Mind the (tummy) Gap!

CORE Function Part 1

What is Diastasis Recti (also known as abdominal separation)

Ok ladies, I am aware that there is still a massive lack of knowledge around diastasis recti – (ab separation) amongst postnatal women – even those who have much older babies and toddlers can be unaware they have the condition. So let’s have a look at what it is and clear up some facts about it…

“Diastasis” means separation. “Recti” refers to your ab muscles called the “rectus abdominis.” These two muscles run down the front of the abdominals and they are joined in the centre by the linea alba. During pregnancy, when the linea alba is softened, it is stretched by the increasing size of the baby and the abdomen. This causes the muscles to stretch and weaken as they lengthen. Eventually, the linea alba may split, and when this happens it is called diastasis. The split tends to start around the belly button area and then moves upwards or downwards depending on how the mum to be affected is carrying her baby.

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So basically, it’s a separation of the abdominal muscles, allowing your tummy to literally bulge out, making it difficult postnatally to lose the “mummy tummy”, or in many cases so you still look a little bit pregnant.  It is most common with women who have multiple pregnancies, carry multiples, have big babies and those over 35. And in fact two thirds of women who have two or more babies have it. Just to add in here that it’s not just pregnant and postnatal women who can suffer from DR –  newborn babies also can have this belly spread, though it should go away on its own. Men can also get it, possibly from doing sit-ups or weightlifting the wrong way, or from other causes.

It is important to know if you have DR both in pregnancy and postnatally and sadly it’s something that is not always checked by your midwife or doctor. I see many women in my postnatal classes and many have never had their tummies checked before. Therefore many women are unsure or unaware they have it and can unintentionally make the condition worse. Women with an untreated DR can suffer poor posture, back pain, pelvic floor dysfunction, digestion problems and an inability to lose their “mummy tummy” despite their best exercise efforts! I have seen clients with children over a year old and more who have had  DR and not known about it.

So how do I know I have DR?

If you have never heard of diastasis recti and have never had your tummy checked then it’s definitely worth heading along to a postnatal exercise class or seeing a personal trainer (who specialises in pre and postnatal exercise) or physical therapist that is familiar with diastasis and can check you over. It’s very simple, painless and quick and I can outline the steps so you can also check yourselves – see steps below and my video.

I would suggest you only check from 6 weeks post birth (when your uterus has shrunk, you have less fluid retention and abdominal discomfort). It makes for a more accurate test and it’s important to test your separation so you can measure progress.

  • Lie on your back with knees bent and feet flat on the floor
  • Place 2-3 fingers above your tummy button with your palm facing you
  • Take a deep breath in, then slowly raise your head and shoulders slightly off the floor as in an ab curl
  • Breath slowly out as you raise up and press your fingers into your tummy
  • The two sides of the rectus abdominus should close together on your fingers – a 1-2 finger width gap or less is fine, but don’t panic if it’s much bigger at first
  • You want to continue to feel for the width (and depth – how far in your fingers go) all the way along the length of your tummy, into your tummy button and below it. The width and depth may vary… it’s common to have a diastasis around the belly button area but can be above or below.
  • If the gap is greater than 2.5-3 fingers then the diastasis recti is present and doming may occur
  • Remember, you are also testing for the condition of the connective tissue (the Linea Alba). The further your fingers go into your belly, the weaker the connective tissue.

I have a one finger gap just above, in and below my tummy button and my youngest “baby” is almost 4!  However it is very shallow and I have a good, strong and functioning core.  Some women get hung up on their gap and closing it altogether. Up until recently we would often advocate that to fully close the gap is necessary as we know that this is best for optimal function. HOWEVER new research shows that some women can function without pain, leaking or poor posture when a DR remains so it becomes necessary to assess each person individually. This is not an excuse not to address a DR after birth, however it does mean we don’t have to get too focused on completely closing the gap – it’s more important to look at having a strong and functioning core.

