Abdominal muscle separation – without a doubt, this is one of the areas of pre and postnatal health that has the most ‘myths’ that need busting. Let’s get one fact sorted out to start with… 100% of women in their late third trimester will have separation of their abdominal muscles that would be considered a ‘Diastasis Recti’. This stretching is a normal adaptation of pregnancy and not something we are aiming to avoid.
Can a Diastasis Recti that persists after pregnancy always be managed without surgery? No – in some cases, even with the best rehab plan, the connective tissue in the midline isn’t able to recover to a point where it can adequately ‘transfer load’ from one side of the trunk to the other. Some women will require surgical management, and this can often be flagged at an initial assessment with a physiotherapist who is experienced in this area – they will be able to identify those who are possibly in this category.
But for the majority of women, conservative management of abdominal muscle separation is adequate for achieving optimal function and strength. At FitRight, we recommend using a holistic and exercise based approach – and to simplify it, here is our ‘5 Step Approach’ to Diastasis Recti management during and after pregnancy!
Step 1 – Get an assessment with a Physio who is experienced in pre and postnatal health
Ok, so this is the gold standard with regards to beginning your journey with management of abdominal muscle separation during and after pregnancy – it would be ideal to get an individual assessment with a physio who really understands Diastasis Recti and exercise during the childbearing years. Here’s what the physio would be able to help you with:
1. Assessing whether you are correctly using your pelvic floor and deep abdominal muscles, also known as your ‘core’.
2. Testing your abdominal separation and what happens when the area is loaded with different exercises and movements.
3. Identifying which movements cause ‘doming’ (see step 2 for more information and examples of this!) and helping you to self-identify when different exercises and movements have gone past the ‘tipping point’ of what your abdominal muscles can handle at the moment.
I completely understand that for some of you, the luxury of being able to get to an individual physio appointment with someone who specialises in this area is not possible for a variety of reasons. And if this is the case, never fear – read on to the remaining steps and self-teach! However, I wanted to put this as step 1 because I know from years of experience that many women need little tweaks and adjustments to the way they are moving and activating their ‘core’ muscles in order to get the results they want from an exercise program. Here are some suggestions for finding a private practice physio in your area: – if you are in Perth, you can see the FitRight team at FitRight HQ in Applecross – book here! – if you are in Perth but FRHQ doesn’t suit you, have a look on our website for our extensive list of other recommended practitioners who we know are terrific with pre and postnatal clients. www.fitright.physio/assessments. – if you are elsewhere in Australia, you can either check out the Australian Physio Association’s ‘Find A Physio’ webpage and search under ‘Women’s Health’ as the specialty, or you can contact me firstname.lastname@example.org with your location and I’ll use my networking skills to see who I can recommend near you!
Step 2 – Understand what ‘doming’ is and how to monitor for it
You’ll come across this word a lot if you go down the rabbit-hole with regards to Diastasis Recti – but what exactly is meant by ‘Doming’? Hopefully you’ve watched the introduction webinar already, which went into this extensively. Just as a reminder and refresher before we get into exercise though… have a look at these little video example of my abdominal wall ‘doming’ with different movements. This second step in Diastasis Management is to empower you to know what it looks and feels like when your separated abdominal wall muscles are overloaded beyond what I call their ‘tipping point’.
This step is also about you understanding that a movement that causes this ‘doming’ can be managed in two ways.
Firstly – is it possible to use your deeper ‘core’ muscles during the movement so that this no longer happens? Have a look at my videos to see an example of me doing the same movements, but with different core muscle activation, and you can see the difference in the amount of ‘doming’.
Or secondly – if it’s not possible to do avoid doming during the movement even with different ‘core’ activation, can you do the exercise/movement in a slightly different way to make it less loaded on the abdominal wall? Have a look at my video of the common exercise of ‘bicycle’, done when I was early post birth. I can do it in a slower, more controlled way, and it makes a big difference.
Or in another example, the common movement of getting up down out of bed is very likely to cause doming in late pregnancy and the early postnatal period when the abdominal muscles have been stretched apart (or perhaps it just becomes impossible to do this movement as you normal would due to the mechanical disadvantage of your muscles!). Many women need to roll all the way over to their side to get up and down from bed during this time, and then in the weeks after birth they can start to do it again without ‘doming’ occurring.
Want to know more about modifications/regressions of common abdominal muscle exercises so that you can adjust your workouts to suit your growing pregnant belly and then your post birth recovering belly? Read on to Step 3!
Step 3 – Learn good technique for common abdominal exercises
If you learn good technique for common abdominal muscle exercises that you may find in gym classes and and understand the regressions and progressions for each then you can alter your exercise options as your abdominal muscles stretch during pregnancy, and as they recover again in the postnatal period.
Step 4 – Learn How To Incorporate Abs Exercise Into General Workouts
Ok, next myth to bust… don’t let anyone tell you that you shouldn’t be doing any abs exercises during pregnancy and early postnatally, it’s not true! I see this message getting out there a lot unfortunately, but what is a more correct version of this message is ‘you are likely to need to modify your abs exercises during and after pregnancy for reasons such as supine hypotension and abdominal muscle separation (lots more explanation about exercise modification in the Pregnancy Essentials Package!), but it’s very important to keep the muscles strong and avoid deconditioning.
It’s just that you’ll need a new repertoire of possibly some less well-known abs exercises, to replace the sit ups and the bicycles and the burpees while they get subbed out for a while.
The following mini workout videos show you some examples of abs and core exercises that can be ‘subbed in’ while the abdominal wall muscles are at a mechanical disadvantage. The first one can be done in pregnancy or postnatal, and the second one is for early pregnancy or the postnatal period – noting that it involves lying flat on your back. Empower yourself to know the best technique for abs and core exercises during pregnancy and early postpartum, and start incorporating these into your weekly workout routine (many of the videos in the workout section include versions of these amongst other cardio, stretching and strength exercises).
Step 5 – Keep Globally Strong
Keeping your abdominal muscles strong during pregnancy and postnatally is really important for both exercise and movements of daily life like lifting and getting up from the floor or the bed. But you know what is equally as important, and can have a big role to play with management of abdominal muscle separation? Being globally fit and strong. Our main aim with abdominal muscle diastasis management and rehab is to be able to ‘transfer load’ across the trunk, and having strong leg and arm muscles, and a good level of general fitness, are very big pieces of this puzzle too. So – make sure you don’t just fall into the trap of doing isolated core exercises – practicing exercises like squats and overhead presses and getting up and down off the floor with modified burpees are also really important so that daily tasks become more ‘effortless’ and you’re less likely to strain and dome.