Caroline Bragg, Head PT for &Breathe explains how mums can tackle the post-pregnancy ab separation known as Diastasis Recti
Diastasis Recti is quite a mouthful, and is commonly referred to as DR. A dome shape around your belly is a clear sign of it and it happens as your vertical 'six-pack' abs (the rectus abdominus) weakens during pregnancy, as the baby grows bigger. It is a natural occurrence, and is linked to how strong your abs, including the side tummy muscles (obliques), were before your pregnancy. It can also depend on how you carry the baby and how big it is.
Most women I see are unaware of DR and/or do not know what the implications are. There is a big grey area around the subject, which is sometimes made worse by also social media and a lot of un-qualified advice. First and foremost mums should know that DR is not a sign of you doing anything wrong. It's totally natural for most women to have some form of it after childbirth. All in all, it simply means that certain movements should be avoided to allow the body to recover and heal naturally.
How to test for DR, and when to ask for help.
A finger test from a GP, physiotherapist or your trained fitness professional is the best way of determining whether or not you have DR. Most women aren't offered it by their GP, or don't know to ask! A well-trained pre- and post-natal physical trainer can check for you, and a more in-depth test can also be carried out by a women’s health physiotherapist. It can be difficult to test yourself, unless you are experienced already, and your abs will be weakened post-pregnancy so it's tricky to flex and measure at the same time. So don't worry if you can't figure it - don't be afraid to reach out for help with this one!
When the rectus abdominus separates and the linea alba (the tendon between the RA muscles) stretches, there is a gap. It’s important that these muscles are not overworked before the gap has healed. If you don’t tackle, it a permanent bulge may occur, as your muscles can't adapt to the shape they had pre-pregnancy. The problems caused by DR go a lot deeper than this though. With a deep or large gap between your rectus abdominus, it is unsafe to return to high impact exercise (such as running or HIIT training) since your core is significantly weakened. Remember that all parts of our body work together and the core group of muscles are like a corset around your middle. Though your rectus abdominus might seem superficial, they play a big part in keeping you upright. Imagine a corset not being done up properly: if your RA aren't working properly, the rest of the core and pelvic floor can't function effectively.
As well as the width of gap, it is important to assess the depth or tension. The gap may be wider at certain parts of the belly and may not close completely, but as long as there is tension of the deep TVA muscles and the gap is shallow, working-out with a 1-2 finger gap is generally non-detrimental. Our bodies are like jigsaw puzzles, however - your diastasis may have completely healed, but you might still be experiencing leakage or lower back pain. That's when a women’s health specialist physiotherapist, like our own resident expert, Amanda Savage, can help make your life better.
What exercise can I do and what should I avoid?
If you have DR, it is best to avoid any exercises which involve forward flexion: sit ups and crunches, as well as things like sitting up in bed (roll to one side to get up instead). Bending to tie your shoe laces is also a no-no: elevate your foot on a step instead). These exercises build up your RA before the gap is closed, but won't allow the muscles to come back together. High impact exercise is also off-limits. You need to wait for your core and pelvic floor to strengthen, before launching into any high intensity workout. Remember that even if you had an emergency C section, you probably did a lot of pushing before the surgery. Taking the time to rehabilitate your core and pelvic floor will mean you will have a much better recovery overall, after which you can get back to your full exercise regime!
Diaphragmatic breathing is a key exercise to help recover from DR, as it works with your pelvic floor and inner core. Activating the pelvic floor correctly is also very important: check with your qualified PT, any &Breathe ambassador or your physio that you are doing it right, as most of us are not! Once you're nailing your PF exercises, integrate them naturally with everyday exercises like squats and lunges. Think of exercising as a way to make you fitter for life, as looking after a baby is physically demanding! There are plenty of postnatal exercise classes out there and your teacher should be giving you the correct exercises for your postnatal phase.
When can I return to training?
There's no textbook answer in terms of when you should return to exercise after DR. It completely depends on the person and everybody’s recovery is different. I certainly recommend working on your deeper core muscles first through gentle rehabilitation. Feeding your body with the right nutrients and antioxidants is also key to healing your body. Above all, be kind to yourself, you have just been through the challenge of childbirth.