Hello lovely people! My name is Gabrielle, I’m a Nurse / Midwife / Personal Trainer. I’m fortunate enough to be part of people’s peripartum journey from early pregnancy, birth through to the postnatal period. I get to see people go through incredible changes and the amazing ways we heal. The more we can understand and work safely with these changes, the better off we all are!
What is actually happening to our core?
There are two sides of the abdominal muscles connected through the midline by fascia called the linear alba. The linear alba is a sheet of pearly white fibrous tissue that takes the place of a tendon in connecting both the left and right side of the abdominal muscles together. When this fascia is stretched and separates, the gap left behind is called a diastasis recti. This gap can be isolated to the area above the belly button, at the belly button, in the area below the belly button or in all three areas at once. It can be deep or shallow, bulge or sink and can completely change how it looks and feels depending on the position you’re in and the amount of load going through the abdomen. So basically, a diastasis can look and act very differently in each person because of the way pressure is created and subsequently managed.
What we know from experience now is that this pressure that stretches the fascia isn’t just caused by growing a baby, but can also be caused by abdominal muscle imbalance, poor posture, poor pressure management and issues in the kinetic chain during movement.
Interestingly a diastasis isn’t only found among pregnant people as it’s also prevalent in young children and many adults who have poor pressure management systems. A poor pressure management system is best described by muscles not strong enough to manage the pressure or the person is found to be using an ineffective bracing method. Both of these things place extra stress upon the fascia and other soft tissues causing pressure to essentially ‘leak out’ of the weakest area. This is why you’ll often see a diastasis recti when someone is performing exercise. The muscles can’t manage the load so the pressure ‘leaks out’ of the diastasis. As such, a diastasis can better viewed as a reflection of the muscles inability to fully manage the outward stress thus overstretching the abdominal fascia. Knowing this can help us redirect our thinking around a diastasis only being a pregnant person problem and simply a problem that arise due to unmanaged pressure.
Why does it happen during pregnancy?
During pregnancy this fascia stretches to make room for a growing baby. As you could imagine there’s only so much room in the abdomen for everything to fit so something has to stretch!
Research has found that by someone’s due date, 100% of people have a diastasis (Mota, et al., 2015). What this tells us is that the stretching is clearly just something the pregnant body needs to go through in order to fit your organs and grow a baby. But here’s the good news! By six weeks postpartum only 60% of people still had a diastasis (Sperstad et al., 2016) and at six months postpartum only 39% of people still had a diastasis (Mota, et al., 2015). If you’re looking at those statistics with a glass half empty and only seeing how many people still have a diastasis, consider this. It took roughly 10 months to grow your baby, and more than half of those people have healed their diastasis in less time than that! Our bodies are truly incredible during the post birth recovery process.
How can we stop further damage and aid recovery?
So we know diastasis happens to every pregnant person, so how can we help it heal and recover during the postpartum period without making it worse?
There is so much that we can do to help reduce the severity of a diastasis and simultaneously protect the pelvic floor. So let’s start with reconnecting with our bodies to learn about proper pressure management systems as soon as you get medical and physio clearance to get back into exercising.
A couple of points to take note of:
– Please please please allow your body time to recover from birth. Don’t jump straight into doing exercise just because you maintained fitness during pregnancy. Birth is a huge event for our body, vaginal or cesarean. Respect the healing process and give your body at least 3-6 weeks of gentle movements and kind thoughts. You just birthed a human, nourish your body and honour the healing process.
– Reconnect your breath with your core and pelvic floor. Only focusing on doing core exercises three times a week to heal your diastasis will be pointless if your breathing pattern is placing unnecessary stress on your linea alba. All those exercises will do nothing in comparison. Address your breathing first!
– Your core is connected to the rest of your body, so don’t forget to train everything else as well! Using isolated exercises to connect to the muscles that worked the hardest to adjust to pregnancy posture ie. Glutes, hamstrings, back, hip flexors. They’re likely going to be tight, overworked and/or weak. It’s very hard to perform a compound movement like a squat if several of those muscles aren’t functioning like they should. Isolate and connect before leveling up!
– Please see a women’s health physio, not just a GP at your 6 weeks visit. The information they can provide you with specific for your body will be invaluable to your recovery.
– If you have deep diastasis, you’ll want to focus on your deep transverse abdominal muscles
– If you have a wide diastasis, you’ll want to focus on your rectus, your 6 pack muscles
– The location of your diastasis (high, middle or low) will reflect the area you want to work on (rib flare, breathing pattern and full core muscle balance).
– Progress your exercises slowly. If you feel ready to level up, I’m a big fan of either checking in with your physio, fitness coach and/or film yourself. That way you can see how you move during an exercise and work on correct technique. Good technique is key to safely progressing!
– There’s no ‘bad’ exercises, there’s only exercises you can manage well, and exercises that are too much. I’d love to say there’s a simple black list of movements to boycott but there’s not. Everyone moves differently, manages pressure differently and connects differently. This is why connecting to your body and being aware of how a movement feels is soooo much more important. It enables you to diversify your exercise list and challenge your body better and safer. – Give your body time and have fun with it. Relearn your new postpartum body, it’s not going to be what it was pre-pregnancy. This isn’t a bad thing, it’s simply a new chapter in learning your abilities. Being patient is important, fascia healing is much longer than muscle healing. We can’t force healing either, so do what you can to give your body the best opportunity to heal, and let it handle the rest.
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), 1092-109