CategoriesUncategorized

How to Correct Diastasis Recti and Turn It Into a Bulletproof Core

As a card carrying member of the Y chromosome I did not write today’s article.

This isn’t to say I lack the confidence or knowledge to do so – in fact, I’ve gone out of my way in recent years to educate myself more on postpartum issues so that I am better prepared to work with & help my female clients.

It’s just I feel this is a topic in better hands with a woman. And not only that, a woman who has had firsthand experience with diastasis recti.1

I don’t feel this is a controversial take.2

If you’re someone – man or woman – who works with postpartum clients it will behoove you to read this article via Certified Personal Trainer and Postpartum Exercise Specialist Gina Paulhus.

She does an excellent job providing actionable solutions to a complex problem.

Hands of physiotherapist checking diastasis recti on belly of postpartum woman

I Can Teach You How to Improve Diastasis Recti with Exercises Anyone Can Do

Have you been told you have diastasis recti? Or have you figured it out on your own while spending some quality time with Google? While it can be scary to think that you have a “hole” in your abs, take heart – there are many non-surgical options available.

I have healed my own diastasis as well as two large hernias with a natural, exercise-based approach. This outcome was confirmed by ultrasound. My healing happened after several surgeons told me that my only solution would be to get total abdominal wall reconstruction – with mesh! 

Note From TG: puh!

What is Diastasis Recti, Exactly?

To answer that question, a bit of anatomy is in order. The two sides of your abdominal wall connect in the middle on a line of fascia called the linea alba. 

This line appears between each and every person’s “six pack” muscle, otherwise known as the rectus abdominis. When that tissue in the midline thins out beyond a certain point it’s known as diastasis recti. Pregnancy is the most common reason a person develops a diastasis.

While more women develop diastasis, it can totally happen to dudes as well.

Certain workouts and non-optimal daily movement patterns can both make a diastasis worse, which is why it’s important to identify when you have a diastasis so that you can take steps to nip it in the bud. 

Hey, Fancy-Pants: You Can Measure Your Own Diastasis

You can measure your diastasis by barely lifting your head and checking the width and depth between the two sides of the rectus abdominis muscles. Anything greater than two and a half finger widths is going to qualify you as a card-carrying member.

You also want the area to feel on the firm side – think trampoline-like. Broken trampolines are no bueno. A doctor, PT or Postpartum Exercise Specialist will be able to assist you in checking if you’re unsure. It’s always going to be a bit of an estimate when using fingers. Ultrasound is the gold standard on whether or not a diastasis is present.1

Every pregnant woman has a diastasis at their due date, so it’s normal at that point in time. By some estimates 39% of women have a diastasis at six months postpartum.2 Because of that peeps, we can’t necessarily assume that everyone will bounce back the same way after giving birth! In other words, stay clear of those show offs on the ‘gram who are hoisting cars overhead a few weeks out from giving birth. The other thing to know is that diastasis can become a greater problem with each subsequent birth because the tissues will stretch faster the more times they have been stretched out before.

Oftentimes if a woman is “fine” after one child she is shocked when, by her second or third child, things have changed a lot in her abs. For other women, the first pregnancy has already led to a diastasis that didn’t resolve.

Everyone is different and each pregnancy is different. I CAN’T EMPHASIZE THAT ENOUGH. The nice thing is, once you know how to correct diastasis recti, the same principles can be utilized during any future pregnancies to keep yourself safe.

And then maybe, you too can hoist a car after giving birth next time (I mean, I wouldn’t).

Young sporty woman with in training

What’s the Big Deal About Having a Diastasis?

A huge part of our core’s job is to be able to handle pressure generated in our body. This pressure is generated when we work out as well as during daily activities. We generate pressure in our core in order to protect our spine. If pressure is generated poorly, it can result in a diastasis forming.

By learning how to fine tune our pressure management, we put our bodies into a position to undo the damage. HOW COOL IS THAT? IT’S LIKE MAGIK. 

