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Abdominal Separation

An Update from Fit 4 Two® Founder and Director, Melanie Osmack. June 2016.

I have been educating myself and others on diastasis recti since 2002. I go out of my way to read everything I can get my hands on, connect with researchers and pick the brains of women’s health physiotherapists. I head to the local medical library twice a year in search of new research.

I pass what I learn onto our franchisees and instructors not just so we can keep you safe, but so we can empower you with research-based information.  I take pride in the fact that Fit 4 Two® provides programs that are not just safe but also beneficial for women with diastasis recti.

In short, I am a self-professed diastasis recti nerd and I thought it was high time to share an update.

What is diastasis recti?
Diastasis Recti (DR), often called abdominal separation, occurs when there is an over stretching of the fascia, the linea alba, that runs vertically between the right and left rectus abdominis muscles. It is often defined as a gap of 3cm+ and can occur anywhere between your pubic bone and your xiphoid process. This overstretching also causes the linea alba to lose tension.

What causes diastasis recti?
Diastasis recti is more common than we once thought. Current research indicates that a majority of pregnant women develop DR. It is caused by a combination of pregnancy hormones dedicated to softening connective tissue and increased intra-abdominal pressure.

Abdominal separation usually develops in the 3rd trimester when the growing uterus puts the most strain on the abdominal wall.  Some women develop DR during the pushing stage of labour as well.  I have seen it emerge in the second trimester among Fit 4 Two® participants who are petite in stature, short waisted, carrying multiples, had DR in a previous pregnancy or who are blessed with a bountiful belly sooner than later.  DR is usually persistent postpartum so a post natal assessment is important.

Why does diastasis recti matter?
DR does not usually cause pain locally, but it often leads to back pain, pelvis pain, and pelvic floor dysfunction during and after pregnancy.  Postpartum, it may affect the aesthetic of how a tummy looks.  Some women with DR look ‘pregnant’ several months postpartum, have a belly button that looks like an extreme ‘outie’ or notice a severe coning shape when they do a curl up.  In some cases, if the diastasis is at the umbilicus, it can make women more susceptible to a hernia.  The good news is that it can usually be rehabilitated post partum. 

Though there is no research proving that we can cause an abdominal separation, there is some that indicates we could worsen one once we have it.  This is why we educate about DR at our Fit 4 Two® classes and either offer to assess for it or encourage moms-to-be and new moms to get assessed by their healthcare provider or a women’s health physiotherapist

How do I know if I have it?
While you can check for DR yourself, I recommend having your abdominal muscles assessed by a professional that has more experience.  This might be your healthcare provider, a women’s health physiotherapist or a certified pre and postnatal fitness specialist.

Typically, the person assessing you will ask you to lie on a mat on your back with your knees bent and feet flat on the floor.  If you are 16+ weeks pregnant, they will likely have you on an incline with your head above your heart so that you don’t get dizzy.  As you raise your shoulders off the mat, they will use their fingers to feel for both sides of your rectus abdominis and measure the gap in between.  Generally speaking, a gap of 3cm+ at the umbilicus (belly button) or 1cm+ above or below the umbilicus, is considered a diastasis. 

If you are being assessed postpartum, it will be more involved.  They will also want to assess the tension of your linea alba, how your gap change or doesn’t change when you engage your deep core muscles before and during the curl up and so on.  

If you are pregnant, and you DO NOT have DR
It is safe and beneficial to train your pelvic floor, transverses abdominals, erector spinae, rectus abdominals and obliques if you can do the exercise well, without pain, without breath holding and with good form.  Avoid exercises that cause your tummy to bulge or your back to sway.    If you aren’t sure about your form, ask a women’s health physiotherapist or a certified pre and postnatal fitness specialist to assess you while you do the exercise. 

If you are 16+ weeks pregnant, supine (lying on your back) exercises should be done on an incline (head higher than your lower body).  This is to avoid putting too much pressure on the vena cava which may cause dizziness.

