Abdominal Separation FAQs: Part II

I’m often asked about diastasis recti (the medical name for abdominal separation) by both pre and postnatal clients and do believe that education is key when it comes to both minimizing and rehabilitating this condition. If you haven’t yet read Part I, you can find it here!

Let’s get started with a bit of research:

Boissonnault & Blaschak (1988) found that 27% of women have a DRA in the second trimester and 66% in the third trimester of pregnancy. 53% of these women continued to have a DRA immediately postpartum and 36% remained abnormally wide at 5-7 weeks postpartum. Coldron et al (2008) measured the inter-recti distance from 1 day to 1 year postpartum and note that the distance decreased markedly from day 1 to 8 weeks, and that without any intervention (e.g. exercise training or other physiotherapy) there was no further closure at the end of the first year. – See more at: http://dianelee.ca/article-diastasis-rectus-abdominis.php#sthash.DaiXewou.dpuf

We can glean a few things from the research above.  What stands out to me is three-fold:  1) most of us are affected by DRA at some point in pregnancy, 2) the body does “some amount” of healing on it’s own in the initial stages postpartum without any additional intervention and 3) the body benefits from (and needs) our help (ie: exercise training and physical therapy) as there is a limit to the healing that naturally occurs.

With this in mind, how will you set yourself up for optimal healing in the postpartum phase? 

“You cannot serve from an empty vessel.” (Elanor Brownn)  and similarly, you cannot be optimally fit, strong, well and functional with a weak core.  

This will take planning, commitment and investment, but you are worth it. I will be by your side as long as you show up ready!  

I’m in the process of developing a “Return to Fitness” Program and can’t wait to share the details.  

And, now back to the FAQs about abdominal separation, which I’m happy to answer:

Will the gap get worse if I have more children?
Well, this all depends, but it comes back to basics.  How are you breathing?  Are you aligned and finding neutral posture throughout daily life?  Are you minimizing intra-abdominal pressure throughout activities of daily living and with effortful work?  

If your alignment is way off, you have a lot of poor postural traits and other suboptimal habits then it’s possible that the more pregnancies you have, the wider the gap in your abdominals will remain. If your diastasis recti wasn’t tested (and rehabilitated) after your first baby, then after subsequent pregnancies, you’re more likely to have a slightly wider gap each time you get pregnant.

Are there things I can do to avoid it getting worse?

Yes, definitely!  Here’s a list to get you started:

  • Avoid forward-flexion movements ie: when getting out of bed.  Don’t sit up from lying, move to the side with your legs narrow and push yourself out of bed from the side with a log-rolling action and supporting from your upper body while bracing with your core and breath.  
  • Moving from a seated to a back-lying position by rolling backwards, also puts direct pressure on the very muscles which have been affected. So instead, approach things from the side to avoid putting stress on the six-pack muscles.
  • Heavy lifting

  • Straining without and support

  • Torso rotations

  • Movements that stretch or strain the abdominal wall, obliques, transverse abs (cat cow, up dog, side bends, back bends, front plank, prone positioning, bicycles, double leg extensions)

  • Avoid movements and actions that increase intra-abdominal pressure, ie: bearing down or valsalva maneuver.

  • Avoid anything that makes belly bulge

  • Avoid forward leaning, hands and knees, bending from hips

  • Avoid traditional abdominal exercises

  • Avoid effortful belly breathing on the inhale and focus on breathing in through the ribcage laterally instead

Gosh, that sounds like a lot!  But, there’s plenty you can do still!  If you have questions, please ask.  I have lots of modifications and ways to help you gain strength in your core despite DRA.

How do I know if my abdominals have healed?
There’s a simple test you can perform on yourself called the ‘Rec Check’. If you don’t feel comfortable doing this yourself, or ask a medical professional to do this, or ask me next time you’re in class.  The test involves placing your fingers above and then below your belly button while doing a small sit-up.  If you can feel any bulging or separation between your fingers above and/or below your belly button, then chances are, you have an abdominal separation.  

In postpartum training, I will perform serial measurements throughout our training sessions at regular intervals to assess your progress and plan your program accordingly.  

Should I ask my provider to check for this?
Most definitely, yes. When you have your six-week or ten-week check-up with your provider, it’s important to go to this appointment armed with a series of questions, one of which is “Can you test my abdominals for me?”.

How long can it take to re-align?
It can take several months for abdominals to re-align. Sometimes, the separation can remain for years after birth, unknowingly. If you’ve been referred on to a Women’s Health Physiotherapist, or you’re performing a postnatal-specific program from someone like myself who’s Pre/Postnatal-trained, then you may see results within a few months, if you continue to perform the exercises on a daily basis.

Remember the research from above?  Most of the time, our bodies need a bit of support in this healing process!  You have the resources at your disposal (myself, local Women’s Health PTs abound), so just reach out for help!

If you’d like me to test your abdominal separation for you, just ask me next time in class. I’m more than happy to do so to help ease your mind.  The test itself takes less than 30 second to perform and is not invasive at all, as I can perform over your shirt.  

I hope this information has been helpful!  I’m here for you, so if you have questions, please just let me know.  I’m looking forward to supporting you postpartum as you “Return to Fitness” and can’t wait to share the details of my postpartum program when it’s ready!   In the meantime, One-on-One training is your best option for an individualized routine to fit your needs.  Book your initial consult today–Postpartum Recovery is the place to start!

Sources:

Claire Mockridge

http://dianelee.ca/article-diastasis-rectus-abdominis.php#sthash.DaiXewou.dpuf

Isa Hererra, Ending Pain in Pregnancy

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