How do you know your limit of how hard you can push? If you see a doming out of your midline during exertion, it’s a telltale sign that you have a diastasis and that what you are doing is making it worse. A poochy lower belly that sags and protrudes is another red flag to watch out for.

via GIPHY

Can’t I Just Have Surgery For My Diastasis?

Yes, surgery is an option. However, I will warn you – even if you choose to get surgery, that doesn’t mean your work is done.

If you haven’t taught yourself how to better manage pressure in your core, the diastasis could very well return. And if it does, the additional scar tissue you will have accumulated might cause more problems. 

via GIPHY

You also will become weaker while you lay dormant waiting for your surgery to heal – the exact opposite of what a diastasis needs, which is more core strength!

Rather than skip immediately to surgery, I would much rather see folks learn how to manage pressure in their core.

This sets them up for success in healing a diastasis naturally, as well as leads them to the best possible post surgical outcome if surgery is chosen. Either way, learning proper pressure management is where it’s at when it comes to healing a diastasis.

There are particular muscles that need to be called out and worked when you’re looking to correct diastasis recti.

  • Learning to contract a special “corset” muscle deep in your abs called your transverse abdominis (TAs) before you perform an exercise can help create tension across your midline. Once that tension is in place, it means that you get the green light to work your core. And working your core is what you so desperately need for healing. Fascia requires stress to heal. But like goldilocks, not too much and not too little is best.
  • Your pelvic floor works as a team with your TAs, so we want to make sure that it is up to snuff. It may be tighter or looser than we want for optimal functioning. Leaking pee when coughing, sneezing or exerting is a sign that things are amiss.
  • Working on how you breathe can go a long way toward healing a diastasis. When our breathing technique is off, it loads excess pressure on your diastasis, preventing the fascia from healing. The diaphragm is a critical muscle for our breathing function.
  • Other muscles can affect how our core loads too. Take inventory of your serratus muscle (the muscle just in front of and under your armpit) as well as your glutes. Both can have a huge impact on healing a diastasis. 

Muscles need time to heal after getting stretched out due to pregnancy or other causes. Rushing right back into all the exercises you did before is a recipe for keeping a diastasis present – or for making it worse. DON’T FEED THE MONSTER! Fascia can heal when we support it with the right environment, but the timing of when we challenge it versus when we let it rest matters. A lot.

Tackle Correcting Your Diastasis in these 4 Steps

Step 1: Work On Your 360 Breathing

 

This exercise will help improve the amount of pressure that is pushed out toward your diastasis, whether we are talking during exercise or during everyday life. Bad habits in daily life can undo a lot of high quality exercise, FWIW.

Step 2: Find Your TAs, Otherwise Known As Your “Corset” Muscles

 

You’d be surprised how many people’s TAs are completely out to lunch! It’s common for the bigger ab muscles to do all the work after a diastasis has formed. Unless we specifically perform an exercise that forces them to come back on board, the TAs could be lost forever.

Don’t let that happen people!

Step 3: Test How Stable You Can Keep Your Core While You’re Moving Your Limbs

If you feel any movement at all in your pelvis, slow the move down, or simply don’t extend your leg as far. This exercise will greatly improve the stability of your core – something everyone with a diastasis so desperately needs.

Step 4: If You’re Having Trouble With Any of the Above Exercises, You Might Need to Do Some Release Work

 

While a professional massage is great, ain’t nobody got time for that on the regular. This technique is great to do at the beginning of your workout to make performing the above exercises easier. And heck yeah, who wouldn’t want to make exercises easier?

What’s Up With Those Abdominal Binders?

They can be a good idea when you’ve just had a baby to use something to help support the abs. But hold up – after the first six weeks I don’t recommend wearing one, and here’s why.

  1. Binding the abs can create more pressure down on the pelvic floor, which can contribute to other issues developing such as pelvic organ prolapse. Bottom-up support in the form of a pair of supportive shorts are safer if you must use some external support.
  2. As I said before, fascia needs some stress to heal. It’s similar to the idea of wearing an ankle brace for the rest of your life – if you do that, your ankle will never get stronger.

