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Diastasis and your gorgeous mama belly.

 In Diastasis, Injury prevention, Motherlife, Movement, Pilates, Postpartum, Pregnancy

A lot of pregnant women I work with are really concerned about Diastasis developing in their belly.

Diastasis Recti (DRAM, or DR) is when the midline of your abdominal wall stretches, thins and in some cases separates. Think of the midline of the six pack muscle thinning and stretching apart.

This happens to ALL pregnant bellies! And to some non pregnant bellies too.

A Diastasis during pregnancy is actually good!

It happens because your abdominal muscles need to stretch A LOT to make room for your growing baby. And the connective tissue between the two sides of your abdominal muscles needs to stretch too. 

A 2015 study showed that 100% of women have some degree of Diastasis at 35 weeks pregnant (1).

This same study also showed that a large percentage of abdominals heal easily after birth within six months. But sometimes a DR will stay stretched after birth and so retraining the abdominals might help to recover optimal function. In some cases, surgery might be even be needed. But not before trying rehabilitative movement and bodywork strategies and seeking help from a womens pelvic health practitioner.

A Diastasis is measured in finger width and depth.

So how many fingers can you fit in the space between the edges of the abdominal wall? And how deep do they sink into the tissue? Two fingers wide or less is considered normal. Wider than two fingers might be normal too, but could also mean your body needs extra help to recover. And, the depth of the squishiness matters. Creating a firmer squish is an important part of the recovery process.

So Diastasis Recti during pregnancy is the normal stretching and thinning of connective tissue that connects the edges of your belly muscles. It occurs to allow space for your growing baby. Thank you amazing and wonderful mama body!

Although a Diastasis is considered a normal part of pregnancy, it’s also possible to consider how you might protect your abdominals to prevent injury. So that when a Diastasis does occur, it stays within a healthy, functional range. Because a more severe diastasis can take longer to recover and be more difficult to rehabilitate after giving birth.

Four ways you can help protect you belly from injury and prepare for easier healing after birth are;

  1. Considering how you align your body during your everyday life.
  2. Learning how to activate your abdominals to stabilise your pelvis without bracing and doming.
  3. Modifying the way you move your body.
  4. Nutrition – what you eat and how hydrated you are.

Alignment

Your everyday alignment is crucial to the way load is transferred through your abdominal wall and midline. By aligning your body in a way that puts pressure out into the abdominal wall you can make a DRAM more severe than it might otherwise have been. Think of it like misaligned wheels on you car and all the extra wear and tear that creates. It’s the same with you body. Mis alignment creates wear and tear and eventually injury. It’s easier to prevent injuries than rehabilitate them, so I wonder what you can do to protect your abdominal midline?

How do you stand or sit? What’s your habitual alignment, or posture?

Do you stand with your pelvis slung forwards, your tail tucked under and your ribs leaning back to counterbalance? Or do you arch your lower back and let your tail stick out behind you whilst collapsing your ribs downwards. These are ways of aligning your body that send pressure out towards your belly and down into your pelvis. This creates extra stress and stretch on the midline abdominal tissues. When your belly is already stressed and stretched during pregnancy, it’s a good idea to decrease the amount of extra pressure going out into the abdominal wall as a result of your habitual alignment.

Did you know there’s an optimal alignment for standing?

It has to do with the relationship between your ribs and pelvis.

Neutral Pelvis has your pelvis balanced right up over the top of your ankles with your pelvic bones in ‘neutral’ –  neither over arched nor over tucked. You could try standing with your tailbone tucked way under to see how it feels. Then untuck and stick your tailbone way out behind, can you feel the difference in those two pelvic positions? Neither of those is ideal for long periods of standing. Now see if you can find the middle point as best as you can. This is the neutral pelvis position. Of course you won’t keep your pelvis in this neutral position all of the time! But you can keep coming back to this middle point – ‘neutral pelvis’ – whenever you remember throughout the day.

Neutral Ribs has your rib cage balanced over the top of your pelvis. The space between the ribs and the pelvis is lengthened, not just the front ribs, but the side and back ribs too. The ribcage is ideally evenly stacked over the top of the pelvis. Imagine as if your torso, from the base of the ribcage to the base of the pelvis, were shaped like a tin of beans. A closed canister with the the ribs stacked parallel over the pelvis. 

If you tip your ribs backwards at the top you compress your lower back and stretch and split the front of your bean tin and the beans all fall out. We absolutely want to keep your beans in the tin! 

Of course, your bones don’t actually make the shape of a bean tin, this is just an image to give you a sense of the way your rib cage and pelvis can align in relation to one another.

Play around with this alignment in front of a mirror and see if you can get the hang of aligning the ribs over the top of the pelvis to create this ‘tin of beans’ alignment. Of course if you’re pregnant you also have a baby bump to accomodate, but you still want to align the boney parts, the top of the bean tin (the lower ribs) with the base of the bean tin (the base of the pelvis) as best as you can. This is for whenever you are upright like standing, or sitting tall like at a computer.

Bracing and Doming abdominals.

