25 Apr Diastasis What??!!
By: Katie Hauck
“It’s been a year, why do I still look 6 months pregnant? Why does my belly look like a scene from an Alien movie every time I do a crunch?” As one of the pelvic health physiotherapists at Vital Physiotherapy, these are two of the top inquiries that plague many women following pregnancy. Diastasis recti, commonly known as “abdominal separation” or “mommy tummy”, is a current hot topic. There is no limit to the online advice that a quick Google search will reveal on the ‘should’ and ‘should not’s’ for exercising with abdominal separation. Often the advice conflicts, which can be confusing. Where and how do you start?
Diastasis recti is defined as the separation of the two rectus abdominis, or 6 pack muscles, that is a naturally occurring change during pregnancy to accommodate a growing baby. Nearly every woman at some point in her pregnancy will experience some degree of separation. This is normal and (other good news) spontaneous, natural recovery in the first 8 weeks postpartum is also normal.
A common method used to determine if you have diastasis is the curl up test. Lying on your back with knees bent, use 2 to 3 fingers and feel along the midline of your abdomen above and below the belly button. While applying pressure slowly lift your head as if starting a crunch. Feel for the ridges of the muscles to hug your fingers on either side and measure the distance of the gap. Traditionally the focus was always on the size of the separation, or gap, issue. Yet, some separation between the abdominals is normal. Even in women that have never been pregnant, a separation of up to 35mm can be seen somewhere along the midline. With a wide variety of distances being normal, other factors are being weighed more heavily in recent research. The ability to efficiently transfer load or create tension across the linea alba, the connective tissue joining the abdominals, is now the emerging trend. When performing the curl up test, you are looking for the tissue to have a springy versus mushy feel- kind of like pushing down into a trampoline where you would get some resistance as you push downward.
The next most common question after understanding how to diagnose a diastasis is ‘What exercises are safe?’ and ‘I was told to avoid abdominal exercises. Is this true?’ To answer this, let’s talk about the anatomy of our inner core. It is made up of the core 4 muscles- diaphragm (main breathing muscle), multifidus (a deep back muscle), transversus abdominis (the body’s equivalent to a corset), and the pelvic floor muscles. When we put these muscle groups together they form a barrel that holds pressure. Just like a fancy Instant Pot, that pressure is looking for an escape valve. Certain exercises or movements challenge the system and lead to higher pressures. Crunches often get the worst reputation for increasing that pressure. The truth is, there are many positions that cause an increase in your intra abdominal pressure and since we are all very different, there is no one size fits all approach in terms of which positions are good or bad. It is best to get this assessed by a pelvic health therapist or other health care professional with perinatal training so that you know how to safely move and return to exercise.
Traditional advice has been to avoid exercises, like the crunch, that lead to bulging or doming of the midline of the abdomen from that escaping pressure. If you were a runner following up with a physiotherapist for an ankle sprain, the typical advice would likely be to rest a couple days when the tissues are inflamed to allow for healing and maybe a brace for some extra support. Would a simple sprain be the end of your running career? In most cases, likely no. Your physiotherapist would then help support you as you begin to challenge those tissues again with strengthening and balance exercises, progressing to a light jog and eventually running once more. What does this mean for muscles in our core? Just like an ankle sprain, the muscles of our core face challenges from pregnancy and delivery that, with the guidance of your physiotherapist, can once again be trained and learn to adapt to load placed on them. Some tips to get started include breathing during an effortful task such as lifting your child, getting in and out of bed or performing a plank. This recruits the diaphragm muscle of the core 4 to assist in pressure control. Additionally, avoiding constipation and straining on the toilet can ensure there is no excessive additional pressure.
Before limiting yourself, let’s chat on how we can help your body find a better strategy to manage pressure and strengthen your core! Together we can create a generation of strong, powerhouse women!