Diastasis Recti – What Is It and How To Correct It?

Diastasis Recti is also known as abdominal separation and is most common in postpartum women and newborn infants. I am really only going to get into the postpartum women for today. The two sides of the rectus abdominis muscle are normally attached down the middle at the linea alba... the midline of the body. During pregnancy, due to the stretching of the abdominal muscles from the growing uterus, these muscles can become separated. Some women have such a small split, they can go through life not even knowing it has happened to them. Others, like myself, can end up with a split going from the xiphoid process (bottom of your sternum) to the belly button. This may be gross for some of you... but, I was able to stick my hand through my stomach muscles after the birth of my second little girl. No fun. I also ended up with two hernia's. So, until these hernia's were corrected by surgery (I highly recommend the Shouldice Clinic in Toronto... but, that could be a whole other post), I could not even correct the split. I had to make sure I did not strangulate the hernia's. Once these corrected, I was able to begin the rehab for my abdominals. Although the two sides will never re-attach, you can train the muscles back to be side by side again.

So, how do you know if you have split your abdominal muscles? Start by laying on your back with your knees bent. Place four fingers of one hand above your belly button and the other hand below your belly button. Raise your head and shoulders off the floor and feel to see if there is a separation of the rectus abdominis muscle. Is there a gap or bulge? Is it above or below your belly button? Lower your head and shoulders back down to the floor and start the next part of the test... if there was a separation. Stay on your back with your knees bent, place four fingers of one hand across the separation, pointing down towards your feet. Raise your head and shoulder off the ground. How many fingers can you fit in the separation? Being able to place one or two fingers in the gap is normal, any more than that, you have diastasis recti.

So, now what? It may seem like it is impossible to correct this split and at times, you will get discouraged. That is natural with any kind of rehabilitation. Here are just a few things you need to know...

What to avoid...

Crunches... that's right, DO NOT do crunches to correct an abdominal split. This will force the muscles out to the side and train the muscles incorrectly.

Sit-ups

Anything that jack-knifes the body – v-sit, straight leg lifts, some pilates, etc.

Getting straight up from a laying position – turn onto your side and push up from there.

Laying on your back over a Stability Ball.

Yoga poses that stretch the abs – up-dog, cow pose, ect.

Core exercises that require you to lift your head off the ground – modify these to keep your head down

Anything that causes your abdominal wall to bulge out.

Lifting / carrying heavy objects.

What to do...

Example Exercise for the Transverse Abdominis

Tummy Vacuum – there are many different versions of the tummy vacuum. This can be done on your hands and knees, with a ball behind your back, while standing and brushing your teeth, etc.

Table Top Single Leg Lowers – just be sure to hold your belly button in your spine. Do not let your lower back and abdominals release.

Leg Slides – begin with feet on floor, then work up to lifting them 2”-3” off

Side Plank

Side Plank Raises

Crunches with Stability Ball or Bender Ball ***depending on the stage of your rehabilitation***

Table Top

Reverse Crunches

Plank ***depending on the stage of your rehabilitation***

With all of the above mentioned exercises, it is EXTREMELY important that you are constantly aware of your abdominal wall and you make sure that you are pulling your belly button up and back, into your spine. This will ensure that you are actively engaging your Transverse Abdominal muscles and that you are on your way to a speedy rehab.

There is some question out there as to whether plank is safe to do with Diastasis Recti or not. All the research I have done comes down to this... as long as you are doing plank properly, yes, plank is safe. I personally did plank daily as part of my abdominal rehabilitation and it worked! That being said, you should make sure to properly support your stomach and really think of pulling your belly button up into your spine. This ensures that you are engaging the Transverse Abdominis. Plank will actively engage all the muscles of your midsection, including the rectus abdominis, external & internal obliques, transverse abdominals as well as the lower back... not to mention the glutes, lats, delts and pecs! This exercise truly a full body workout and I highly recommend it be added to all programs... again, as long as it is done properly. This is where a trained professional becomes necessary. Certified Personal Trainers are able to help you maintain proper posture and ensure safety throughout your workout. When dealing with Diastasis Recti, make sure you find a trainer that has the experience dealing with this specific problem. Not all Pre and Post Natal Specialists have dealt with Diastasis Recti and without the knowledge and experience necessary, they could cause more damage to the abdominals.