One common way of activating your abdominal muscles is to ‘brace out’. Sometimes this happens when you’re doing an effortful movement like lifting a heavy box, or your toddler. You press out into your abdominal muscles as if pushing your abs out into your waistband to create the feeling of strength and stability to feel strong enough. You can recognise the bracing action easily during pregnancy because ‘bracing out’ will often create a ‘doming’ or ‘triangle’ like shape down the midline of your abdominal wall. It’s possible that ‘bracing out’ or ‘doming’ with your abs throughout pregnancy might contribute towards developing a wider diastasis which could be more difficult to rehabilitate after giving birth.   

Instead, learn how to activate you abs deeply and safely by hugging your baby in and up as if lifting your baby up underneath your belly button. This hugging motion helps to create more of the stability and strength your body needs when doing difficult movements, but in a safe way that doesn’t over stress or strain the tissues.

What movements might contribute to Diastasis?

There are certainly some exercises and movements that are best avoided during pregnancy. But every body is different. And every body can manage different movements with differing amounts of pressure going safely through their abdominal midline. 

Its a good idea to avoid any movement that create’s the ‘bracing out’, doming effect on your belly. Because ‘doming’ tells you that you’re over loading your core, and not in a good way. And whilst your belly might be ok, it might not either.

So are there specific movements and exercises you should avoid during pregnancy?

Exercises such as traditional ‘sit ups’, or holding a plank position, or even a downward dog in yoga are common ways to over stress the midline during pregnancy. But so is carrying a heavy toddler, pushing a heavy shopping trolly, or lifting a heavy basket of wet washing. If you find that any movement creates the doming effect in your belly, then that’s a good movement to avoid, or to modify. Perhaps you can do a plank with your knees down, or take some of the wet washing out so the basket isn’t so heavy.

Another everyday movement to be careful with is getting up from lying down, especially from your back. As in when you wake up in the morning, instead of sitting up by rolling up as if doing an abdominal curl up or jack knife type of movement, it’s better to roll lazily onto your side and use your hands to help push you up to sitting. Likewise when moving from sitting to lying down use your hands to support you onto your side before then rolling onto your back if you wish.

It’s the way you do a movement or exercise that matters rather than the exercise itself.

If you can do a movement without bracing or doming and you enjoy it, then go for it! But if your abs ‘dome’, then you could be doing damage, so don’t do it, or modify the movement until your abs stop ‘doming’. That goes for any movement whilst pregnant. It’s good to avoid movements that overload your core from the point in your pregnancy when you just feel really super stretched. And this is most likely from sometime during your second trimester.

Also, any movement that makes your abdominals dome like this needs to be modified or avoided until well after birth (until about sixish months postpartum) when your connective tissue has had a chance to recover. Of course the length of time for healing is different for every woman. For some it may be four months and for some it may be more like two years! If you’re not sure if your body is healing as well as you’d like then please do see a womens health practitioner such as physio, osteopath, chiropractor or postpartum corrective exercise specialist.

Nutrition

Nutrition plays a crucial role in how your body manages pregnancy and heals afterwards. What you eat impacts the health, elasticity, and integrity of your connective tissue, your muscles, bones, tendons and ligaments. Your abdominal midline is made up of connective tissue and is immensely affected by what you eat and how hydrated you are.

It’s a good idea to include basics like vitamin C, healthy fats, and collagen supporting foods such as leafy greens into your prenatal diet. Naturopath Kate Harrison of www.littleyarrow.com also suggests including the following nutrients specifically for tissue health, in your pre/postnatal diet; Protein (builds and repairs tissue), Zinc (collagen production), Copper (collagen production), Silica (collagen production) Vitamin A (builds, supports and repairs connective tissue) and bone broths if you’re not vegetarian.

How you are in your body every day affects how your muscles function.

Of course every woman is different and has a different body structure, muscle tone, diet and movement or exercise history.  Simple changes to alignment and better awareness of how you move your body can help to protect your body during pregnancy so as to prevent a Diastasis from becoming too stretched.

How you sit, stand and move your body, impacts your alignment and creates stretch and/or tension in the muscles and connective tissue in either a healthy or a not so healthy way. And what you eat influences the make up of your connective tissue.

So during pregnancy, take good care of the basics. Eat deeply nutritious food and keep hydrated. Learn how to connect you abdominal muscles by drawing them in and up instead of bracing out and ‘doming’. Pay attention to your alignment and how the way you move your body impacts the way your belly activates.

Lets keep your body healthy, functional and strong through pregnancy so you can also be healthy and strong afterwards as well. It’s often much easier to prevent injury rather than rehabilitate it. So take care of your belly during pregnancy. You’ve only got one and she’s truly amazing.

Your long term health and well being is so very valuable and important.

If you want to learn about helping your body recover better after giving birth, you can get a FREE guide right here.

(1) https://www.ncbi.nlm.nih.gov/pubmed?term=((Prevalence%20and%20risk%20factors%20of%20diastasis%20recti))%20AND%20da%20mota

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