You can always apply tape to your abdomen while trying to bridge the gap between wearing a binder and going with nothing. I know many folks who have healed their diastasis who swore by the tape. I like Rocktape best for this, although KT tape can also work. And you also get to cover yourself in brightly colored strips so that randoms can ask you questions.

It’s a great ice breaker. 

What are the Keys to Healing a Diastasis To Completion Once and For All?

Why, I’m glad you asked.

1. Build a more efficient and effective breathing pattern.

Good breathing patterns help our structure and also prime our nervous system to push out the optimal hormones to heal. The 360 breathing drill in the video above is a great start.

2. Improve posture.

Poor posture puts a ton of pressure out on a diastasis, preventing healing. Good posture, in a nutshell, involves stretching tall and stacking our ribcage over our pelvis well. Make grandma proud, yo!

3. Perform exercises that strengthen the full body.

When the rest of your body is strong, less pressure is applied to the abdomen. Strong glutes and a strong pelvic floor in particular really matter for how a diastasis heals! Since your pelvic floor can be too tight or too weak for optimal functioning, it’s important to figure out what’s going on with yours. See my article on prolapse here for more information on the pelvic floor.

You can also read more about leaking here.

4. It’s not enough to have strong abs.

They need to be balanced! A corrective exercise specialist can check out how your muscle balance is looking and prescribe a workout plan to help. If you need help with the other muscles I mentioned as well, such as the serratus or the glutes, once again a corrective exercise specialist can save the day.

5. Whatever you do, STOP DRAWING IN YOUR BELLY in an attempt to support your diastasis!

This is only going to make things worse since it interferes with the natural functioning of your core. Take my word for it. The halter tops will have to wait.

Remember, I have healed my own diastasis as well as 2 large hernias with this exact full body approach. This outcome was confirmed by ultrasound. My healing occurred from committing to an exercise plan after a few different surgeons told me that my only solution would be to get total abdominal wall reconstruction with mesh!

About the Author

Gina Paulhus, CPT and PCES Certified, has been a personal trainer for over 20 years. Through her company Home Bodies she offers in home as well as Zoom 1:1 Personal Training. Gina’s passions include helping men and women heal from a diastasis as well as from hernias. She is a two time author. Gina is also the creator of the world’s first Adult Gymnastics Camp.

Sources

1 A T M van de Water 1, D R Benjamin 2. Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): A systematic review of their measurement properties and meta-analytic reliability generalisation. 2016 Feb;21:41-53. DOI: 10.1016/j.math.2015.09.013

2 Patrícia Gonçalves Fernandes da Mota, Augusto Gil Brites Andrade Pascoal et. al. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Observational Study Man Ther. 2015 Feb;20(1):200-5. doi: 10.1016/j.math.2014.09.002. 

CategoriesFemale Training personal training

A Thoughtful and Reflective Discussion On Postpartum Training

My son, Julian, was born January 31, 2017.

Four days later my wife, Lisa, accompanied me to the gym.

The workout wasn’t anything crazy. There were no burpees, no deadlifts, no squats; hell I don’t even think there was a barbell involved.

If anything, the field trip served as more of a rendezvous back to normalcy for us.

Our world had just been knocked the fuck upside down during the previous 96 hours, and, after the shellacking we had been taking, a lifetime in Azkaban would have seemed a better alternative.

So yeah, heading to the gym, even for 20 minutes, was exactly what we (she) needed.

It was an oasis for us.

Copyright: realstock / 123RF Stock Photo

That Time the Internet Got All Judgy On Us

Lisa’s first postpartum workout, if you want to call it a workout, wasn’t anything to write home about. I think I had her do some deadbugs, side planks, a few Pallof Presses, bodyweight step-ups, and, yeah, okay, there was a barbell involved…

…she did some light bicep curls.

To her credit Lisa trained all throughout her pregnancy.

