Minding The Gap
Abdominal Muscle Separation During & After Pregnancy
It will never cease to amaze that a little human being can grow to full development for nine months in a woman’s abdomen.
One of the inevitable consequences of this, however, is that there has to be a lot of shifting and stretching of the surrounding organs and tissues to allow this to happen!
The “six pack” muscle, or Rectus Abdominis muscle, is actually two muscle bellies with a line of connective tissue down the middle called the Linea Alba (LA). From about 18 weeks of pregnancy, when the baby starts taking up more space above the pelvis, the LA has to start stretching, and the RA muscles move apart from each other. This separation is called ‘Rectus Abdominis Diastasis’, or RAD, and is aided by the fact that pregnant women have a hormone in their body called Relaxin, which allows connective tissue to be stretchier.
MYTH TO BUST – The abdominal muscles do not ‘tear’ or ‘split’, but the connective tissue between them does need to stretch and this is a very normal consequence of pregnancy.
In pregnancy, after the LA has begun to stretch, it is highly recommended not to use the RA muscle anymore. This means no abdominal crunches or planks in your exercise program, and avoid using this muscle in your daily life by always rolling completely onto your side to get up from a reclined position like bed or the couch.
You can, however, continue to exercise the abdominal wall in a different way, by focusing on the Transverse Abdominis (TA) muscle, and there is scientific evidence that this can significantly reduce the rate of RAD after childbirth. The TA is the deepest layer of abdominal muscles and acts like a ‘corset’ to hold in the abdominal contents and give support to the spine. A physiotherapist can show you how to do these exercises correctly, and the FitRight Pregnancy DVD and Bump&Me exercise classes are specifically created for this purpose.
MYTH TO BUST – although it is important to keep the abdominal muscles strong in pregnancy, make sure you are not doing this in a way that pushes the abdominal contents into the weakened midline, such as crunches or planks.
In the early days or weeks after you have given birth, it is recommended to get your RAD checked by a physiotherapist. This is done with a very simple test of performing an abdominal crunch exercise while the physiotherapist feels the midline of the muscles above and below the belly button. They will tell you how wide the gap is in finger widths, but more importantly how deep it is, and should give you some basic TA muscle exercises to perform on a daily basis. It is also necessary to continue to avoid using this muscle while it’s separated, the same as during pregnancy.
If your RAD is diagnosed as being significantly deeper or wider than the norm, it is generally recommended to wear some abdominal support to help the recovery. You may be given Tubigrip (an elastic band of material that you step into and wear around your middle), or you may choose to purchase a pair of SRC Recovery Shorts. These shorts are specifically developed to assist with RAD recovery, and being shorts they are more likely to stay in place as you move. This extra support is most important in the first two months.
MYTH TO BUST – Although abdominal muscle separation will have some natural recovery after childbirth as the uterus and abdominal organs settle back into their pre-pregnancy position, after 8 weeks it has been proven that there is no more natural recovery and you need a specific exercise program to close any remaining RAD (which very likely does not involve crunches!).
FitRight Baby&Me and MumTime classes are specifically designed to help to fix any ongoing RAD, with small class sizes and close supervision by the physiotherapist instructor. They will ensure that nothing you are doing causes the abdominal wall to ‘dome’ upwards, or the gap to deepen.
MYTH TO BUST – Make sure that you release that the width of your RAD is not as important as the depth. Anything up to 1.5-2 finger widths can still be ‘normal’, however this gap should be nice and firm in the midline. It is when the LA is lax and the gap is deep (even if it is quite narrow) that unwanted consequences can occur.
An ongoing RAD means suboptimal support in the abdominal cylinder and ‘core’, and is highly associated with pelvic floor muscle dysfunction (including vaginal prolapse and incontinence), abdominal hernia and back pain.
In summary, it is highly recommended to see a physiotherapist who specializes in obstetrics both during pregnancy and after childbirth, to prevent and manage the inevitable abdominal muscle separation that occurs. In pregnancy, you should learn how to activate the deep abdominal muscles and how to safely integrate that activation into a gym program and your daily activities. After birth, you should identify early on if you have a significant separation and wear additional support if you do, and learn correct postnatal exercises to assist the recovery. Finally, you should have it checked again at 6-8 weeks when any natural recovery would have taken place, and if there is any remaining separation at that stage you will be taught a specific exercise program to get it back to it’s optimal strength as soon as possible.