How do you know if you have healed and to what extent can you classify yourself as restored if there is still a gap? Its all about the connective tissue strength and health, how you can connect with your core system and your individual function. If you have no pain, leaking, have good activation of your core muscle system, your connective tissue is strong along your midline and your posture improved then even with a small DR you have may found your balance.

However, if you do suffer from this condition there are many exercises that you should avoid altogether until your tummy separation has knitted back together (and fear not –  you CAN improve your diastasis – we will come on to that later)

What exercises should I avoid doing if I have DR?

  • Exercises that require lying backward over a large exercise ball.
  • Yoga postures that stretch the abs, such as “cow pose,” “up-dog,” and all backbends
  • Abdominal exercises that flex the upper spine off the floor or against the force of gravity such as: as crunches, obliquecurls, “bicycles,” roll ups/roll downs, etc.
  • Pilates mat and reformer exercises that utilize the “head float” position, upper body flexion, or double leg extension. Pilates 100s definite no-no.
  • Any exercise that causes your abdominal wall to bulge out upon exertion.
  • Lifting and carrying very heavy objects.
  • The full frontal plank (side planks ok) as the core muscles have to work against gravity and puts great pressure on the abdominal wall.
  • FULL press ups (as above re full plank) Press up against the wall ok

With regards to every day movements, try not to sit straight up from a lying position –  roll to your side and  push up from there (like when you are pregnant) and try and always engage your core muscles whenever you lift (babies, toddlers, car seats, whatever!), twist or get up from lying or crouching.

How Do I Fix It?

The key to closing a DR is to learn how to correctly engage your core….

Now this is something that is talked about a lot in some exercise classes, particularly Pilates and it’s something that many people are unsure about and in my opinion don’t do properly! You want to connect with your deep core muscles in order to start to knit your DR back together. We are talking about your TVA muscle –Transversus abdominis which is the deepest of the abdominal muscles and wraps around the abdomen between the lower ribs and top of the pelvis, functioning like a corset. It is NOT sucking your tummy in as hard as you can.

Breathe in and on the breath out contract the transversus abdominis by drawing your tummy button in towards your spin…

No movement of your hips, pelvis or spine should occur as you gently connect you TVA. If you palpate your tummy just inside the left and right hip bones, this deep contraction should feel like a light, deep tension under your fingertips, not a contraction that pushes your fingers out.

Now, as well as activating your TVA – you also want to be working your pelvic floor at the same time. Which brings me on to pelvic tilts – a great exercise for everyone to do – but especially important for postnatal ladies and safe to do from birth.

Pelvic Tilts (lying down)

Start in neutral position, lying on your back, feet on floor, knees bent.

Breathe in, fill your lungs and let your belly expand. Then exhale, emptying your lungs, whilst gently drawing your tummy button right back towards your spine. Keep your shoulders down and your neck relaxed. Focus the work between your pubic bone and waist. Keep your gluteals (buttocks) relaxed

There are a number of visualisations which may help :

Imagine ‘zipping up’ the gap from below the belly button, to above.

Visualise doing this exercise on sand, don’t let your feet indent the sand – instead indent the sand with your lower back.

Whichever works for you, remember to exhale as you draw your abdomen inwards, and inhale as you allow your tummy to expand and your lungs to fill. Don’t raise and lower your chest (it’s all in the tummy), don’t hunch your shoulders, and don’t hold your breath!

You will find that as you do this, your pelvis will naturally tilt forward as you contract the transverse muscle.

OK, now add in your pelvic floor exercises (now we’re really multi-tasking!). As you draw in your transverse abdominis muscle, pull up your pelvic floor. Remember; don’t hold your breath, all these muscles work together best whilst breathing. Exhale and release all muscular effort, allowing your pelvis to gently roll into the neutral position.

Repeat 8-10 times – holding each tilt for approx. 30 secs

In my next blog post I will outline more safe deep core exercises you can try and hope to have some videos to accompany them! And we have touched on pelvic floor but this needs to be looked at in more detail so that will be in Core Function Part 2.

I run a postnatal exercise class at Horfield leisure centre on a Wednesday 11am so please feel free to come along to that or contact me for further information.

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