Image: Prenatal Massage, Right In Your Own Cozy Home!

Healing Diastasis Recti

Strengthening Your Core Postpartum

During the postpartum phase, we have two primary goals: Healing and nurturing the Mother, and caring for, and feeding, the Baby.

During this time, many women want to get back to their schedule and resume some familiar activities that they drew all sorts of benefits from. And, one of those activities happens to be exercise for many women following positive daily life patterns.

Of course, it's no secret that pregnancy can affect a woman's core muscles.

What is Diastasis Recti? Are DRA and RAD the Same Thing?

Diastasis recti, also known as rectus abdominis diastasis (RAD) or Diastasis rectus abdominis (DRA), refers to the separation of the right and left rectus abdominis muscles along a vertical line directly in the center of the front of the abdomen, the linea alba, passing right through the center of the belly button.

During pregnancy, the uterus grows in size, causing the linea alba to stretch out and become thinner. This is by design and allows the mother's belly to accommodate the growing fetus. The degree of DRA ranges from tiny gaps, shallow areas smaller than an inch to longer and deeper gaps spanning the entirety of the abdomen. With time, and the proper care, even this can be resolved.

Can Diastasis Recti Be Severe?

My co-therapist and I worked on a new Mom whose uterus was protruding from her belly. This is the extreme, and may cause secondary symptoms like severe lower back pain, incontinence and leaking urine, constipation, difficulty breathing and moving, and even fever at times. (For those that felt concerned reading this, know that this Mom's uterus stopped protruding and she was fine after some time.)

However, in 99.99% of cases, there are no other symptoms besides the primary sign, the presentation of a linea alba that has what feels like dents, or an indentation, along the vertical plane of the tissue. There may be one gap or multiple gaps. Every woman is different, and every pregnancy is different. Severe RDA is considered to be defined as a gap 2.5 centimeters wide and 2 centimeters deep or more.

How Soon Is Too Soon to Address Healing Diastasis Recti?

You can start working on restoring your muscle strength and tone right away. If you've had a vaginal delivery, you can start right away. If you've had a C-section, you will want to wait 4-6 months, or whatever your OB-Gyn tells you.

There is a caveat to all this, and that is this: Some exercises and activities will harm your efforts to restore your body; be aware of what's safe and why, and commit this to memory, as it's key information for staying at your peak physical condition, in terms of your core muscles.

You've Got DRA? You're Not Alone!

OK so it's been established that you have Daistasis recti. It happens. Statistically, you're actually in the majority. The statistic that's thrown around is "up to 60%" of women experience this, postpartum.

This actually draws from an article published in the BJM (British Journal of Sports Medicine - September 2016 - Volume 50 - 17) conducted in Norway, and relied on palpation by physiotherapists, palpation being a trusted means of ascertaining the presence, and extent of, diastasis recti abdominis (DRA) or rectus abdominis diastasis (RAD) in the patient.

DRA In Postpartum Women 60%? Some Experts Say Closer to 100%!

I would posit that the rate is actually far higher in the United States than in Norway, perhaps owing to different lifestyle variables affecting outcomes. I say this based on my experience as a postpartum LMT. I am qualified to assess, not diagnose.

However, my assessments are within my scope of practice, and apparently, almost all women seem to have some degree of diastasis recti in the months, and years, following pregnancy.

My colleague studied under Carol Osborne, the woman who basically pioneered the practice of Postpartum Massage in the United States (formerly only being practiced in other lands like India and other seemingly random spots on the globe), said that in her class, Carol Osbourne had the students partner up, and did the diastasis recti check. Everyone who had ever been pregnant had some degree of DRA. Everyone.

And, that includes women who had given birth even years before. And so, the 60% statistic may not apply to our population here in the U.S., and that includes many women who have come to live here from other countries. Perhaps the 60% statistic is flawed?

The same study performed by Candido et al, demonstrates that women who engage in vigorous exercise, as well as regular walking, more than three times weekly, had little or no diastasis recti amongst the study's test subjects.

So, if you've been exercising, great. If you haven't, now is not the time to start an insane program of fitness. Focus on your own recovery and the baby's care, instead.

What Should I Avoid Doing To Exacerbate My DRA?

Probably, your LMT has already informed you that doing crunches is best saved for later, in the case of a vaginal birth, at least six months after giving birth. Crunches, sit-ups, and exercises like this that activate your core muscles in the front, are to be avoided right now. This is true whether or not you have DRA.

Some women make the decision to jump right into a too-strenuous fitness routine too soon, because they wish to get back to a "normal life." While it's totally understandable, there may be consequences that are unanticipated. Certain exercises can actually worsen their DRA condition. Please be patient. Six months passes very quickly. You'll be there soon enough!

Also, we advise clients to avoid bending over and picking up the baby from low cribs, couches, and the floor. Don't pick up that speck of lint that you see on the carpeting. Let someone else do it. Right now you probably have more people willing to help you than you will at any other time in your life, except perhaps your own time as an infant!

Get Up With Care

If you're lying in a supine position, that is to say, on your back, don't get up by lifting your upper body into a vertical position. That's what we all do, usually, but for the next six months or so, try this instead:

From the position of lying on your back, go onto your side. Lift up using your arms, and then once you're up, swivel back until you're upright. It does take some practice, and so we are planning to add a video to this page to make the process clearer. It's easier watched than explained, for many.