I am constantly researching Diastasis Recti and Postpartum Fitness. At this time, I am actively researching the affect of plank and diastasis recti. If I do find any strong evidence that plank should not be done while correcting an abdominal split, I will add a new post right away. The world research on postpartum fitness is still so new. Recommendations are changing constantly. It is important that you find a trainer that can work with you and is actively up to date on all things related to postpartum fitness. It is too easy to get certified and then just fall behind the times. If you are thinking about getting a personal trainer, meet with them first. Talk to them and see how you feel at the end of the meeting. Go with your gut and make sure they are properly qualified. This can be a whole other post... maybe it will be one day!

If you have questions, feel free to contact me. If you like my little tips and blogs, follow me!

Sandra

Twitter - @BeachesFitness

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www.beachesfitness.ca

What Parts of the Body Should You Exercise After Giving Birth?

If you want the simple answer... all of them!  Each area of the body should be exercised, but all in their own way and for their own reasons.

The upper body is important to strengthen, now that you are going to be carrying around an ever-growing baby as well as their car seat, diaper bag and don't forget your purse!  Also very important to strengthen and correct the posture in the upper back for the hours and hours of breast-feeding or bottle feeding.

The core, well, besides the obvious reasons of toning up the stomach muscles that have been stretched and sometimes separated during pregnancy, this is also the fact that the core supports your entire body and weak stomach muscles are going to lead to poor posture and a sore back.  Each case has to be looked at individually though.  After my first pregnancy, I had split my rectus abdominis muscle, this is called Diastasis Recti.  After my second pregnancy, this split was worse.  The muscles were split from top to bottom and I could stick my entire hand in my stomach.  I also had 2 hernia's to deal with.  I could not do any crunches or any other abdominal that required that same action.  But, through research and years of experience, I found the combination of exercises that worked and my muscles are now side by side again.  they will never re-attach without surgery, but as long as I maintain them, you would never know the difference.  If I had gone to a post-partum class or personal trainer that did not know about my issues, I could have done far more damage and possibly strangulated my hernias.  So, again, the exercises for the core section are determined more by the clients pregnancy, delivery and recovery.

The lower body is extremely important to exercise, not only for aesthetics, but also for weight loss in general.  The larger muscle groups require more energy and therefore burn more calories.  The larger the muscle group worked, the more calories burned during a workout.  The more muscle mass a person develops, the faster their resting metabolic rate... so, they will burn more calories at rest than they would if they did not have toned and healthy muscles.

While breastfeeding, the body is still releasing a lot of the same hormones as it did during pregnancy.  One of the main ones being relaxin.  This hormone is intended, by your body, to relax and open the pubic bone in preparation for birth.  But, the hormone can not zone in on just one area and it affects all joints in pregnant women as well as breastfeeding moms. So, the one thing you do need to be careful of is over-stretching.  Stretching is still important, but you have to make sure not to hold the stretch for too long or push too far.

How Soon Can a New Mom Return to Exercise?

Wondering how soon you can return to an exercise program after giving birth?  The standard answer is 4-6 weeks, but research is constantly changing and expanding in the field of pre and post natal exercise.

An athlete, that enjoyed a healthy pregnancy and a complication free, vaginal birth, could return to training after as little as a week.  This is the extreme case, and should only be done under the supervision of a professional.  But, for the rest of us, it all depends on your pregnancy, your delivery and your recovery.  Every woman is different, and so is every pregnancy.  

