Your Core During and After Pregnancy: Abdominal Separation, Diastasis Recti, & Exercise
As I've said before, our bodies are truly amazing things. Not only do we actually grow humans, but we transform and adapt to accommodate the growing baby over an almost 10 month period. As you can imagine, there's a lot of stretching and shifting that goes on as our little babes continue to develop, including the natural separation of our abdominals to accommodate this rapid growth.
As we learned last week from our discussion about the core and pelvic floor, we know that restoration and restrengthening is of course imperative post birth. During this discussion, we'll first define Diastasis Recti, learn how to assess it, go over certain exercises to avoid during and after pregnancy, and then talk about a few safe core strengthening exercises that I believe to be some of the most beneficial for both during and after pregnancy.
What is Diastasis Recti?
Diastasis Recti Abdominis or DRA simply refers to the separation that often occurs in the rectus abdominis during pregnancy as your belly grows. Our rectus abdominis is made up of two sides: the left and right. These two sides are held together by connective tissue called the Linea Alba which begins at about your sternum and tracks all the way down to your pubic bone. This tissue is what stretches to accommodate your growing uterus.
A good visual (besides the one above) is to imagine filling a woven basket or bag with your groceries. It will bend and stretch to accommodate all of your items without breaking. The fibers of the bag will stretch and misshape a bit, but your groceries are safely stored.
For a lot of women, this separation will mostly heal by the 6-8 week postpartum range. However, studies are finding that a large number of women do in fact still have a significant "gap" later on postpartum. In a study published just this year from the British Journal of Sports Medicine where 300 first time mothers were followed from pregnancy to 12 months postpartum, their findings showed that at 6 weeks postpartum, DRA was assessed in 60% of their participants. At 12 months postpartum, 32.6% of the same participants still had abdominal separation . But what does that truly mean? In other recent studies and conversations in the women's health community, physical therapists suggest that although abdominals may not return completely as they were prior to pregnancy, the true indicator of DRA can be better measured by assessing not only the separation, but also the density and restoration of the linea alba after pregnancy. (We'll go into more detail during assessment)
Signs or Symptoms That May Indicate an Unhealed Diastasis Recti:
1. Low back pain
2. Pelvic Floor Dysfunction (Remember, the core and floor are work side by side).
4. Separation somewhere down the midline of more than 2 finger widths in conjunction with softness or lack of tension of the linea alba. (Most noticeable near the belly button.)
5. A constant and noticeable bloated look of the abdomen
How to Check for Diastasis Recti:
First and foremost, as I have recommended in previous articles, if you have any uncertainty about your recovery postpartum, I highly recommend seeing your local Pelvic Floor Physical Therapist for a full assessment and at the very least, peace of mind. With that being said, there are ways for you to assess your abdomen for DRA on your own. I'd recommend giving your body a bit of time to adjust post-birth, so I'd say wait till you are about 2-3 weeks postpartum. The steps for self-assessment are as follows:
1. Lie on your back with your knees bent and pull up your shirt so your stomach is visible.
2. Walk your fingers down the midline of your stomach. Starting just under your sternum, move slowly down to your pubic bone. How does it feel? When you press down, do you feel tension in the linea alba? Are some spots noticeably softer than others? Do you notice any places where your fingers seem to sink in farther than others?
3. Using your index, middle, and ring finger on one hand, press straight down into your stomach just above your belly button. Tuck your chin and lift only your head off of the floor-- you are not doing a crunch during this assessment. Only your head should come up, leaving your shoulders still on the floor. (Be sure to record your results, i.e. one finger width, two, three, etc.) You can repeat this a few times just to familiarize with the process and feel. Remember, no crunching!
4. Move your fingers up a bit more above your belly button and perform the assessment.
5. Perform another assessment just below your belly button.
6. Finally, perform the assessment at all three measurement sites again, only this time as you lift your chin, exhale your breath and perform a small kegel. Take note of your assessments.
To measure your healing process and progress, I recommend re-assessing every 2-3 weeks. Be mindful of any signs or symptoms you're feeling and be sure to write it down. Visiting with a women's health PT is highly recommended if you're experiencing any of the afore mentioned symptoms.
Here's a great video from Pre and Postnatal Specialist and fellow fit mama Jessie Mundell on how to check for DRA.
Can Diastasis Recti Be Healed?
Absolutely, but remember, it's not all about the gap. Many WHPT's are now suggesting that the degree of separation doesn't fully explain whether your your diastasis is fully healed or not. It's the tension that you feel when pressing down on your midline or linea alba that can give you a much better indication. We want to know more about how that connective tissue is responding. For example, if you still have a separation of 2 finger widths but when assessed, your connective tissue feels dense and doesn't allow your fingers to push too far down into your abdomen, this most commonly reflects that you have in fact healed your diastasis. If during assessment your midline still feels soft and you can still press pretty far down into your belly even during your pelvic floor cue, it is more likely that there is still work to be done. In very severe cases, surgery may be recommended. However, there's a lot the can be worked on prior to that conclusion.
If your own assessment more closely reflects a softer midline with noticeable gap, please don't worry! Working with a physical therapist and experienced fitness professional that focus on proper & restorative core and pelvic floor exercises first will help you heal your core and regain your strength postpartum.
Exercises to Avoid During Pregnancy and Early Postpartum (or with DRA):
1. Exercises that require a constant downward facing position such as planks, pushups, etc.
2. Exercises that push the belly outward in a bulging manner such as crunches, sit-ups, double leg lifts etc.
3. Exercises that stretch the abdominals such as some poses in yoga like up dog.
4. Heavy lifting (Ok let's be real, we start carrying a baby in a carseat almost at day one. So here's where that special breathing we focused on last time becomes super important. Click the link if you missed it.)
5. Running (I'm not saying you can never run again! I'm just suggesting you find a lower impact cardio method to focus on until your floor and core have had a chance to be healed and restrengthened.)
Safe Core Strengthening Exercises for Pregnancy and Postpartum (DRA safe)
Start with 2-3 sets of 5-10 reps of each exercise and rest when needed.
Remember to use the Core and Pelvic Floor Connection Breathing we learned about last week during the exertion point of each exercise. (Click the link to review.) Also, be sure to watch your alignment. Untuck your tailbone, stack your ribs over your hips, do not let them thrust outward, and lift your head slightly.
Here's a quick video on how to cue your Core and Pelvic Floor Connection Breathing during an exercise like the squat:
Stay strong mamas!
As always, be sure to consult your doctor and or physical therapist before starting any new exercise program. This article does not in any way take the place of the guidance of a qualified health professional.
1. Jorun Bakken Sperstad1, Merete Kolberg Tennfjord1,2, Gunvor Hilde2, Marie Ellström-Engh2,3, Kari Bø1. "Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain." British Journal of Sports Medicine (2016).
Up next: Running During and After Pregnancy
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