While no where near the same intensity she was accustomed to, she deadlifted, swung kettlebells, performed hip thrusts, and even used natural progressive overload (her growing tummy) to crank out her chin-ups.

 

View this post on Instagram

 

A post shared by Tony Gentilcore (@tonygentilcore)

At the same time, she remained cognizant it was imperative she listen to her body. If at any point something felt off or “wonky” she stopped and we made the appropriate adjustments.

I wholeheartedly believe that it was her dedication and diligence to strength train throughout her pregnancy which resulted in a smooth and seamless birth.3

NOTE: For a more detailed article expounding my approach and thought processes on the topic of women and strength training through pregnancy go HERE.

Fast forward several weeks and I posted this video on my Instagram page of Lisa hitting a bench press personal record:

During her maternity leave we took advantage of having more time to workout together, and I was proud of her for staying proactive during this time.

She listened to her doctor, she listened to her body, and she was able to regain (some) of her pre-baby strength levels rather quickly (in no small part because she stayed consistent with it during her pregnancy).

I say “some” because we made it a point of not pushing the envelope with other movements such as deadlifts and squats.

Nevertheless, there was a woman who chimed in with her own concerned, if not bordering on scathing remarks and comments on the matter.

“It takes a lot longer than 2-3 weeks to retrain the postnatal core! And wouldn’t she still be bleeding at this stage? That’s an open wound that needs time to heal/ and she needs lots of rest to repair her DRA and PFM tissues, especially if there’s additional birth trauma. I would get her to see a women’s health physio or pelvic PT first, if you care about her recovery. What postnatal courses have you done?”

Oh-no-she-didn’t.

It was all I could not to go into an all-out Beyonce “Lemonade’esque” rage.

“I DON’T CARE ABOUT HER RECOVERY?” – grabs baseball bat.

“WHO SAID ANYTHING ABOUT 2-3 WEEKS?!” – smashes windshield.

via GIPHY

But I didn’t do that.

In the woman’s defense what she (probably) read and saw was some meathead bragging about his wife hitting a heavy bench press a few weeks postpartum.

How could she have known that in the weeks leading up to that Lisa had also been performing a plethora of diaphragmatic/positional breathing drills, deadbugs, birddogs, carries, hip stability drills, and many other exercises that don’t equate to near the engagement on social media as a bench press?

#mostboringexerciseever

#actuallymaybethisismoreboring…zzzzzzzzzzzz

 

I kindly reiterated that Lisa was cleared by her doctor, that she had been taking things slow up until that point, had been using appropriate progressions, and that she had a pretty smart strength coach (and the world’s #23rd ranked tickle fighter) in her corner writing her programs.

The same woman also stated:

“There’s nothing badass about being a victim to the social pressure to get your body back, it’s stupid really.”

Given no one ever came close to mentioning anything about social pressure or being a victim, at the time, I didn’t have much of a response. She was likely projecting based of experiences in her past, and I chose to ignore it.4

I mean, my wife’s been lifting weights since she was 13 years old, it’s part of her DNA. What’s more, we were engaged in an activity we enjoyed doing together (working out), and she really loves benching, why should I have to defend that?

However, upon further reflection I could see where this woman was/is coming from.

Don’t get me wrong: I still feel there was an exorbitant and egregious amount of “assuming” on this woman’s end.

Like, who in the flying fucks of fucks was she to assume we didn’t take all the precautions in the world? But, deep breaths Tony, I could see how my initial post may have been triggering and come across as a bit too braggadocious.

Moreover, I can see how the message could have been misconstrued.

As oxymoronic as it sounds (and this is likely why this particular woman called me out), women that exercise through their pregnancy are often at MORE risk for postpartum issues. Many feel pressure to head to the gym as soon as possible after giving birth because they actually feel “okay.”

To be clear: This was not the case with my wife. It had everything to do with not wanting to throw an ax into her face from cabin fever.

