Diastasis Recti Abdominus. Such a buzz phrase these days in pregnancy and post-partum. It hovered around throughout pregnancy like a bad smell. Like it was something to be careful not to get, like a disease or an injury. I thought it was about time to look into the up to date information about this 'condition' and put down some of the common sense take-homes I've learnt. Because really I'd say there is a lot of fear-mongering around diastasis, or DRA, and it doesn't need to be like that.
What is a diastasis?
Diastasis originated from the latin word for separation. Essentially the abdominals separate to make way for your growing baby. They separate along a line of connective tissue called the linea alba. The abdominals don't split, they move apart, and the linea alba widens and becomes stretched somewhat, but it doesn't tear open. Sounds grim but it's really a very natural and painless thing the body does in order to accommodate a whole human inside of you. 100% of women in their late third trimester will have a diastasis. It's unavoidable, so there's nothing you can do to 'avoid' it.
(Picture courtesy of Baby Centre - thanks guys)
Many women will have a remaining diastasis after they've given birth and anything up to a 2cm gap is considered quite normal. Post-partum programmes that claim they can close the gap are more than likely capitalising on every mama's dream of the flat tummy and 'getting that pre-baby body back' but the fact is if there's still an untreated gap at 8 weeks post partum, you're more than likely looking at a long term diastasis - it's not that simple to close it. And you know what - there is not too much wrong with that at all. Except until there is. You see the gap isn't the issue. The problem arises when the gap, or the linea alba, or your pelvic floor underneath it all, isn't functioning properly.
There are women out there who have a long term 2cm diastasis and lift a 1RM snatch with perfect form and function, who are able to generate the right control and tension across the gap by recruiting and coordinating the correct pelvic floor muscles and everyone's happy. By doing this correctly, these women stand a chance of preserving the integrity of their midsection, spine and pelvis and defending themselves against pain and women's health problems. But more often than not there are women out there who have a long term 2cm diastasis that isn't functioning as it should. With a floppy gap at the front of your tummy where abdominals used to meet, one that suggests your pelvic floor and your deep muscle system aren't working properly and that doesn't tighten when you move, stand up, lift, twist, bend or carry, you're more prone to problems...problems of reduced trunk control and those knock-on issues associated with that. With a soft gap at the front of your tummy it's harder to generate, maintain and hold onto the decent intra-abdominal pressure needed to look after your fragile post-partum pelvic floor on cough, sneeze or jump. And moreover it's harder to strengthen that pelvic floor without the correct coordination, which can lead to all sorts of other complications including continence issues and pelvic organ prolapse. And therein is where the problem lies. Not with the gap itself, but in it's function.
The 'dreaded' coning or doming
You may have already heard about the term coning, or doming, as something to beware of during exercise whilst pregnant. Amongst more serious fitness fans coning can become quite the fearsome term. It's basically the linea alba under enough stress that the abdominal wall can't contain everything (your insides) so well. Pregnant or post-partum the same applies - if you see coning, don't panic, but this is your body's way of telling you you're maybe not controlling things so well, and to back off or change it up. Common movements that can cause coning include bracing and breath holding during lifts, poor posture/positioning during functional movements, pull ups or hanging from a pull up bar, and specific abdominal exercises such as sit ups, v-ups, toes to bar. Athletes who don't pay attention to this and repeatedly perform movements which cause coning on a regular basis run the risk of compromising the integrity of the linea alba more than needs be. This can lead to longer healing times, reduced control of the midsection and increased women's health complaints or complications post-partum.
Measuring your own diastasis
Firstly if you're pregnant, don't bother. You're bound to have one to a greater or lesser extent at some point during your pregnancy. If you're post-partum, I'll describe how to measure your own diastasis, but don't get too hung up on this. There isn't a magic number of centimeters that will tell you if you have a functional abdominal wall or not. And even if you can easily sit up from bed, get up from the floor, go on that run, squat five, ten, a hundred times in a row... unless you're able to recruit your deep muscle system correctly, your diastasis (and potentially continence or prolapse concerns) may just stick around. The only sure-fire way to know whether you have a problem with functionality is to get it checked by a women's health physio.
But anyway I digress... how to measure it. Lie flat on your back with your knees bent, your feet on the floor. Lift a hand towards your tummy and find the middle of your abs. Lift your head and move your chin towards your chest in a mini-crunch position, rolling only your upper body and shoulders off the floor. Push your fingers downwards fairly firmly. You may need to wriggle your fingers around a bit to get your bearings, you should feel your abs and then, potentially, a gap. If it's a big gap you may even be able to slide your finger/s from side to side between the gap.
Is the gap working?