Generally, after a healthy pregnancy and a complication free, vaginal birth, a new mom can return to exercise after 4 weeks.  After a c-section, the soonest I recommend is 6 weeks.  For both cases, it all comes down to if the doctor or midwife has cleared you for exercise and how you are feeling.  Please, listen to your body!  I offer modifications to all the exercises in my Mom-Friendly Fitness classes, because every case is different and the most important thing to remember is to listen to your body.  I ask that all my moms (well, all my clients), communicate with me openly.  If something feels uncomfortable or hurts, we can always work around it and still get results.  Any trainer should be able to offer modifications, but especially anyone that works with pre and post natal clients.

I have had clients start with me 1 week post-partum, and I have had mothers that have waited well over a year.  Each case, the mom has done what works for her.  The sooner you return to exercise, the easier it will be to loose the baby weight.  It is important for each mom to decide what is best for her physically and mentally.

Group Fitness Classes with Toddlers and Preschoolers

After having my first daughter, I signed up for Stroller Fitness and Baby & Me Fitness classes. I loved them both and continued them until I had to return to work. I lost all the baby weight before returning to work and I had enough energy to get through the day. My daughter also loved the classes, and it was nice to have that time with her since it was benefiting both of us.

Once I returned to work, I also starting working part-time as a personal trainer. I introduced Mommy & Me fitnuyouess classes to the club I was working at and continued to workout through my 2nd pregnancy.

It was not until after I had my 2nd daughter that I had a hard time getting back into shape. I could not find a class that would allow me to bring both kids to the class and my daughters hated the gym daycare... and they would go ANYWHERE but there! That is when I realized that there were no classes for moms and their kids once the kids turned 16 months old! Even Stroller Fitness classes would not allow toddlers! So, I decided to start my own business and offer the classes myself. It enabled me to work with my kids by my side, but it also gave a lot of moms the opportunity to exercise with their kids close by. I started by offering Baby Fitness classes in a local church basement, and added Stroller Fitness classes in the local park once the weather warmed up. I designed the classes so that the moms with young babies could wear and incorporate the kids into the workout or so the moms with the older toddlers and preschoolers could get in a great workout, while their kids played in the attached playroom. The classes slowly gathered interested and I am now offering classes in the Beaches, Upper Beaches and Leslieville. I am looking to expand into other parts of the East End of Toronto, but it all takes time to gather enough interest.

I still have my youngest come with me to the class once a week, but the rest of the time she is in Nursery School. I am lucky enough to be able to keep my kids with me while I work and I love it. My oldest is in JK now and only gets to come to the classes on PA Days, and she asks constantly if she can come. They both love playing with the other kids and babies.

I love teaching the classes. Some moms are more determined to lose the baby weight than others, but they are all looking for a welcoming, social atmosphere and I try my best to offer that. All the kids (my own included) have good days and bad, but overall, it is a mom and kid-friendly class and we all have a great time!

I started my business as a way to help moms that have a hard time finding the time, energy and money to exercise. My own kids are growing quickly and soon I will not have either of them tagging along to the classes, but I will continue to offer these classes in order to help the moms out there with kids over 16 months of age. Of course, babies are welcome as well. I have moms that started with me 4 weeks postpartum with their first baby and are now still with me with their 2nd child (some still on the way)! It is great to see the babies and families grow!

Benefits of Exercise For All Women

The changes that a womens body experiences throughout pregnancy and the first year postpartum are dramatic and have an affect emotionally, physically and mentally.

BENEFITS OF EXERCISE

Exercising on a regular basis will help improve your immune system. You will sleep better at night and notice increased energy during the day. Depression and anxiety can easily be controlled by a regular workout routine. Cravings for sweets and junk food will quickly be replaced by an increased appetite for natural, wholesome and nourishing foods, helping you improve your overall health. Increased flexibility and muscular strength will improve skeletal balance and reduce the strain on your body which can lead to injury and pain from day to day life.

