Diastasis – What you can do to aid in postnatal core recovery
By Gabrielle Brennan from G.LORRI LABOUR BODYWORK
NURSE/MIDWIFE & PERSONAL TRAINER | MALVERN EAST, VIC
What is actually happening?
The linear alba, a pearly white sheet of fibrous tissue, connects the left and right sides of the abdominal muscles through the midline fascia. During pregnancy, this fascia can stretch and separate, resulting in a diastasis recti - a gap that can occur above, at, or below the belly button, or in multiple areas. The appearance and behavior of diastasis recti can differ among individuals, depending on the position and load placed on the abdomen. It is now known that the pressure responsible for stretching the fascia is not solely attributed to pregnancy, but can also stem from abdominal muscle imbalances, poor posture, poor pressure management, and movement issues in the kinetic chain. Diastasis recti is also prevalent in young children and adults who have poor pressure management systems. When muscles are unable to manage the load or an ineffective bracing method is used, pressure can "leak out" of the weakest area, causing stress on the fascia and soft tissues. This is why diastasis recti can be observed during exercise, where the muscles are unable to fully manage the outward stress, leading to the overstretching of the abdominal fascia. Recognizing that diastasis recti is not just a pregnancy issue, but a problem arising from unmanaged pressure, can help redirect our understanding and management of this condition.
Why does it happen during pregnancy?
During pregnancy, the body undergoes tremendous changes to accommodate the growing fetus. The fascia, a thin layer of connective tissue, stretches to create space for the baby as the uterus expands. This natural process is essential for the health and development of the baby, but it can also lead to a diastasis, or separation of the abdominal muscles.
Studies have shown that by the due date, 100% of pregnant individuals experience a diastasis, highlighting the inevitability of this condition during pregnancy. However, the good news is that the body has an amazing ability to heal itself postpartum. Research indicates that 60% of individuals no longer have a diastasis by six weeks postpartum, and by six months postpartum, that number drops to 39%.
It's important to recognize that these statistics demonstrate a remarkable healing process that occurs within the body. In less time than it took to grow and birth a baby, more than half of those with a diastasis have already healed. Our bodies are truly amazing and capable of incredible postpartum recovery. By taking steps to support this process, individuals can feel empowered and confident in their post-birth journey.
How can we stop further damage and aid recovery?
While diastasis recti is a natural occurrence during pregnancy, it's important to take steps to support the body's healing process postpartum. The good news is that there are many ways to reduce the severity of a diastasis and protect the pelvic floor during this time.
The first step is to reconnect with your body and learn about proper pressure management systems. This involves understanding how to engage the deep core muscles properly and how to breathe correctly during exercise. It's important to wait until you have medical and physio clearance before resuming exercise after giving birth, as starting too soon can actually make a diastasis worse.
Once cleared for exercise, it's important to start with gentle movements that focus on rebuilding the deep core muscles. Pilates and yoga are great options for this, as they emphasize proper alignment and breathing techniques. It's also important to avoid exercises that put excessive pressure on the abdomen, such as crunches or heavy lifting.
In addition to exercise, there are other lifestyle factors that can support the healing process. Proper nutrition and hydration are essential, as is getting adequate rest and managing stress levels. Working with a pelvic floor physiotherapist can also be helpful in identifying any underlying issues that may be contributing to a diastasis and developing a personalized plan for recovery.
By taking a holistic approach to postpartum recovery, individuals can support their body's natural healing process and reduce the severity of a diastasis, while also protecting the pelvic floor and promoting overall health and wellness.
A couple of points to take note of:
Allow your body time to recover from birth, as it is a huge event for our body, regardless of whether it was vaginal or cesarean. Respect the healing process and give your body at least 3-6 weeks of gentle movements and kind thoughts.
Reconnect your breath with your core and pelvic floor, as breathing patterns that go up through your shoulders and out your abdomen overuse your core and pelvic floor, hindering their healing. Proper breathing engages your diaphragm and works with your pelvic floor muscles.
Address your breathing first before focusing on core exercises to heal your diastasis. Only doing core exercises three times a week will be pointless if your breathing pattern is placing unnecessary stress on your linea alba. By improving your breathing, you reduce pressure on your core and pelvic floor.
Train other muscles that worked the hardest to adjust to pregnancy posture, such as glutes, hamstrings, back, and hip flexors, as they are likely to be tight, overworked, or weak. It's hard to perform compound movements like squats if these muscles aren't functioning properly. Isolate and connect with these muscles before leveling up.
See a women's health physio for specific information and invaluable guidance during recovery. They can provide you with information specific to your body and help you develop a personalized plan for recovery.
Focus on the area of your diastasis: deep transverse abdominal muscles for deep diastasis, rectus/6-pack muscles for wide diastasis, and the location of your diastasis (high, middle, or low) will reflect the area you want to work on, such as rib flare, breathing pattern, and full core muscle balance.
Progress your exercises slowly and check in with your physio or fitness coach for correct technique. Filming yourself during exercises can also help you see how you move and work on correct technique.
There are no "bad" exercises, only exercises you can manage well and exercises that are too much. Everyone moves differently, manages pressure differently, and connects differently. Connecting with your body and being aware of how a movement feels is key to safely progressing and challenging your body effectively.
Be patient and have fun with it, relearning your new postpartum body. Fascia healing takes longer than muscle healing, so it's important to give your body time to heal and do what you can to give it the best opportunity to heal.
If you're interested in experiencing the benefits of labour bodywork, we invite you to reach out to us.
References:
Mota, P., Pascoal, A.G., Carita, A., & Bo, K. (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual Therapy, 20(1), 200-205. https://doi.org/10.1016/i.math.2014.09.002
Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bo, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: Prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine, 50(17), 1092-1096. https://doi.org/10.1136/bjsports-2016-096065
