My client has had 2 caesarians. With cardio, core training, good nutrition- how much ab tightness can she get back?

I thought I might chime in on this because I am in the same boat as your client :)
I think the answers already provided have been great:
1) You can not spot reduce by doing tons of ab work. Muscle and fat are two distinct tissue types and you're not going to turn one into the other by doing lots of focused core work.
2) To lose weight, you have to expend more calories than you consume (through diet, exercise or the combo).
3) Strength training & increasing lean muscle mass help boost metabolism (along with lots of other great benefits).
4) Pelvic floor and transverse-specific exercises would be great to include for your client.
ALL GREAT RESPONSES, and really great tips for a variety of clients.
Congrats to your client for making progress already. I think I would just add that the best weapon is consistency over time. No quick fixes, no fad diets and no immediate miracle results. Stick with it.
I had a c-section with my twins (who are almost 4) and had my best body ever about a year after they were born. I had a second c-section about a year ago and it's been a little tougher to come back from it, but that's my own fault & I recognize that (a little busier, a little more stress, a little less will power & more bad habits :).
I think it's important for us to have realistic expectations as to what's possible. The strength of the core and body composition can be addressed with training BUT there are some things that exercise & good diet are not going to fix. My skin on my stomach will never be the same as it was before carrying twins without a surgical fix; however, I was able to work hard, overtime, consistently to get the definition and strength back in my core.
best of luck to you and great advice everyone.

Fat cells only multiply during two potential times in a person's life: adolescence and pregnancy. This may affect the difficulty of weight loss, but it is not impossible with appropriate diet and exercise. There is also a possibility that the elastin in the skin may not match the loss of subcataneous fat (fat under the skin) that occurs.

Try not to exceed more than 2-3 days of core training per week. It may be tempting, but know that research has shown that abdominal training has no relation to fat loss in the midsection. Continue core training, but do not expect any direct adaptation except for temporary tightening of the stomach and abdominal strength.

The best way to lose weight (despite any condition or circumstance) is to burn more calories than consumed. There is no magic here, just proven science (the 1st law of thermodynamics). To find out the amount of calories you consume per day with activity, go to www.apexfitness.com and use their fitness calculators. Then begin food logging your calories every day. If the goal is one pound of weight loss per week, you must have a calorie deficit of 500 calories per day as there are 3,500 calories in one pound of fat. You can achieve this deficit by burning 500 calories, not eating 500 calories, or both!

If calorie restriction proves to be too difficult, you can purchase supplements such as theromogenics and meal replacements to assist you. The best ones on the market are at www.dotfit.com. Abide by these guidelines and, by science, you WILL lose weight. Make sure to take a multivitamin so you will not lose muscle during weight loss.

Your client need to be extrememly disciplined in order to regain her core strength and pre-pregnancy abs but it can be done nowadays!

A C-section is a surgical procedure so there will always be some scarring, but there is no cutting through muscle with the exception of the uterus. When a C-section is done, two sets of abdominal muscles are 'separated' not 'cut' from one another. A transverse (horizontal) cut,the so-called bikini cut C-sec, actually has fewer complications. and less noticeable than the (vertical) incision.

The fascia is one of the layers cut during a c-sec. Fascia covers the muscles and acts as a sheathe much like a girdle. Of course if your muscles are not tightened and strong there is a lot more compacting for the fascia to do! After giving birth the fascia will be back to 90% of its original strength within in 6 weeks, the other 10% will come back within a year. You cannot strengthen or tighten your fascia without surgeryso it is so important to stay within the dr's recommended weight gain.

Exercises to train the pelvic floor and transverse abdominis are important to focus on. Vaginal deliveries in which an episiotomy is made also creates a dysfunction to the pelvic floor and causes weakness in the core as well. Whether it's a vaginal delivery or a c-section, the pelvic floor and the TA act as a sling for the baby and this is why you need to train these specific muscles to regain core strength http://youtu.be/aqLPJ4R0KiI

If your client notices her belly protruding over her incision, this is usually referred to as the "shelf" and it's mainly fatty tissue damage which eventually turns into scar tissue. Since this is your client's 2nd c-sec, her scar tissue will obviously be larger than a single c-section.