BENEFITS OF EXERCISE DURING PREGNANCY

One of the most important ways to prepare for pregnancy and childbirth is proper exercise. A regular workout will help with circulation (reducing the middle of the night leg cramps that we all love!), digestion (reducing the heartburn that a lot of pregnant women experience), and constipation (if this was not uncomfortable enough to experience during pregnancy, constipation can also lead to hemorrhoids). Hormones released throughout pregnancy cause muscles and ligaments to loosen, requiring greater muscle tone and proper posture in order to avoid further discomforts. Exercise can help an expectant mother deal with her changing body (and body image) that very often affects her self-esteem. Pregnancy is a time to be proud of your body and show it off to the world... you are carrying a new life in your belly, be proud and let the world know it!

BENEFITS OF EXERCISE IN PREPERATION OF CHILDBIRTH

The demands of labour and delivery differ for every women, but one thing remains the same – you must be prepared mentally and physically. The abdominal muscles must be strong and you must be able to focus on how you are using them. Learning how to “feel” the correct muscles in your core is an integral part of the prenatal fitness training. Strengthening exercises for the pelvic floor, cardiovascular endurance and flexibility training are key components to an effective prenatal fitness routine. All of these components will aid you through the delivery process as well as the postpartum recovery and leading into the years of taking care of your new baby. Returning to your pre-pregnancy fitness level is much easier to achieve if you remain active throughout the 9 months.

BENEFITS OF EXERCISE IN POSTPARTUM PERIOD

So, now you have had your baby and you feel like you are stuck at home. This is the most important time to get out of the house, stay healthy and interact with other mothers. Emotionally, this time can be a roller-coaster ride for most women. Most women are exhausted due to lack of sleep, are sore from the recovery process and carrying a new baby around all day, worried about regaining their pre-baby body and feel isolated from being home alone with a baby all day. Exercise can help with all the above concerns. Emotionally new mothers need the support of other mothers that understand what they are experiencing. They also need to take some time to take care of themselves in order to be better prepared and able to take care of their babies, who are completely dependent on them for nourishment, comfort and most importantly – love.

Finding Time for Mom

So, any women (ok, most women) that have had a baby, knows what it is like to battle with your body image after birth. Most of us go through the same battles... how to feel good about yourself when you are not happy with your body, you are overtired and have circles under your eyes, you are at the beck and call of your new baby (so how can you possibly take care of yourself), you question if you are doing the right things for your child and if you are a good mother... you pretty much question your entire life!

I went through the same issues after having my children. I did not want to even leave the house I was so depressed about my body and my overall appearance! I tried to workout at home when ever I could, but I never seemed to have time to complete a workout... if I even had the energy and motivation to start one! I tried to find a place that I could take my kids with me to workout, but there did not seem to be any options. The child care rooms in the big gyms were all so cold and closterphobic... even my oldest daughter would not stay in there without crying most of the time (and she would go to anyone, anywhere)!

Once I moved back to Toronto, I decided to create a personal training studio that was mom-friendly. There was a gap in the fitness world and I felt the need to fill it. I turned a basement appartment into a personal training studio (still constantly being improved, but it is a great space for now) and made the bedroom into my office and a playroom for the kids. It has worked out so well! Moms can come in with their kids and know that they are safe and happy while they work out. The kids are more than welcome to come into the studio to check on mom and tell them a quick story, but of needed, the gate can be closed and mom knows she can have some time to take care of herself... for once! I kept my playpen and baby rocking chair, along with a bin of baby toys, so even the younger infants can be amused while we whip mom into shape. I have always allowed for a flexible schedule... I mean, I am working with a lot a moms, I know life does not always go as planned with young kids around... plus, my commute to work is pretty good... down a whole flight of stairs, not so bad, so I can always change my schedule to suit my clients needs.

I love the women that I have met. We get the moms back into shape, discuss various challenges as a mother and wife (yes, we talk about you boys), give each other advice on potty training, sleep (or lack of), discipline... anything moms need to talk about. I have been able to help some wonderful women with their overall health, fitness and confidence - if only I could have found someone to do this for me! I am so happy with my decision to open a private studio! I have thought about expanding into a larger studio space, but for now I love the cozy atmosphere that only a home run studio can offer.