I recently started teaching a prenatal yoga series for the YMCA. The class is small but is allowing me the opportunity to talk about the things I'm passionate about- prenatal and postpartum exercise, mama-ing, and supporting other women. Each week I pick a topic to discuss that is relevant to prenatal and postpartum exercise and blab for a few minutes at the beginning.
Last week our discussion topic was diastasis recti (DR). Since changing my focus to prenatal and postpartum fitness, I'm engulfed in all things fitness for this population and see at least one blog post about DR a week- it's a hot topic amongst my peers so, I was shocked when the mamas in my class had not heard about it.
At my six-week postpartum my OB did a regular check and said, "Well, you're good to go" but, was I? She did not assess me for DR nor did we discuss safety and what to look out for when I was exercising.
If you are familiar with Diastasis Recti you've likely found out about it because you're frustrated with your postpartum weight loss and perhaps a persistent pooch in the lower belly making you look like you're still pregnant. You could also be having pelvic pain or, could be leaking urine.
If this is the first time you're hearing this term, here are five things you should know:
1) What is Diastasis Recti (Abdominis)? DRA/DR
Diastasis Recti occurs when the Linea Alba, the connective tissue that connects and spreads tension through the rectus abdominis (the muscle responsible for the "six pack"), becomes stretched, thinned and weakened. The two sides of the rectus abdominis separate away from each other limiting the ability of the muscle to create force. DRA can cause improper functioning of the core and therefore the pelvic floor.
Although there is very little research on DRA, Boissonnault & Blaschak (1988) found that 66% of women have a DRA in the third trimester of pregnancy and that 53% of those women continued to have a DRA immediately postpartum. Additionally, at 5-7 weeks postpartum 36% remained abnormally wide. Coldron et al (2008) found that this distance decreased markedly without intervention from day 1 to 8 week postpartum. You can read more research related stuff here.
DR can occur with years of improper loading on the abdominal wall or, for our purposes, during pregnancy continuing into the postpartum period. More specifically, improper alignment, breathing and inappropriate exercise selection during and after pregnancy are contributing factors. In addition to a protruding belly, left untreated, DR can play into lower back and pelvic pain, incontinence, pelvic organ prolapse and hernias.
2) Poor posture affects Diastasis Recti
Posture during and after pregnancy is going to be a huge factor. Aim to keep your ribs over your hips so that your diaphragm which lives in your ribs is able to work with the rest of the core (pelvic floor, transverse abdominis, and multifidis), some of which lives in the hips . Additionally, avoid rounding through the shoulders, tucking the bum, or flaring the ribs all of which can throw off alignment and increase pressure on the abdominal wall.
3) Exercise selection can affect Diastasis Recti
But, it can be very individual. It used to be believed that any exercise that put excess load on the front of the body should be avoided later in pregnancy- planks, front squats, push-ups, and burpees are all examples. Additionally, curl-up and rotational exercises like crunchies, leg lifts and bicycles can increase the pulling force on the rectus abdominis causing greater stretching of the linea alba. However, some women can perform these exercises with little issue. A good rule of thumb is to look for dome-ing, coning, or the midline of the stomach to create a loafing effect.
4) You can test yourself for DR
Step 1: Lay on your back with your knees bent, head and shoulders on the ground looking up towards the sky.
Step 2: Take the first two fingers of one hand and place them directly above your belly button.
Step 3: On an exhale, slightly pack your chin (give yourself a double chin) and lift your head. If you have diastasis recti you will feel a gap the width of those two fingers or larger.
Step 4: Check the fascial tension- repeat step 3 but this time, perform a gentle pelvic floor contraction. Notice if the tissue feels taut like the tip of your nose or if it feels somewhat soft like your earlobe. It should feel taut.
Step 5: Continue to test at the belly button and just below.
If you feel a gap two finger widths or more or, you feel softness (consistent with that of your earlobe) ask your physician for a referral to a pelvic floor physical therapist (physiotherapist). Or, seek a prenatal/postpartum exercise specialist for help.
5) DR is not (just) about the Rectus Abdominis
Well, not completely. It used to be that the primary method to treat DR was to simply bring those muscle bellies back to the midline and close the gap. But, more recently, the focus is on the ability to generate tension in the linea alba. Step 4 in the above DR assessment is testing that tension. One of the primary ways to increase that tension is to learn to engage the transverse abdominis and pelvic floor like we learned here.
As always, let me know if I can help you in any way. You can email me her.