Weight training can really boost metabolism; targeting large muscle groups and burning calories should tighten the abs. With all the core training her muscles should look good when the fat burns off I think her results will be fantastic if you add more variety and muscle groups

Thanks so much for all of your input. I have been working with my client on more cardio, better nutrition, strength training, etc and have discussed the fact that there is no such thing as spot training and that she needs to focus on how far she has come as opposed to the fact that her stomach isn't the same as it was. She has been so obsessed with the c-section that I thought words of wisdom from some other professionals, besides me, would be helpful.
Thanks so much for all your advice, suggestions- so good to know this resource exists.

Hi, Bettie

I noticed you mentioned core training but not strength/weight/resistance training. While every woman is different and we don't know if your client will be where she was before, but you can help her be better than she is now.

Someone else mentioned weight training and I really think that it is the missing component to your client's training. The weight training will allow for more fat burning and better body recomposition.

I would advise getting a full certification at some point in Pilates as well, rather than just personal training or group exercise, as it is brilliant for pre-and post-natal conditioning. There is a huge market for this client type and similar and you can have the edge on other trainers, if you do it all. Often the time spent with a fitness professional, getting the body ready before the birth, will have set up their body for great results in the post-birth period.
Each woman I've worked with has had an individual experience with healing from a c- section or vaginal birth, the scar tissue and its effects on surrounding abdominal structures, the speed of their weight loss, and their comfort level of moving an area that has been "traumatized." This can also be different for each baby they have!
Alas, not all Pilates is equal...It is often a buzzword when the actual science of it is awesome. Pilates taught by those trained under Physical Mind Institute, BASI, Balanced Body and Stott is your best hope in getting the best training out there. The teaching will likely be very precise, it is long and incorporates much invaluable work relating to clients that have specific issues. There are so many continuing education workshops to keep up on the latest for these clients. It is training detailed toward the core and the body functioning as a whole, working deep tissue that is generally missed by regular fitness training, "abs" classes, and Yoga- which although great for flexibility, it does not appear to teach students how to access their specific musculature needed in the trunk, without overworking or straining other areas, such as using hip flexors or lower back muscles for exercises that should be recruiting deep and surface abdominals for the main tasks. Nor do many exercise disciplines appear to be focused on addressing the weak/strong muscle imbalances that we all have. I love it for that.
Proper use of breath for ab and core work will also teach clients not to "push out" their abs and "brace" to feel strength(often builds abs that look bunchy and stick out) and instead, to contract abs steadily, almost like a continuous gentle pulling around the waist of a "drawstring" or a 'seatbelt "while maintaining easy flow of breath. They will experience a new feeling of "burn" from "new' muscles firing, will break a sweat, and find that their body will start to feel connected even after doing a maximum of 5-10 reps.
It is crucial to teach ALL clients how to locate the different muscles for moving and stabilizing the torso correctly, especially for their current condition. I create progressive programs that address any recovery that has not happened naturally or through physical therapy, and exercises for the long-term that can also eliminate pain. This is also important work for anyone who has had abdominal or back surgery as the two areas are linked physiologically. I'm amazed at how many people need fitness professionals' help in these areas, whether it be for a post-surgery cancer patient with incisions for chemo port insertions/removal, someone post-colon surgery or liver transplant surgery or those who have had the often unnecessary and failed "back surgery".
And lastly, I am an advocate of patience and training clients to improve their attitude toward themselves about this. There really is no "race" and reaching a goal in lightning speed is often a sign that there is trouble ahead in maintaining those results or thinking that speed is the sign of a successful workout program...I'm yet to see it be a factor in any fitness success story in my 22 year career! Yet there are always results for those who quietly follow a consistent balanced plan and have help in keeping the faith in the journey. I remind clients their progress is about staying focused on their own timetable and away from the false fitness promises they read in magazines, see on a TV show, or think a celebrity believes, is the answer for them. :)

The answers given are all excellent. One point, of particular importance, is that the degree of recovery is directly related to the severity of the procedure. In other words, all C-sections are not the same. Degree of tissue involvement, time for delivery, pre-delivery muscle strength and others all impact the degree of recovery.

First step, have your client speak with her OB-GNY for more specific information on expections and guidelines for the intensity and specificy of exercise(s).

Take care and good luck to your client.