Diastisis Rectus Abdominus Muscles

(Separation of the Abdominal Muscles)
by Merrin Keaney - Physiotherapist MD Health

Over your pregnancy, your abdominal muscles have stretched to accommodate your growing baby. In between the 2 main muscles at the front of the abdomen runs a softer, more ligamentous structure, the linea alba. This structure also stretches to allow for the growing baby.

It is quite common for the linea alba to stretch, resulting in a ‘gap-like’ depression in the abdominal wall (also called diastisis recti).

This may be related to:

·         a large baby or more than one baby (i.e. twins)

·         small pelvic brim or a petite frame

·         a pronounced sway back

·         poor abdominal muscle tone

·         Repetitive high pressures in the abdomen caused by lifting, constipation (straining) or coughing

·         Genetics. For some women, it is simply how their bodies respond to pregnancy.

·         Separation in a previous pregnancy significantly increases the probability, and severity, of the condition in subsequent pregnancies.

Separation can occur anytime in the last half of pregnancy but is most problematic after pregnancy.  After giving birth, your abdominal muscles are weak and stretched, and can predispose you to back ache or injury. As a new mum, you will be lifting, pushing and pulling frequently; therefore it is important to protect your back against pain and injury.

The abdominal muscles act as a corset to support your back and abdominal organs. By strengthening these core muscles, you will improve this support, reduce the risk of lower back pain and help regain your figure.

For Best Results, Start Reconditioning Soon after Childbirth

Starting your abdominal reconditioning soon after pregnancy will help you yield the best results. The longer you wait to begin abdominal reconditioning, the harder it becomes to restore your core strength/tone and decrease the width of the separation. So if possible, start exercises that restore the abdominal wall in the initial months after childbirth.

Where to start

1.       All fours

Start on your hands and knees. Make sure you have a slight arch in your back and let your tummy drop. Breathe in and as you breathe out, draw the lower part of your tummy as if you are bringing your belly button towards you back. Hold for a few seconds then relax. Do this five times to start. Build up to 10 seconds each practise whenever you can during the day. Remember not to pelvic tilt or hold breath.

When you are able to do this progress:

2.       Lying on your back

Lie on your back with your knees bent. Make sure you have a slight arch in your lower back. Place your hands on your hips. Breath in and as you breathe out again, draw your belly button towards your back and you will feel the muscle tighten under  your fingers. Imagine you are pulling a belt in one notch tighter. Build up to ten- hold for ten seconds each. Remember not to pelvic tilt or hold your breathe.

You can then progress to doing this exercise in sitting and standing. Try to always have these abdominals working, especially as you are lifting and carrying. They will help you with good posture and support your back and tummy.

Special Precautions for Women with Abdominal Separation/Diastasis Recti

Avoid all activities that place stress on your midline, that stretch or overly expand the abdominal wall through everyday activities, exercise or inhalation techniques.

Some Types of Movement to Avoid

·         Most traditional abdominal exercises that work the exterior abdominal muscles, such as crunches and oblique curls. NO SIT-UPS.

·         Exercises that require lying backward over a large exercise ball.

·         Yoga postures that stretch the abs, such as “cow pose,” “up-dog,” all backbends, and “belly breathing.”

·         Movements where the upper body twists and the arm on that side reaches backward, such as during a tennis serve

·         Rising from a supine position by rolling up and twisting at the same time. Instead, roll first onto your side, and then use your arms to help push yourself up to a sitting position.

·         Lifting and carrying very heavy objects.

·         Intense coughing while your muscles are unsupported.

Recommendations

MD Health’s Physiotherapist or Exercise Physiologist may advise you to wear some support like tubigrip or brace during the day. It is also helpful to get back into firm fitting clothes eg. Pre-pregnancy bike shorts to add support and to remind you about tucking in the tummy.

Reconditioning after pregnancy with abdominal separation can be more challenging. To safely and effectively restore your abdominal wall you need a postnatal exercise program that is specifically designed for women with abdominal separation – which we can do for you at MD Health. If you have any questions regarding these exercises please do not hesitate to ask us at MD Health Physiotherapy.