However, this mentality can often lead to dire circumstances because their body is still healing. Just because someone may want to perform kipping pull-ups paired with sandbag carries through a grenade field for AMRAP doesn’t mean you should.

You CAN still exercise postpartum, but it’s important, nay, crucial, to respect the notion that your body still needs time to “catch up.”

I guess maybe I should have said that from the get go when I originally posted that video of Lisa bench pressing.

That said, it was something the woman said in her initial comment to me that really struck a chord:

“What postnatal courses have you done?

Shit.

None.

Now, I’m not an idiot.

I understand, to the best of my Y chromosome having abilities, the intricacies that coincide with helping a woman train through her pregnancy, as well as how delicate matters are in the months postpartum.

The first few months are all about rebuilding the base (specifically to address the pelvic floor and diaphragm, to get the “core” connected, working, and to progress from there).

After that, a person’s capabilities and foundation matter more than whatever time frame it takes to get them deadlifting appreciable weight again.

As far as the BIG no-no’s to avoid immediately postpartum:

  • Plyometrics – burpees (please, stop), jumping, stairs, and running.
  • Anything coming close to max-effort loading.
  • Front abdominal exercises (planks, sit-ups, push-ups, leg lifts, or anything that makes the abdominals bulge anteriorly or uses the core to support a lot of bodyweight).
  • FWIW: Any sort of Fight Club is out of the question during this time as well.

I’m also aware that the postpartum “phase” doesn’t just refer to weeks or even months. Women can present with postpartum issues years after the fact, and it’s imperative to respect that and know how to assess and program accordingly.

But, to go back to the woman’s comment (what postnatal course have you taken?) that was a massive mea culpa.

I had taken none.

She got me there.

At that point I felt it was my responsibility to remedy the situation.

And that’s what I did (and am still doing).

Pregnancy & Postpartum Corrective Exercise Specialist 2.0

In recent years whenever I am asked by other health/fitness professionals what course I’d recommend they look into my immediate answer is Dr. Sarah Duvall’s PCES course.

It’s without hesitation the most valuable continuing education resource I’ve come across in the past four years, and it’s also had the most impact on my own coaching.

Every pregnancy is different.

Every woman who is postpartum is different.

There are a LOT of women out there and you WILL undoubtedly need to know this information and know how to apply it.

As it happens, Sarah just revamped the entire course: PCES 2.0

  • 34 hours of content loaded with a tsunami of lectures, videos, and case studies.
  • CEUs available
  • Save $150 off the regular price through Wednesday (2/24). Access to the course CLOSES on March 5th.
  • FYI: Payment plans available.

This course will teach and show you the appropriate assessments/screens to use as well as the corrective strategies to implement to address everything from pelvic floor dysfunction to incontinence to rectus diastasis. In addition, and this is what I dig the most about Sarah’s approach, is that strength training can and should be a part of the process.

Remember: You only have till midnight on 2/24 to SAVE $150 and access to the course shuts down on 3/5.

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CategoriesFemale Training

One Year Postpartum: Are There Any Special Training Considerations?

The short answer is a resounding yes.

A lot of articles and information directed towards postpartum women cover the initial weeks and months after giving birth. That’s awesome. But what about one year after? Five years?

As Dr. Sarah Duvall, creator of Postpartum Corrective Exercise Specialist, mentions below in today’s guest post: once postpartum, always postpartum.

PCES is an outstanding course, and one I’m currently going through now. It’s only being offered for another week, with a special offer for TG.com readers below.

Enjoy!

Copyright: vadymvdrobot / 123RF Stock Photo

Are there any special considerations for training a woman that is over a year postpartum?

For this question we need to ask ourselves, “does the postpartum period end at an arbitrary time?”

In some cases, yes.

Time does have a positive impact and in other cases, no. So, let’s take a look at when time matters and when it doesn’t.

In the early stages postpartum women are still dealing with excessive ligament laxity that was needed to help get the baby out. Most women notice a decrease in the laxity by 4-6 months postpartum but for those that continue to breastfeed, the laxity can continue well over a year.