As you enter into your third trimester, when developing DR is very common due the growing uterus putting strain on the abdominal wall, I recommend that you start exercising as though you have DR.  As mentioned, we do not have research to prove that we can cause it through movement patterns, but it seems like a logical choice to avoid putting excess strain on an abdominal wall that is already enduring a lot of pressure.  This is my current opinion and I look forward to seeing more research done in this area.

If you are carrying twins or multiples, I recommend that you begin exercising like you have DR by about 20 weeks of pregnancy.  You may have already developed an abdominal separation by then anyways, but I feel it would be wise to avoid putting excess strain your your abdominal wall sooner than later.

If you are pregnant and you have DR

1. Avoid abdominal exercises that put strain on the rectus abdominis like abdominal curls, v-sits and front planks. You'll want to avoid other less obvious exercises that engage the rectus abdominis like push-ups and cable pulley tricep press downs.  When in doubt, ask your physiotherapist or certified pre and postnatal fitness specialist for guidance.

2. Focus on pelvic floor and transverses abdominal exercises to prevent discomforts and prepare for postpartum recovery. Pelvic floor lifts (Kegels) and baby hugs are good choices.

3. Choose mindful movement strategies.  Ex. When getting up out of bed, roll over onto your side and use your upper body muscles to bring yourself to sitting.

4. If you are not already seeing a women’s health physiotherapist, I recommend booking an appointment. Through a full assessment, they might find that there are treatable muscular imbalances contributing to the diastasis and related discomforts. 

5. Register for a prenatal specific fitness program with instructors who are not just certified to teach fitness, but certified to work with pre AND postnatal women.  At Fit 4 Two® all our prenatal classes are designed to support women who have DR and other prenatal related conditions. 

If you are postpartum

Remember, even if you didn’t have DR in pregnancy, you may have developed it during the pushing stage of labour. 

While you can check for DR yourself, I recommend having your abdominal muscles assessed by a professional that has more experience.  This might be your healthcare provider, a women’s health physiotherapist or a certified pre and postnatal fitness specialist.

If you have an abdominal separation postpartum

1. Avoid abdominal exercises that put strain on the rectus abdominis like abdominal curls, v-sits and front planks. You will want to avoid other less obvious exercises that engage the rectus abdominals like push-ups and cable pulley tricep press downs.  When in doubt, ask your physiotherapist or certified pre and postnatal fitness specialist for guidance.

2. Focus on pelvic floor and transverses abdominal exercises.  If you are not sure where to start, seek out a Fit 4 Two® Tummies 4 Mommies program or book a one-on-one session with a women’s health physiotherapist or a certified pre and postnatal fitness specialist.

3. Don’t cave under the pressure to ‘bounce back after baby’.  It took 10 months for your body to grow an amazing human being.  Give yourself time to restore your core and mindfully ease back into fitness.  Do you want to set yourself back weeks or even months because you ignored your diastasis?  I think not. Show your amazing body some love.

4. Choose mindful movement strategies.  Ex. When getting up out of bed, roll over onto your side and use your upper body muscles to bring yourself to sitting.

5. If you are not already seeing a women’s health physiotherapist, I recommend booking an appointment. Through a full assessment, they might find that there are treatable muscular imbalances contributing to the diastasis and related discomforts.  Wouldn’t you rather find that out sooner than later?

6. When you are ready, seek out a postnatal specific fitness program with instructors who are not just certified to teach fitness, but certified to work with pre AND postnatal women.  At Fit 4 Two® we offer a postnatal core rehabilitation program called Tummies 4 Mommies® and all our multi-level postnatal fitness classes are designed to support women who are healing DR and other common perinatal conditions. 

But I read on the Internet....

I love the Internet.  It is an inspiring place where we can gather information and ideas.  It gives us a platform for communication anytime, anywhere.  It's one of my favourite things.  Unfortunately, there is no 'accuracy police' making sure that everything posted as fact is based on actual evidence.

If you read something on the Internet that contradicts any of the advice on this page, especially if it makes you feel nervous about choosing the benefits of an active pregnancy or postpartum, I hope you will contact me at melanie@fit4two.ca 

Sincerely,

Melanie Osmack
Founder and Director of Fit 4 Two®
 

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