Belly Binders Are Safe and Effective

You may want to consider wearing a belly binder. There are many brands, and the famed LeLeche Society even makes one. If this is your first time hearing about this, it may seem weird, even anachronistic to bind your belly. Belly Binders are safe and effective, there is no question.

To be clear, this is nothing like a corset, the garment women wore in England in the 19th Century that caused women to pass out from lack of air. These belly binders do not go over the ribs. In fact, if you buy one, and it DOES go over your ribcage, then you need a smaller size.

Wear this device faithfully. It helps the abdomen to grow back together.

Acceptable Exercises Are Gentle Exercises

I'm sure you recall that I just said that you don't really want to activate your core. OK; now I am going to qualify that statement.

You actually can activate your core, but only in a significantly less strenuous way than a crunch or sit-up, or even some Hatha Yoga asanas might.

Remember: In most instances, doing these sorts of exercises that place a ton of resistance on your abdominal muscles may be a fine idea, but for now, it's to be avoided at all costs.

Squat, Don't Bend! Kettle-Bell Suitcase Carry

If you're standing, and want to pick up anything, remember to squat at your knees and not to bend at the waist.

Actually, this form of movement is preferred and even builds up your strength, rather than potentially costing you the integrity of your core muscles.

To that end, you can even squat and pick up a kettle bell, walk around your space, and squat again to replace the kettle-bell.

Next, do this again with the other hand. Of course, this activates your core to some extent, but to a far lesser extent than bending exercises or random life movements might.

Heel Slides: Doing the Moonwalk On Your Back

Heal Slides are healing; really, it's true! It's an easy exercise to perform.

While lying on your back with bent knees, slide one heel along the floor, then return to the starting position. Repeat on the other side. To clarify, you're sliding toward your head, and then away from your head. Your knee should rise, then fall. The bottoms of your feet do not touch the floor, but rather keep your foot flexed to prevent this while your knee is up.

Four to six, and later, eight to twelve repetitions is the ideal number, with three to four sets.

Actually, while doing Heel Slides while lying on the back is most common, you can also do the Heel Slide exercises while seated upright on the floor.

You can lean back on your arms or sit upright. Either way, you're doing the same Heel Slides.

A variation calls for you to keep your foot relaxed and the bottoms of your feet on the ground at all times.

The Yoga Bridge

The Setubandha Sarvangasana, or bridge pose, is also highly recommended. This is Hatha yoga even toddlers can do!

While the focal muscles in action are the glutes and back, the abdominals are activated oppositionally, and so of course to a far lesser extent than the muscles doing the hard work in this pose.

If you're not already familiar, begin by lying on your back, knees bent, feet flat on the floor, the distance between your feet roughly equivalent to the width of your hips.

With your hands at your sides and palms against the floor, inhale and lift your hips, letting the weight of your body press your feet into the ground.

Do not lift your shoulders. Keep your body aligned and breathe deeply five times.

Yoga scholars usually recommended three repetitions of each pose throughout time, but four is actually just as good, if not better.

Abdominal Tightening As Isometrics

Isometric exercises rely on the person doing the exercise to provide the resistance. This is opposed tom using the body, or a part of the body's weight, as resistance. During this time, exercises that directly work the abdominals by using weight cannot be adjusted, however, when using isometric pressure, you can vary the resistance to suit your requirements.

Lie flatly upon your back. Begin by tightening your abdominal muscles, imagining that you're trying to bring your belly button inward to touch the floor. Contract for ten. Release and repeat four to eight times, with three to four sets, each.

You can do an advanced type of exercises just like this, after a few weeks or months, adding the element of alternately raising one foot, then the other, with each inhale. Do not raise far off the ground; a few inches works the muscles, too.

Bent knee fall out: Lie on your back with bent knees and feet flat on the floor. Brace your abdominals, then slowly lower one knee to the side while keeping the other knee and hips still.

Planking: A Trend That Went Viral, Now For Moms

Do you remember the trend when people were planking everywhere, and uploading the images to Instagram? Those planking exercises that people loved to boast about are too much for you right now.

But a modified plank is not.

Wall planks and side planks will help you develop core strength without putting undue strain on your abdomen. You can even try side planks on your knees.

Doing the wall plank is easy. You basically lean forward against the wall with your arms, and hold that pose. You can do this four to eight times, three to four sets each.

The side plank is also performed standing, only in this variation, you lean against the wall using only one arm, and you're leaning sideways, not forwards.

The side plank on your knees is the same idea, only you are positioned closer to the ground, on your knees.

In all these modified planks, you're just leaning.

Pelvic Floor Exercises Are Okay

If your session included Pelvic Floor Massage Therapy, please know that you can start doing all of those exercises your therapist did with you during the session right away, and that the exercises are all safe to engage in during your postpartum time.

If you're unsure what these exercises are, you might want to schedule a session concerning this aspect of your healing, specifically, as there's a lot to go through.

When Is It Too Much?

Know the signs of straining your abdomen, the sensations and discomforts this brings, and quickly cease the activity that's causing this over-engagement. Even the exercises described above can be performed in such a manner as to cause too much abdominal contraction. Remember: You're trying for a gentle workout with the aim of healing, not a workout like you did preparing for a marathon with totally different goals.

If you've strained, or think you have, be sure to give your body a few days to rest before trying to work the abdomen again, even indirectly.

You can do these exercises daily.

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