For many years I admit to being ‘anti-plank’ for people with a stoma. I used to think it was an exercise that created too much intra-abdominal pressure and increased risk of parastomal hernia.
However, over the years I’ve changed my view. I now have a more nuanced view and feel that a plank CAN be a great exercise if it’s done correctly with the right approach, modification and build up.
Steady tiger... before you rush off to your exercise mat, hold fire and read on.
There are a billion different ways to do planks and many ways to modify and adapt. So in this article and video I hope to show you some variations and how you can find a ‘plank alternative’ that suits you and your current level/recovery.
Before I continue, I’ll just explain what ‘planking’ is if you’re not familiar with it.
The classic ‘plank’ is an exercise essentially to strengthen the muscles of the core, abdomen, shoulders and back. It’s a very popular ‘core’ exercise used in gyms, fitness and Pilates classes.
There are often online ‘planking’ challenges to see how long people can hold a plank position for and apps to encourage you to do it daily (30 day planking challenge etc).
This image shows a classic forearm plank – the type you’ll often find shown online, in a class or in a circuit session. It is usually a static exercise – i.e. you don’t move whilst doing it and you hold a stable braced position. *NOTE - read the whole article before you try ! this level is NOT a starting point.
The idea is that you hold it for a set period of time whilst maintaining good technique. This might be 10 seconds to start with and then building up to many minutes. There are also options to add hip dips, and lifts of the arms and legs in this position making it even harder.
The question of whether this is an appropriate exercise for someone with a stoma is rather more complex.
And, as is typical with many questions related to exercise, the answer is ‘it depends’. There’s also lots of variation in the technique of this classic forearm plank and it’s important to do it correctly – with the hips slightly higher and deeply engaged abdominals.
I know plenty people with stomas who regularly plank like this (with good form) without any problems at all.. and in fact the classic forearm plank is something that I’ve brought into my routine over the last couple of years.
BUT – and this is a BIG BUT – a classic forearm static plank is one of the hardest versions and something to build up to over many months or even years after surgery. And you also need to do it properly with the right form. This is not your starting point after stoma surgery.
Planking like this is a super advanced exercise for someone with a stoma (and actually anyone who’s had abdominal surgery, a baby or is just out of shape). It requires a lot of strength in the shoulders and core and it increases intra-abdominal pressure, potentially increasing risk of hernia IF you're not ready and strong enough. And I’ll say this again – it’s NOT a starting point.
If we consider that the stoma is a ‘weak spot’ in the abdominal wall, then when we do a plank (or any advanced abdominal exercise actually), the increased pressure needs to go somewhere and it’s likely to find the weakest exit point – increasing risk of hernia.
But when we’re strong enough in our core, we can manage this intra-abdominal pressure more effectively and the plank then becomes a more appropriate exercise. You need to be sure you can control and manage your intra-abdominal pressure BEFORE you even attempt an exercise like this.
Having the strength and control to manage intra-abdominal pressure will help you to reduce your risk of hernia.
But we need to do that in more progressive way – starting with other exercises and easier plank variations.
Put simply, your core needs to be strong enough to DO a classic plank.. Don’t use a plank to get strong.
An aside on push ups…
As an aside, the same can be said of doing a full press up too. Press ups create a similar force on the abdominal wall to planking, so approach press-ups carefully and build up to them slowly over many months. Tips like remembering to ‘breathe out on the exertion/push’ will help you to control ‘intra-abdominal’ pressure and create less force on the abdomen, starting on your knees and ensuring you’re strong enough to execute good form.
Back to planks…
Ok.. so if we accept that we need to get strong BEFORE we do a full on plank, how do we do that and then what are the plank variations?
Building up with other core exercises first such as pelvic tilts, bridges, exercises in a box position, mini side planks and other level 1/beginner Pilates exercises is essential. You’ll find exercises like this in classes at The Ostomy Studio.
Being able to activate and control the deep abdominal muscles is critical before you progress to anything more challenging like a classic plank. An awareness of how to feel and contract your deep abdominals is the priority.
And remember that planking is a whole body exercise and you need strength through the shoulders, arms, neck and back too. If something is weak or there’s a limitation somewhere, you’re likely to compensate or use poor technique.
Form is EVERYTHING with planks and an awareness of what all the muscles are doing and how they’re feeling is key.
You need to build a strong foundation and good core function, where all components of the core – including your pelvic floor – are working together in synergy.