This matters because laxity creates instability and increases vulnerability to injury, especially in the pelvic floor.

So, being further along postpartum is a real win for not having to worry about the extra ligament laxity.

Most of the stories I hear from patients about post-delivery prolapse development happen in this one-year window. There is still a chance of women getting prolapse outside this time frame, but thankfully, the chances go down with the recovery time.

Why does this matter?

Women should take it slow getting back into impact exercise that could place an unnecessary strain on the pelvic floor while it’s still healing. (This goes for C-Section ladies as well!)

Incontinence or leaking during exercise is another one of those pesky issues that a significant number of women complain about and we often associate with having a baby. A survey taken among women that experience leaking showed that women with no leaking three months after delivery had a 30% chance of experiencing leaking twelve years later.

This is a significant number!

Now we’re talking about a woman who decides to get in shape and head to the gym and all of a sudden she is experiencing this pelvic floor issue she never had before.

Why does this happen?

I think it’s a breakdown of the system. An accumulative effect, if you will.

When proper steps aren’t taken postpartum to ensure complete pelvic floor recovery, our system can form compensations. Sometimes these compensations can take years to show up. Much like many preventable chronic injuries throughout the body.

The same thing can happen with the core. If 100% of women that go into delivery have a diastasis, then checking for it should be a routine part of any initial visit. Pregnancy pushes women into poor movement patterns.

The large amount of weight in the front causes a posterior weight shift and lengthened abdominals.

Because of this weight shift, women will often end up with tight paraspinals and a hinge point at the T12-L1 junction. This can cause back pain and tightness as well as perpetuating a poor breathing system that prevents complete core recovery.

Along with this weight shift, the baby itself pushes up on the diaphragm continuing to shut down deep breathing. Proper breathing is the foundation for core and pelvic floor recovery.

These postural compensations can stay with women for the rest of their lives unless someone gives them the right corrective exercises to break these patterns. Checking for a diastasis and asking key questions about pelvic floor health should be high on the priority list for a woman at any stage postpartum.

Check out this video for a couple key posture tips that help promote diastasis healing.

 

Bottom line, once a woman is postpartum she is always postpartum.

Being pregnant increases her risk of pelvic floor issues, diastasis and postural changes.

These risks are not limited to the first year or even the first five years postpartum. These are issues that affect many women for the rest of their lives. The good thing is that with a little knowledge we can do something about it. These women can have hope for healing at any stage in life.

Postpartum Corrective Exercise Specialist (Special Offer For TG Readers Only)

I’m not going to beat around the bush, if you’re a fitness professional you should considering taking this course.

It will undoubtedly make you a better coach and better prepare you for the delicate nature of working with women postpartum (which, as Sarah noted, never really ends).

I’ve trained several women through their pregnancies and have obviously trained hundreds after the fact.  I thought I knew what I was doing, and I’ve done okay.

I guess.

This course has helped me immensely and has really shed a spotlight on some coaching/information gaps on my end. I can’t recommend it enough.

Sarah only offers it a handful of times per year and she’s been kind enough to extend it for another week so my readers can take advantage. What’s more, if you use the coupon code TONYG at checkout you’ll get an additional $50 off your order.5

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About the Author 

A wife, mom and adventure sports athlete, Sarah is a women’s fitness specialist that takes functional training to a whole new level. In her unique approach to treating patients, she believes in teaching. Fully understanding every aspect of the body is a necessity to complete healing. She integrates functional movement with cutting-edge exercises to bring you results-driven programs for postpartum recovery, with an emphasis on the pelvic floor and abdominals. When she is not hanging off the side of a mountain, Sarah enjoys writing and presenting at http://www.CoreExerciseSolutions.com and figuring out how her patients can continue to pursue their dreams and lead a strong, adventurous life. 

References

Viktrup L, Rortveit G. Risk of stress urinary incontinence twelve years after the first pregnancy and delivery. Obstet Gynecol. 2006 Aug;108(2):248-54.