Abdominal Muscle Separation Postpartum

Apr 16 2014     /     , , , , ,

Do You Have Diastasis Recti (You May Not Realize That You Do)? Most Traditional Core Exercises Can Do You Harm

Written by Ashley

This post is for all you mommy’s out there, and particularly the ones that might suffer from diastasis recti, or a vertical gap between your ab muscles. You see, I developed diastasis recti during my second pregnancy and I never really knew that it was there. Now that I know it’s there, I think it’s very obvious – but I think I just tried to avoid looking at my post-baby stomach for so long that I missed seeing it. About a year ago, however, it was brought to my attention by my doctor. She didn’t tell me what to do about it, but just said that it was very common and asked if it bothered me. Clearly it didn’t if I didn’t know it was there.

Let me back up and explain the condition first (taken from this website). Diastasis Recti, also referred to as Divarication of the Recti or Rectus Distension, is the separation of the Rectus Abdominis (or 6 pack) abdominal muscle from the Linea Alba (mid-line connective tissue) at the front of the abdomen. It doesn’t always return to its natural position after childbirth and can cause a pooching or doming of your stomach, sometimes making you appear still a few months pregnant. As well as the aesthetic concerns, diastasis recti is associated with a weak core (& pelvic floor), leading to a lack of strength & stability in the entire pelvic region & midsection. Untreated diastasis recti increases the likelihood of developing pelvic organ prolapse, incontinence, and low back pain. Over 1/3 of women will have a gap of two fingers or more after their first baby. After second or subsequent pregnancies, this figure is more like 2/3, especially if the gap wasn’t closed effectively after the first.

I’ve always blamed my little extra pooch I have on extra skin that just won’t go away after my second pregnancy. Turns out, however, that it is the diastasis recti that is causing the pooch. So, I did what I thought I should do: a lot of core work. But the problem hasn’t been getting better – in fact, I feel like it’s been getting worse. So naturally, I upped the core and ab work. And the pooch just wouldn’t budge.

And then…I had an epiphany. I finally did some research online, then talked to my dear friend who is a women’s health physical therapist who actually helps people fix their diastasis recti for a living. I’m actually feeling very stupid that I didn’t talk to her sooner, before I got hard core into the core work. Because it turns out that the exercises I’ve been doing have actually made the gap worse, not better. There are certain core exercises that will make this condition worse, which now explains why my pooch has gotten worse!

So I finally talked to my physical therapist friend and got a list of which core exercises I should do to help close the gap and hopefully ditch the pooch and which exercises to avoid because they make the gap wider. And it turns out most of the ones I’ve been doing are on the “bad” list. So in an attempt to help all you other mommies out there who suffer from this as well, I wanted to share the information so that we can all get our pre-baby stomachs back!

Movements to Avoid:

  • Crunches
  • Sit-ups
  • Backbending
  • Oblique twists
  • Planks
  • Curl-ups
  • Lying backwards over an exercise ball
  • Exercising on your back and knees
  • Carrying or lifting heavy objects
  • Deep belly breathing
  • Any activity that stretches or overly expands the abdominal wall
  • In general it is best to avoid anything that “jack-knifes” the body, by pivoting at the hip and placing strain on the abdominals. Examples of these movements are straight leg lifts or holds while lying on your back and similar Pilates or Yoga moves.

If you are like me, you look at this list and say. “s*#t, these are all of the core exercises I’ve been doing! Especially planks!” Personally, I love doing planks. But I guess that’s going to have to change, to these…

Exercises to Help Fix Diastasis Recti:

Learning to properly activate the transverse abdominis is key in diastasis rehab and is much more subtle than a rectus abdominis contraction. Feeling the lower abdomen just inside the front hip points, make a “shhhhhhh” sound and feel the muscles flatten under your fingers. Trans Abs work in synergy with the pelvic floor muscles and can be strengthened together. Activate both Trans Abs and PFM (kegel) and perform a diaphragmatic breath without allowing expansion of lower abdomen or pelvic floor.

Heel Slide with Belly Scoop

Begin by lying on your back with your palms facedown on the floor. Bend your legs to place your feet flat on the ground. Scoop the belly to perform a pelvic tilt. The pelvis should curve the body into a “C” shape. Slowly slide the right leg out to straighten it, stopping just before the leg becomes completely straight. Slowly bring the leg back in toward your starting position. Lower the pelvis to your starting position, rest and then repeat for five to eight repetitions moving the right leg. Rest and then switch sides to straighten the left leg instead. Repeat for an additional set.

Modified Crunch with Towel

Begin by wrapping a bath towel around you, with the ends of the towel held in your hands, hovering just over your belly button. Perform a modified crunch by activating your abdominal muscles to lift your head, neck and upper shoulders off the floor. Keep your head aligned with your body as much as possible—resist the urge to dip your chin toward your chest. Pull the ends of the towel closer to your belly button as you lift up—this helps to move your abdominal muscles back together. Repeat for a total of 10 times and then perform two additional sets.

Manual Reconditioning

Lie on your back with your feet flat on the floor. Put your hands on your stomach, fingers pointing away from your head. Contract the abdominal muscles to perform an abdominal crunch that slightly lifts the shoulders off the ground. As you crunch up, push the abdominal muscles in and down—manipulating them to where you would want them to return. Slowly lower your head to return to your starting position. Repeat eight to 10 times and work your way up to completing three sets.

Pull-Ins

Lie face up on the floor with your head resting on a pillow and your knees bent with feet flat on the floor. Place your hands on your stomach on either side of your naval to support your abdomen. Take a deep breath in and, as you exhale, gently pull your belly button toward your spine to encourage the gap to close. Hold this position for 10 seconds then slowly relax. Repeat the exercise 10 to 20 times.

Leg Slide

Lie face up with your head resting on a pillow, knees bent and feet flat on the floor. With your pelvis in a neutral position and your lower back just slightly off the floor, pull your belly button into your spine and slowly slide your right foot out along the floor until your leg is straight. Pull your foot back toward your body and repeat the slide with your left leg. Perform 10 to 20 leg slides. Once you are able to easily do 20 leg slides, perform the exercise by keeping your sliding foot lifted 2 to 3 inches off the floor rather than sliding it along the floor.

Single-Leg Floor Touch

Lie on your back with your head on a pillow, knees bent and feet flat on the floor. Keeping your right leg bent, lift your right foot off the floor so that your thigh is perpendicular to the floor. Lift your left leg up to meet your right leg. Pull your belly button into your spine and contract your abdominal muscles . Keeping both knees bent and your right leg still, slowly lower your left leg until your foot touches the floor. Lift your leg back to the starting position. Repeat the floor touch with your right foot. Complete 10 to 20 repetitions with each leg. Once you are able to easily do 20 reps, perform the floor touch with both legs at the same time.

Splinting

Finally, splinting can be helpful, especially in more severe cases of diastasis. My physical therapist friend recommends the Better Binder Post-partum Support. There is also the Tupler Technique, which comes as a package (DVD, book, and splint) to guide you through the exercises. My physical therapist friend did this program herself and I think it’s the one I’m going to try. I need help and support and I think the guided exercises on a DVD will be good for me

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