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FITNESS

Diastasis Recti during Pregnancy


Diastasis recti is a very common condition that commonly occurs during pregnancy and can extend into the post-partum period and affect women and men in varying stages of life. There has been a recent upswing in research regarding the prevalence, risk factors and best treatment practice for DR. DR has a significant impact on the structural integrity of the abdominal wall and can lead to issues with back/pelvic pain, poor posture, incontinence, pain with intercourse and an overall decrease in satisfaction with body image. Specific abdominal exercises, regardless of whether they are started before, during or after pregnancy have been shown to decrease the risk, severity and improve the overall reduction of DR. You can successfully retrain your abdominal muscles, address posture and prevent/correct compensatory strategies with our pregnancy programs modified for diastasis recti.

Diastasis Recti Do’s & Don’ts during Pregnancy

Diastasis Recti, an ab separation, occurs in 33-60% of pregnant women.[1][2] Some research indicates almost all women will experience diastasis recti by the end of pregnancy. You are more prone to this abdominal gap if you have a weaker abdominal wall, if you are carrying a large baby, if you are carrying more than one baby, if you have a narrow pelvis, if you have more than one child and had them close together, or if you’re over 35 when you get pregnant. After that long list of predisposing factors, you can see why 33-60% of mamas have diastasis recti during the second half of pregnancy.  That said our bodies are made to bear children and are also resilient in getting back to their prior self.

This abdominal separation occurs when the tissue between the right and left recti is distanced more than 2 finger widths. You can’t change the pressure on your abdominal wall – you’re pregnant! But there are a few things you can change: posture, functional moving in daily activity, strength in the transverse abdominis and pelvic floor and stopping exercises that can make it worse.

Generally, women don’t have this ab separation during the first trimester, but if you experience any discomfort in this area, you may want to modify your core exercises. If you have had diastasis recti with previous pregnancies you may or may not have it with this pregnancy.

Lisa, mom of 3, healed her diastasis after her second pregnancy and was able to go through her third pregnancy without the diastasis reoccurring.  You can read more about her story here.

HOW DO I EXERCISE WITH DIASTASIS?

We have a comprehensive pregnancy workout series, completely safe for diastasis recti!

Tip #1 Correct your posture

There are a number of exercises you can do to strengthen your core. But because we spend so much time sitting, standing, walking, etc. it’s key that you train your TA to activate throughout the day.

As you move daily – in exercise and in daily activity – you will want to work “functionally” with your diastasis recti. Anytime you bend, lift, twist, etc. think about tightening your TA. This will reduce the strain on the linea alba where the separation occurs. It will also reduce pelvic pain and back pain! When rising from bed or the floor, roll over and do a side sit up (instead of sitting up straining the belly muscles). Think about making a few postural adjustments and activating the transverse abdominis every time you pick up your toddler or car seat.

It sounds simple, but years of habit can take a bit to correct.  In fact some studies show it takes thousands of repetitions to correct bad habits.

From a standing position, stack your rib cage over your pelvis and keep your pelvis stacked neutrally over your feet.  Or as I like to call it “close your ribs”. Don’t stand with a swayback and open rib cage. This exacerbates the issue. The smallest of changes – closing the ribs and stacking the pelvis over the feet – takes pressure off the linea alba (where the recti separation occurs).  And to be honest…it’s the 23.5 hours of care that occurs outside of your workout that count the most!

Tip #2 Activate the Transverse Abdominis & Pelvic Floor

You will want to start training the pelvic floor and transverse abdominis – these muscles act as a sling to support the baby and are extremely important both during pregnancy and after pregnancy. It will also help in getting a flat stomach after the baby is born.

The first exercise is the Transverse Abdominis (TA) breath –Abdominal muscles help move the diaphragm and give you more power to empty your lungs. So why is this helpful in women with diastasis recti? Think of your mid-section, or your core, as everything but your limbs. It’s a powerhouse that needs to work in harmony for healthy and resilient muscles.

Note: When you first learn the TA breathing technique, it might be easier to make the connection lying down. Then move to a seated position or standing position. If you have diastasis recti – and don’t necessarily have all the posture pointers mastered from above, try it from the lying position. It is best not to be in the lying (or supine in anatomical terms) position for too long as the pressure of the baby restricts blood return.

It sounds simple, but it is hard to train our brain this way. So practice, practice, practice, and we will do it again after your baby is born.

Tip #3 Stretching and strengthening

It kind of goes without saying, but if we take care of our body it will more than likely take care of us. Daily exercise is essential. And that doesn’t mean a solid 40 minute exercise routine everyday, it can mean moving 20 minutes a day. In your first trimester I know you are green to the gills. In your second trimester you feel like superwoman. And in your third trimester all those aches and pains can kick in.

As you move daily – in exercise and in daily activity – you will want to work “functionally” with your diastasis recti. Usually this means you need to see a physical therapist or physiotherapist for some 1-1 attention. In addition, making a few postural adjustments, activating the transverse abdominis and doing functional exercises that don’t make your diastasis recti worse are LARGELY beneficial. Healthy (from toning) and supple (from stretching) muscles will treat you well!

While including overall strength and stretch exercises, there are some modifications to your overall exercise routine, like not doing planks.  We cover this full list of don’ts in Tip #5.

I recommend using a comprehensive workout that does not load the abs – like our pregnancy workouts. Anytime your abdominal wall is “loaded” i.e. putting extra pressure on the tissues by doing pushups or planks, you can worsen your diastasis recti. We still do pushups, but in a functional way so as not to load the abs.  You can read more about the Don’ts during Pregnancy Exercise below.

 

Tip #4 Exercises you should avoid

There is no universal list of don’ts in the diastasis recti world. But because it is usually the the intra-abdominal pressure that causes the recti muscles to have a bigger gap between them, our direction is to stay away from applying extra intra-abdominal pressure.

In addition to abdominal exercises for diastasis recti, you should also include overall strength and stretch exercises. That said, there are some modifications to your overall exercise routine.  So we will cover a general list, as well as a program modified for diastasis recti.

In the postnatal period this list is different – you will want to read up on postnatal diastasis recti.

You should refrain from twisting and spinal flexion (crunches). We also recommend you don’t do planks, push ups,  and most traditional abdominal exercises.  These are very general recommendations.  If you have the body awareness and know how of activating your transverse abdominis you can perform these exercises (although the most benefit will be seen after the intra-abdominal pressure – your baby – is out!)

safe-exercises-diastasis-recti-pregnancy

 

[2] https://bjsm.bmj.com/content/early/2016/06/20/bjsports-2016-096065.full

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