WHAT IS DIASTASIS RECTI?
I have been teaching pilates and providing personal training coaching to post natal women in Singapore since 2013 and is seems there is still little information provided by doctors to pregnant women about diastasis recti, what it is and what to do and not to do if you have it.
Diastasis recti is common among pregnant women and the chances of having diastasis recti can increase with each pregnancy. However, not every woman is aware that the post baby ‘pooch’ she is carrying or the weakness and abdominal bulging she experiences in certain positions is in fact diastatsis recti. Sadly, women often mistake this ‘pooch’ as a need to lose weight and can unwittingly embark on a course of vigorous cardio exercise and strength training that may in fact make the condition worse.
'Diastasis' means separation and ‘recti’ refers to the rectus abdominis muscles. These are part of the group of muscles making up the core. During pregnancy the right and left halves of the rectus abdominis muscles can spread apart at the body’s midline - the linea alba. This is caused by the widening and thinning of the mid line tissue due to the uterus expanding against the abdominal wall. It can happen towards the end of the pregnancy but is often more noticeable post birth when the abdominal wall is lax. Please be aware that when muscle separation occurs, the muscles have not 'split' and there is no tear in the muscle. The rectus abdominis muscles have simply moved further away from one another because the connective tissue has weakened (think of an elastic band being over stretched and losing its elasticity).
When I train clients during their pregnancy I encourage them to ask their doctor to check for diastasis recti at their six week postnatal check up. The sooner women receive the correct advice, the sooner they can assist the healing process.
Diastasis Recti can take different forms. The size of the gap can vary from mild separation to severe. The size of the gap can also vary at different points of the core, at the naval, and above and below the naval. This diagram below depicts some of the different scenarios. The size of the gap will affect what exercises you can and cannot perform and how long it will take to improve.
Diagram above: 1. Normal, 2. Open diastasis, 3. Diastasis below naval, 4. Diastasis above naval, 5. Fully open diastasis.
If you do have diastatis recti post birth the first thing I would say is do not panic or become disheartened and PLEASE do not compare yourself to other new mums who may not have any muscle separation. Over the years I have found there are no set of rules to predict which mums-to-be will or will not have this condition. Women who stay active during pregnancy are not guaranteed immunity to muscle separation, however, I do believe that looking after posture and performing the correct exercises during pregnancy leaves women in a better physical position and mental mindset to regain fitness post birth. Women who have not exercised during their pregnancy are less confident about resuming an exercise routine and can find the process more daunting.
Every body is different and so is every pregnancy and if you do find yourself faced with diastasis recti please get yourself the right team of people to help you (doctors, physio, personal trainer, or pilates teacher etc). You may hear doctors talks about surgery but I would recommend you explore all avenues before heading down this road. For some women the gap will close quickly and naturally but for others the gap may remain stubborn. Following an appropriately designed exercise regime and making adjustments to your day to day activities and posture can work wonders. It does of course take time and commitment but assisting your body in the healing process in this way will produce many long term benefits.
WHY SHOULD YOU BE AWARE OF THIS?
Ignored, diastasis recti can lead to other health issues. Back pain is a common complaint I see. Back pain occurs due to the increased pressure placed on the back muscles as they compensate for a core that is no longer able to function at full capacity.
Other symptons can include:
a stubborn ‘pooch’;
restricted range of movement;
increased risk of hernia;
and pelvic instability.
If your doctor did not examine you at your 6 week check up and you suspect you may have disastsis recti then see you doctor for confirmation. Your doctor may refer you to a physio or suggest you use a personal trainer or pilates teacher to assist you.
Exercise is deemed to be one of the best and least invasive methods of healing diastatsis recti. Some exercises will not be appropriate for women with muscle separation and depending on the size of the gap some exercises can in fact widen the gap. Always engage the help of an expert before trying anything new. Sit-ups, crunches, push ups, and front planks are examples of exercises to be avoided unless you are under the supervision of a qualified personal trainer or physio who is aware of the size of the gap and can advise you accordingly. Similarly swimming breaststroke and certain yoga poses including backbends, upward dog and double leg extensions can exasperate the condition if performed too soon and without expert guidance. Many women unknowingly prevent healing because, in addition to having a new baby to carry, they may also be lifting and carrying much heavier toddlers in a way which distorts their posture and applies a heavy force to the weakened core. A professional will be able to guide you on day to day adjustments you can make to your routine and not just exercises to perform during pilates classes or personal training sessions.
Bellybelts are sometimes prescribed by doctors and physios for women with wide abdominal separation and I often get questions on the benefit of these. These can certainly be useful and sometimes necessary and I would always advise you follow the recommendations of your doctor and physio. There are nonetheless arguments that unless you have a good grasp of how to engage and control your core muscles and your posture then the belt alone is unlikely to fix the situation fully. The view is that the belt may prevent some women from focusing on their muscles in the right way when they move because they become reliant on the support of the belt. Therefore, if you are advised to wear a belt I would recommend speaking to a physio or personal trainer to see if you need help engaging your muscles and breathing and standing correctly. This might help you get the best results from the belt.
WHAT SHOULD I DO ONCE THE SEPARATION IMPROVES?
Once you see improvement you should continue to build your core strength gradually and consistently, especially if you are planning another pregnancy at a later date. A strong core prior to conception can help you with the next pregnancy, labour and recovery post birth. A strong core will also help your health in general.
Donna O’Shea of Donna O'Shea Fitness, is an award winning fitness trainer and is based in Singapore. Donna provides personal training and pilates sessions and specialises in prenatal and postnatal exercise.