall
      • She had to create arbitrary finish lines so she wouldn’t burn out
  • Don’t lose sight of your dreams!


37:19 –

Breathing Exercises to Destress

  • It depends!
  • Place your hands on your rib cage and take a nice deep breath
    • What did you feel when you inhaled?
      • “My thumbs went out and back and my fingers went up and out” – Menachem
        • This is what we want – nice even rib cage movement
    • It’s also easier to perform this exercise lying on your side because it decreases postural control
    • Standing is the hardest


41:54 –

Accessory Muscles for Breathing

  • Learning to breathe properly with proper pelvic positioning can help heal a diastasis
  • A lot of women complain about their bra straps falling off with accessory breathing, which tells you they’re using their accessory muscles
  • Accessory muscles = helpers
  • Typically you don’t want to use the accessory muscles the whole time on a leisure run
    • Can cause trigger points and “knots” from overuse


44:25 –


  • Key advice:
    • “Our body is capable of more than we think – and that includes healing… you’ve gotta have the mental capacity to be able to let it heal” – Dr. Duvall
    • Check your attitude
    • “Our body is listening to us put it down” – Dr. Duvall
      • Be a bit more positive – fake it until you make it!
  • Where can we find you?
    • Website: coreexercisesolutions.com
    • Google Sarah Duvall
    • Glutes, Core, and Pelvic Floor
      • Great overview


Picture of Menachem Brodie

Menachem Brodie

Coaching since 2000, Menachem Brodie has been working with athletes in a number of settings, and a broad variety of sports.


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