So let’s assume you’ve been doing some Pilates style exercises and you have good awareness of your deep core, you can control and activate it and you feel ready to try some plank variations.
This is how I progress my clients and classes towards a plank. Some people don't progress further than level 2 or 3 and that's totally cool too. Start with level 1 - understand the connection and engagement of your core - and move through the levels as you get stronger.
This may take some weeks or even months to work through these levels after surgery. Spend some time (probably weeks) at each level and then progress when you feel ready and strong.
*NOTE - if at any time in any of these exercises you feel a pop or pain around your stoma, then stop straight away. If you feel pulling, doming or sense of pressure around your stoma, then take it back to the previous level and spent a little more time getting strong at that level first. If you progress properly and really listen to your body you shouldn't feel anything uncomfortable at all.
Level 1 – Plank preparation – post surgery, new to planks
Plank Prep
Start in a box position and simply stay here and breathe. Be aware of your deep abdominals like a belt. Draw your abs in as you exhale. Hold for 5-10 seconds and relax - repeat 5 times.
Baby plank rocks + breathing
Start in a box position, but slide your hands out further in front of you. Rock your hips through until you feel some 'engagement' in your core muscles.. just enough that they feel 'turned on' but not under strain - and your body is in a straight line. As above, stay here and breathe. Be aware of your deep abdominals like a belt. Draw your abs in as you exhale. Hold for 5-10 seconds and relax out of the position - repeat 5 times
Level 2 – Progressions and alternatives
Hover Plank Prep
In a box position, extend your hands out a little in front. Curl your toes underneath.
Inhale to prepare, then as you exhale engage your deep core muscles and lift your knees off the floor about 1 inch. It is literally a tiny lift. Your thighs should stay vertical.
Slowly lower to the floor and repeat 3-5 times. Watch the video to understand this best.
Box Step Outs
In a box position slide one leg out behind you and put your weight into your toe. Slide the 2nd leg out to join it and pause in a long arm plank position, then step your feet back in straight away. Don't hold that position yet. Keeping your bum in the same place throughout. Watch the video to understand this best.
Level 3 – Progression planks
Hover to Long Arm Plank
Starting from the 'Hover Plank Prep' position above, then exhale and extend your body forwards by straightening your legs (as if you're in a tunnel) until your body is in a straight line and your weight is over your arms. Keep your hips slightly lifted. Pause and then return to Hover Plank Prep position and slowly lower knees to floor (*important). Repeat 3-5 times
Hold for longer
Once you’re here, try building up the time of holding the long arm plank - remember to breathe :) holding for 5-10 seconds and building up to 30 seconds.
Level 4 – More challenge
Now you've mastered long arm planks, lets head down onto our elbows which is more challenging.
Forearm Step Outs
Start in a forearm box position with your bum in the air. Curl your toes underneath you and then step one leg out behind you, take the second leg out and take your weight into your toes - exhaling to engage your core. Keep your hips slightly elevated in a V shape and gently lower your hips to the point you feel 'engagement' but not strain through your core.
Pause, then step your knees back into the start position and repeat 3-5 times.
To progress this, hold the forearm plank position for longer. Building up from a few seconds to 20-30 seconds, remembering to breathe throughout.
And finally, you could try some of these more advanced variations in level 5
Level 5 – Planks with movement – forearm and long arm
Hold either a long arm or forearm plank and add some movements such as toe lifts, knee drops or arm taps, or simply hold it for longer.
So there you go. There are literally LOADS of variations and modifications to a plank and so much nuance and subtlety to the movements.
Try them out and see how you feel. Remember to work through the levels, breathe, never hold your breath and feel your way into a movement gradually.
Always watch out for bulging or pulling around the stoma or any wounds and a feeling of pressure. If so, back it off and try a lower level option.
In time you may be able to build up to longer holds and more challenging movements, but PLEASE treat the plank and your stoma with the respect they deserve.
I’d estimate that it took me around 2-3 years to build up to doing a 30 second hold forearm plank.
If it doesn’t feel good to you (and be honest with yourself), then there are millions of other core exercises that will strengthen your abdominals in the right way. Play with it gently and tune into your muscles and how you feel. Join a class at The Ostomy Studio to find out more.
You can book a 1:1 appointment with stoma rehab expert Sarah Russell to learn more about plank techniques and modifications, or join an online class at www.theostomystudio.co.uk