How do I know if my gap is able to function properly? Well, you can't really, without specialist help but you can get an idea by yourself. Again, gently push your finger into the gap, now concentrate on doing a pelvic floor squeeze whilst at the same time tightening your tummy muscles - does the gap become less springy? Is there a decent amount of tension there? Or does it remain floppy? REMEMBER this just gives you an idea.
Ok so you've been to the physio, you have a 2cm gap that needs some work. What now? How do you close the gap? The most important thing that we know from current research is that your abs - your six-pack if you will - CANNOT close the gap. In fact, by using typically common abdominal patterns, the gap 'closes' during the task, and the linea alba, that fascia, goes saggy. So in this way, closing the gap before doing any of your homework, may actually be worse. Remember the gap itself isn't a muscle so you can't train it to close, but with some careful attention, the muscles to the side and underneath the gap can do a really good job at regaining control. And control basically means maintaining tension across the gap. So what can you do to improve the strength and coordination of these 'deep muscles' and increase the tension of the abdominal wall?
Another little tangent please take note...what I'm about to describe is generic advice. Some gaps may heal on their own, others may need a lot of work. Some women will be tighter or more dominant in some muscle groups over others. Some gaps are in the upper parts, some in the lower parts, each will have their own assortment of symptoms. I'm going to say it again that only a one-to-one consult with a physio will tell you this.
How to start healing
I've done my digging. It's with thanks to the incredible programmes and courses out there that I can give you all of this information: Girls Gone Strong, Anthony Lo, Diane Lee, Jenny Burrell, Brianna Battles, Mutu - I've immersed myself as much as I can with their advice. There's so much content, and much of it is brilliant, but if you want one take home it's that to 'heal' your diastasis - that is, to improve it's function, and potentially it's appearance in the longer term, you'll need to start with the basics: connecting and coordinating your deep muscle system.
This is MORE than just pelvic floor squeezes. Start by trying this lying down.
1. Breathe In
2. Fully relax your pelvic floor, feel your belly relax, your ribcage expand.
3. Breathe out
4. Gently squeeze your pelvic floor from your back passage, to your front passage
5. Continue the out breath and feel your abdominals coming together as if they're being tightened by a corset (this helps visualise how to engage your trans abs (TA).
6. Breathe in and repeat step 2 - being able to fully relax your pelvic floor is just as important as being able to switch it on.
Only use your breath and your muscles, don't brace, don't hold your breath and don't squeeze or clench your butt.
You'll need to train the brain how to do this, like a baby learning to walk. It takes an awful lot of practice and quite a decent amount of time (I'm talking months). It's likely to feel tedious and frustrating but be kind to yourself. You can teach your body how to do this, and if you can do this lying, you can then do it sitting, and you can then do it moving. Slowly you'll retrain you brain and your body in how to coordinate itself and eventually, you won't actually need to think about it anymore. Only when you are confident that you can maintain this control, of the deep pelvic floor muscles system and the trans abs, can you begin to start training with any more intensity.
How to progress
When you're at the stage of wanting to reintroduce functional movements, there are a few pointers I've learnt about from my own training:
💥 Select three dimensional patterns that take you out of the forward/backward (saggital plane). I love a good turkish get up, kettle bell round-the-worlds, wood chop and clock-lunges
💥 Work on unilateral singe leg work (three dimensional lunge patterns, split squats, single leg deadlift patterns)
💥 Choose single arm work (dumbell presses, unilateral pulls, offset carries)
💥 Pay attention to glute and deep core anti-rotation strengthening (bridges, pallof presses, pilates patterns, clamshells, banded walks, side planks)
💥 Never forget your posture - don't butt squeeze, clench or hyperextend at the top of movements
💥 Avoid your typical abdominal exercises (crunch, sit up, v-up, toes-to-bar) and high impact exercises (jumping, skipping, running) for longer than you'd like.
Only when you're absolutely (abs-olutely... sorry!) sure that your diastasis is working properly, should you reintroduce these last exercises. Remember, you'll be performing all these movements with the appropriate breathing and control techniques as highlighted earlier.
And lastly, enjoy it! You're rehabbing yourself after the most epic accomplishment. What an incredible achievement this is. You're starting to learn what your body needs, what feels a little wobbly, what needs more or less work. It's so empowering. Don't be too afraid to experiment and respond to what you learn about your body. And email or message me if you have any questions, I'm more than happy to try and help.
Oh, and go and see a women's health physio. Did I say that already...?
If you're still reading - I'm excited to say I'm working on something behind the scenes. There's been a fair bit of feedback suggesting some of you would be really interested in a post-partum program! Is it for you? Let me know so I can keep you updated 😊
Comments
Post a Comment