Abdominal separation? Diastasis what? Pelvic Floor Physio?

Over the years, I have done many talks for new mom groups, and one of the first questions I always ask is, who has abdominal separation?  The second question I ask is, who knows what abdominal separation is?

I’m always shocked to find that most people have never even heard of it!

It boggles my mind that post birth, women are not immediately referred to a pelvic floor physiotherapist.  It’s like if someone tore their ACL, and 6 weeks later, their doctor “cleared them for exercise” after asking a few questions, and doing no hands on assessment to assess function, and no referral to a physiotherapist.  Then that injured person who has just scratched the surface on his recovery journey, goes for a run because his doctor said he was in the clear, and re-injures himself.  Sounds pretty ridiculous right?  

That’s basically how we’re treating women post-birth.  

Let’s back up a second.

We need to establish a few things.

1. Abdominal muscles don’t separate
2. Pregnancy, labour and childbirth leaves you injured no matter what your birth story!

So let’s define abdominal separation.  The medical term is diastasis recti (DR) which translates into abdominal separation, but do your abs actually separate? No they don’t

We all have rectus abdominis (RA) muscles, and in the centre, there is a thick piece of connective tissue called the linea alba that joins the two sides of the RA During pregnancy, your midsection is growing for upwards of a year, and once you reach a certain size, that connective tissue will start to stretch to make room for your growing baby.

After birth, depending on many factors (i.e. fitness level, tissue integrity and mobility, genetics etc.) that connective tissue may not bounce back completely, leaving you with what feels like a gap in your abs.  This is going to make you weaker and less stable, making it an injury to the body that you need to rehabilitate.

How do you find out if you have a significant DR?

The first thing you need to do after 6 weeks of rest and recovery, is to book an appointment with a pelvic floor physiotherapist (PFPT).  As a fitness professional, I insist that all my clients see a PFPT before resuming training with me.  

As a specialized trainer, I’m able to assess DR and track progress, but seeing a PFPT will allow you to get a better understanding of how your pregnancy and birth affected your body and what rehabilitation exercises you need to be doing to re-train and stabilize your core to avoid further injury, and to be able to exercise without causing more harm.  

So how is DR assessed anyway?

It used to be thought that the distance of the separation (measured in finger widths) was the only thing that mattered.  It turns out that that is only half the story!  We need to not only assess the width of the separation, but the tension you can generate between that separation with the deeper core muscles.  That tells us how well your core is functioning, despite the stretch in the linea alba.  

What do you need to know about exercise post-birth?

After having a baby, it’s important that we exercise for many reasons, including mood management, blood flow, fat loss, and so many other reasons, BUT, we need to make sure we are exercising in an appropriate way, especially for the first year post birth.  

Exercises that need to be discontinued after having a baby are any that increase your intra-abdominal pressure.  Sit-ups and crunches are the worst offenders here.  People want to lose belly fat so they try to target their belly with those exercises.. but we don’t lose fat in an area by “working” that area.  Fat loss happens proportionate to your body, so let’s avoid injury and take those two exercises out of our repertoire.

Exercises that we need to carefully and slowly work back into: planks and push ups.  These two exercises can be fine, but you will need to know how to contain the core before challenging your abdominal wall against gravity.  This is when it’s important to work with a trained professional to be able to help you figure out how to progress there.

Jumping/impact also needs to be slowly introduced back, but is more of a problem for anyone experiencing incontinence.  Speaking generally though, if you feel pressure on your pelvic floor or leak urine when jumping… don’t jump!

Aside from that, most exercises are okay, but one thing I’ll tell all clients, postpartum or not, your core needs to work with every single exercise you do.  After having a baby, our goal is to re-train the core to engage automatically before performing any exercise.  Your PFPT and postpartum fitness specialist can help you learn to work with your deep core breathing through all exercises until your body recovers and does it naturally.

If you are looking for more help when it comes to recovering from postpartum conditions, please don’t hesitate to book a complimentary discovery call to see how glowing mama courses and coaching programs can help!