By Team Member: Shirley Srubiski

The most common reason mamas will seek our help is to get rid of their mummy tummy after having a baby…or two.

This bulging of the stomach is usually the result of a condition called Diastasis Rectus Abdominis. The increased intra-abdominal pressure during pregnancy causes the left and rights sides of rectus abdominis (the “six pack”), to separate leaving a thin sheath of connective tissue to provide support for the abdominal wall.  We explain this in greater detail here.

The best course of action is to minimize the risk of getting a diastasis in the first place… to do the work prenatally by following an appropriate exercise program. While the latest research indicates that up to 100% of women will have some degree of diastasis in their third trimester (Mota et al., 2015), the connective tissue can be trained to create enough tension and support to minimize the separation and also to significantly help with healing postpartum.

The good news is that you can rehabilitate these muscles and regain function of the abdominal muscles with specialized programs such as our Build A Mom package.

And remember – it’s not about the gap, but rather about the integrity of the tissue holding the two strips together. This support starts at the deepest layer of the abdominal muscles, known as the Transverse Abdominis, which also attaches to the connective tissue and pulls to create tension in and stabilize the torso. This stability can exist despite there being a space at the most superficial layer; your body just needs to learn how to create it.

Taking the following steps can go a long way to minimizing a diastasis and leave you with an easier pregnancy and recovery overall. It’s important to remember that a diastasis is not just about aesthetics, but a lack of prevention and treatment can leave you with some very real, and lasting dysfunction.

Practice the Foundation Breath
If you haven’t been introduced to the foundation breath, I highly recommend you check it out this video.  The Foundation Breath is probably the most important exercise you will ever do because it teaches your core muscles (pelvic floor, transverse abdominis, multifidus, and diaphragm) to work together to provide support and stability. It’s not just about doing your kegels any more; it’s about training the pelvic floor to work functionally with the other core muscles. This is an easy exercise to do and should be practiced daily throughout pregnancy.

Be mindful of your posture
We have all been told not to slouch, to stand tall, etc., but good posture is about much more. It’s about properly aligning joints so tissues aren’t stretched, twisted, or crunched but left at an optimal length to function at their best. During pregnancy, the abdominal muscles and their connective tissues are already stretched and weakened from the growing uterus and hormonal changes. Improper alignment will just pull and twist these tissues even further creating a recipe for dysfunction.

Proper alignment requires a conscious effort, so keep the following tips in mind.

  • Maintain a gentle curve in your low back and avoid tucking in your bum.
  • Keep the shoulders back and chest open.
  • The head should sit so the ears are over the shoulders and not stick forward.
  • Knees should be soft rather than in a locked position,
  • Weight should evenly be distributed throughout the feet.

Exercise
By exercise I do not mean sign up for a boot camp, in fact, please don’t. The growing trend to militarize fitness exercise has become associated with punishing the body. At a time when there are so many demands on your body to sustain a new and growing life this is the last thing a pregnant body needs. High intensity exercise programs such as crossfit, running, and heavy weight lifting will increase risk of ending up with a diastasis and/or pelvic floor issues such as incontinence and pelvic organ prolapse. With more weight and compromised stability there is inadequate core support for these activities during pregnancy.

Walking, stretching, and light resistance training are great options during pregnancy. Training the body’s stabilizers, increasing muscular endurance and incorporating corrective exercises allows for a smoother pregnancy and recovery overall.

Stay away from crunches or anything that puts you in a crunch-like position (e.g., v-sits and oblique twists) as these will increase the pressure on the abdominal wall and pelvic floor and create too much load on the spine.

Avoid front loaded positions such as planks and push-ups since the added weight and gravity will push on the separating abdominals and connective tissue.

Most importantly, listen to your body and don’t ignore aches and pains. If things don’t feel quite right or you are unsure of what’s safe to do, seek out the help of a qualified pre & post-natal fitness expert.

See a Pelvic Floor Physiotherapist
The pelvic floor and transverse abdominis are synergists; meaning they work together and when one isn’t working properly, chances are the other isn’t either. The evidence shows that 66% of women with a diastasis will also have some form of pelvic floor dysfunction (Spitznagle et al., 2007). A pelvic floor physio will assess your pelvic floor and abdomen and give you strategies and exercises to reduce dysfunction and prepare you for birth and recovery.  You can book an appointment with a pelvic floor physiotherapist who will come and see you in your home.

Prepare for your recovery
The most healing, without any outside interventions, of a diastasis happens within the first 8 weeks post-partum (Coldron et al., 2008). It is ideal to prepare in advance of this time. Since most women will have some degree of diastasis and because it’s difficult to get an accurate measure of this until the uterus goes back to its normal size (6-8 weeks) our philosophy is to treat each woman as if she has a diastasis and optimize this 8 week recovery period. Even if the tissues aren’t necessarily separated they have been through a lot and will need some degree of rehab. Once you and the babe come home there will likely be little time to think about restoring your core so the best strategy is to prepare ahead of time and have everything you need ready.

One of the best tools to help reduce and heal a diastasis is a belly wrap such as the Bellies Inc. AB tank and wrap. It’s meant to be purchased while you are still pregnant and packed in your hospital bag. Once the baby comes out the wrap goes on ASAP and is worn as much as possible for the first 8 weeks or based on your pelvic floor physio’s recommendations. In addition, schedule your post-delivery follow-up appointments with your physio ahead of time so you have one less thing to worry about once you come home.

This is a time for rest, to heal and to bond with your babe. Give yourself the time and the tools to properly restore your body.

Start NOW
Whether you are thinking about having babies, pregnant with your first (or fourth), or if you are finished making babies, the time to start working on core stability is now. It is never too early or too late to create a strong and functional core.

Shirley Srubiski is a Registered Kinesiologist who strives to create a fun environment where clients are motivated to reach their fitness goals. She is passionate about helping individuals move better, feel stronger, and achieve healthy, active lifestyles.