Maternity Physio

Diastasis- Do I have one ? and how to heal it

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 What is a Diastasis?

Diastasis is a stretch in the connective tissue running down the middle of your tummy. This connective tissue joins the rectus (“six-pack muscle”) in the centre. This stretch in the tissue is quite normal during pregnancy but in some women it doesn’t resolve afterwards. The tissue remains stretched and leaves a gap between the rectus muscle. If the gap is more than 2 fingers wide it is termed a diastasis.

So what? Well it leaves you with a pot belly you may not want. But more importantly, it causes a weakness in the core (abdominals/pelvic floor/diaphragm/back muscles) and that is bad news if you don’t want to have back pain, pelvic pain, urinary incontinence or pelvic organ prolapse down the line.

How do I know you have a diastasis?

Not everyone with a pot belly and weakness around their middle will have a diastasis. You may just have some weakness in that area and be standing in a “still pregnant “ posture ie. pelvis tipped forward (more about alignment below).  You can test for a diastasis with your fingers. Lie on your back with knees bent, lift your head and shoulders from the floor. Use your fingers to feel the tummy at your belly button level, you may have to dig in gently, a bit. See if you can find the borders of the rectus muscle and then see how many fingers you can fit across the gap (if any). You can look at this video for a demonstration. Someone with a diastasis may notice stretched, crinkly skin in that area when standing or testing like above. If you have trouble checking it, a post-natal physiotherapist or qualified postnatal trainer can test it for you.

Ok, I do have a diastasis what can I do about it?

It`s important to also mention umbilical hernias at this point. That’s when some of the abdominal organs poke out through a particularly weak area of the connective tissue. This looks a bit like that scene from the movie “Alien” with Signourney Weaver. If you notice anything poking through the gap- go to your GP as that may need surgical repair. Right! That’s hernias out of the way, back to the diastasis and the solutions available to you.

A splint?? Some people have suggested splints or a corset that wraps around your middle and literally holds the sides of the gap together to allow it to apparently heal (alongside some strengthening exercises). It may be good for a little while to give you some feedback from the weak area. BUT, the problem with this is that the crinkly stretched tissue isn’t going anywhere just because you have pulled its sides together with a splint. It won`t allow any tension to be created in the stretched connective tissue. So a splint isn’t going to be much use in the long-term. Some great research by Canadian PT Dianne Lee found that on ultrasound activating the deep core muscles didn’t close the gap but it did create tension in the connective tissue. That tension is something great to build on and help give your body stability.

What about Sit-ups to strengthen the area? NO

Sit ups or planks (without a good pre-contraction of your deep core muscles like pelvic floor) will only exert an outward force on the abdominals, worsening your diastasis and a downwards force on your pelvic floor.

So lets talk about some good solutions now for diastasis now.

  • Alignment

“When are you expecting”. Not a question anyone likes to hear when they are not pregnant. I have been asked this (and felt like crying) on 2 different occasions about a year after having my first son not because I had a diastasis but because of the way I was standing. I was standing like I was still pregnant ie. pelvis tipped forward and tummy poking out and didn’t even realise it. Sometimes our posture forgets how we held ourselves before we were pregnant.

At present, there is a strong emphasis on alignment especially in standing when it comes to healing a diastasis, and it kind of makes sense. If you are standing with your ribcage hanging back or thrusted forward,  it is going to unzip an already open zipper at the front. This incorrect alignment will also make it difficult for you to engage the deep core muscles and get them working in synergy.  If you want to heal your diastasis you have got to learn how to stand right and keep standing right. It WILL make you stronger.

So try to keep your ribcage like a straight cylinder stacked over your neutral pelvis. (you can check this sideways in a mirror). With and without holding your child. This way you will be firing those deep muscles in no time and allowing your diastasis to heal

If you are having trouble maybe try this ski jump trick suggested by PT Julie Wiebe to achieve optimal alignment and connect with your pelvic floor.

Breathing

And “exhale”

Apparently new mums are bad breathers (something else to feel guilty about:)). Maybe as a result of having a baby pushed upwards against the diaphragm during pregnancy.  These are also some everyday habits we like to adopt that can alter our breathing pattern thus preventing a connection with your core and allowing the diastasis to heal

1) Sucking in your abs the whole time or “belly gripping”. Maybe you have gone to lots of exercises classes and you were told to draw your bellybutton inwards. You need to let this go and relax your tummy as sucking it in all day long causes an increase in abdominal pressure which pushes up against the diaphragm and down onto the pelvic floor so core muscles are not firing together.

2) Belly breathing. Taking big breaths into your belly can stretch a diastasis more. If you look down as you breath, does your belly rise and fall quite a lot? Then you may be a belly breather. Now imagine that 12 times per minute for every minute, that outward pressure on your diastasis will undo any good strengthening exercises you do

3) Upper Chest breathing. Look down again as you breath. Are your chest and shoulders rising up and down? This shallow type of breath isn’t allowing those core players to connect and your exercises will be inefficient at getting the strength back. Not to mention having a tight neck and shoulders the whole time

This video shows you what your ribs should be doing when you inhale, moving outwards like an umbrella. Breath into your diaphragm, this will allow the diaphragm and pelvic floor to work in synergy.

Ok, this is how to connect to your deep core muscles when you breath. Place your hands on the lower ribcage, relax your shoulders and tummy muscles. As you inhale you should feel the ribs move up and outwards. Look down to check your tummy and upper chest are not rising excessively. Now you can exhale, as you do so, purse our lips as if blowing a balloon. You should feel your pelvic floor and abdominals tension naturally. Yay! You have now connected with your deep core. Practice this till you get the hang of it and try to make umbrella breathing part of your everyday life. And you thought breathing was easy!

Nutrirition

Ensure you are having a balanced diet during this post-natal period and staying hydrated to encourage maximum recovery. I am not a dietician, but I am sure good nutrition is all part of a good healing process. If you want advice, you can find a registered dietician on the BDA`s site http://www.freelancedietitians.org/

Releases

Some tension in tight muscles like your obliques, pecs or hip flexors may be hindering your progress. They can be literally pulling you into that awkward alignment that exacerbates a diastasis, despite your hard work connecting and strengthening those deep core muscles.  You can have these assessed by a postnatal physiotherapist or try some stretches and releases with a tennis ball or a foam roller to see if you can find any tight spots.

Core Strengthening

When you have got all of the above working, then you can proceed with building strength in the abdominals.  Try some basic Postnatal exercises at first, then you will want to get into standing, do squats, pull-downs, lunges and step-ups, but don’t forget to carry through with the good alignment and breathing techniques mentioned above.

Keep moving, walking and buggy classes are a great way of keeping you fit and sane. Please contact me if you want a list of qualified post-natal trainers working in your area.

Good look with your journey. Remember if something doesn’t feel right, don`t struggle get in touch. The Mummy MOT check is an ideal way to assess your postnatal body including the abdominals and give you the right guidance to get you on track.