This blog is for the ladies. Raise your hand if you know what ‘diastasis recti’ is? Maybe you have no clue. Maybe you don’t know and you actually are suffering with it. Perhaps you know what it is, have it, and have no idea how or if you can heal it. Diastasis recti is a condition where the rectus abdominus, the 6-pack abs, separate during pregnancy and do not come back together postpartum. Approximately 2 out of 3 women experience this following pregnancy. Men can experience this, too, due to excess weight gain/belly fat and weakened core muscles.
Let me tell you about my experience. I’ve have been physically active my entire life. I began teaching group fitness in 1998, received my bachelor’s degree in Exercise Physiology in 2001, and my Doctorate of Chiropractic in 2005. I have trained in general group fitness, yoga, Pilates, cycling, aqua fitness, and am a Level 1 CrossFit coach. I cannot recall a time when diastasis recti (DR) was ever taught or discussed in all my years of teaching and education about the human body.
In 2012 I gave birth to my first child, my daughter, via C-section. Throughout my pregnancy I was told to continue doing all the exercise and yoga I had been doing prior to pregnancy unless I noticed any pain or discomfort. I continued to teach my power yoga and Pilates classes without any hesitation or issues, however, I did stop running because it did not feel comfortable with the impact. Long story short, unbeknownst to my doctors my baby was breach, 4 days late, and turned out to be an emergency C-section. After my recovery I returned to teaching and began running again. I noticed my abdominal muscles did not look right, or like they did prior to pregnancy, but I realized my body had been through quite a bit and everyone says pregnancy changes everything. I kept in mind I needed to give my body the space and time to get back in shape and I needed to tone down my expectations and be more kind to the situation and myself.
In 2014 I got pregnant with my son. Again, I continued to teach yoga classes and halted my running. The style of yoga I teach is power flow, or vinyasa, so with each pregnancy I continued to do intense practices with handstands, forearm stands, back bends, arm balances, and vinyasas. Backbends felt especially great as I always carried my babies high, so the act of opening my belly more took pressure off my lungs and diaphragm. Once again, my son was breach and I underwent a C-section in January 2015. As before, I recovered great and returned to exercise without regard, however, once again I noticed my abdominal muscles looked funny. I looked bloated, my “innie” belly button was now an “outie”, and there was a notable pooch I could not suck in. I began to research “separated rectus abdominus postpartum” because that’s exactly what it looked like…space between the ab muscles. There it was, “diastasis recti” was the term and it fit the description I had seen following both pregnancies. It is not a condition due to the C-section, it is simply a condition developed during pregnancy as the abdominal region spreads to make room for the growing baby. The fascia between the rectus abdominus muscle stretches and the transversus abdominus muscle (TVA) stretches and weakens.
I checked out what could be done for it and found a list of dos and don’ts. The list of don’ts included planks, push-ups, sit ups, back bends, and twisting abdominal exercises; just about everything I do in my yoga classes and home practice. Not only were they don’ts postpartum with DR, they were also don’ts during pregnancy to prevent DR. Holy crap! No one told me! The list of dos included very basic abdominal exercises geared towards strengthening the TVA: marching, heel drops, heel taps, pelvic tilts, etc. Fortunately, once the diastasis is healed the list of don’ts may become safe to perform.
After a couple of weeks of doing the exercises recommended I was bored. I thought to myself, “This is like pretending I’ve never exercised before in my life.” I could easily do the exercises and felt like I wasn’t making much of a difference visually to my abdominals, so I quit. In May 2015, 3 months postpartum, I began CrossFit. I jumped right in with push-ups, sit-ups, V-ups, toes to bar, even GHD sit-ups. (All the no-nos!!!) I thought to myself, “I just need to exercise to rebound from this last pregnancy. Look at all I can do! I can still do all my yoga, everything in CrossFit, and I’m getting stronger. This diastasis recti thing will just go away as I continue to work out.”
Fast forward 2 years and I still battled with DR. Unless I sucked in my stomach I looked as though I was 4 or 5 months pregnant. I looked bloated, but had no digestive issues. I really thought it was something I just had to live with, and it was not impeding my progress in the gym. It was in a Kinesio Tape seminar that I learned to tape my abdominals to help splint and encourage them to come back together. I noticed huge gains in my gym performance when I taped my belly. After a while, for whatever reason, I stopped taping. I began to do more bar work on my own. I knew chest to bar pull-ups, kipping toes to bar, bar muscle ups, and ring muscle ups were things I wanted to improve and I was willing to put in the extra time to do it. It was a matter of 6 weeks of solo work, in addition to CrossFit 3-5 days a week, teaching 3 yoga classes a week, training for a Ragnar trail race, and continuing with my very physical job of doing chiropractic work when I herniated a disc in my neck causing severe spinal cord compression needing surgery to remove the disc and fuse my spine at C5-6. There was no one incident that caused this disc to herniate, rather than a series of events and recurrent neck pain that suddenly changed. Hindsight, I could not help but think that the DR had some involvement. Sure, I could do just about anything I wanted, but at what cost?
DR is an indication that the core is weak. A weak core can lead to postural issues, improper body mechanics, low back pain, hip pain, and spinal instability. DR can contribute to the “mommy tummy” so many women wish they could lose, but assume it’s the badge of motherhood they’re left to carry. It can also increase the risk of an abdominal hernia. As a chiropractor, I preach core strength to patients day in, day out; showing core exercises, postural exercises, proper movements, being mindful in the gym, etc. Even though, personally, I could do a muscle up, toes to bar, sit-ups, and push-ups these were all no-no exercises with DR, and likely perpetuating the issue. But I could DO it all! Nice ego trip I was on. You see, our bodies are AMAZING. This intelligent design will figure out how to compensate to get the job done regardless of any roadblocks. The other muscles that were compensating for my weak TVA were able to get the job done, but put too much stress on other structures leading to a fault in my foundation, my spine. Even though I knew these moves were my weak points in CrossFit, I thought they needed more work to get better. Sometimes we are our own worst enemy.
Once the light bulb went off in my head, I realized that in dealing with this neck injury now was my time to re-evaluate my core and my foundation. I patiently waited until 3 weeks post op when my surgeon cleared me to return to exercise and began those boring, basic, DR exercises. Once again, I began using Kinesio Tape on my abdominals, too. I have also started doing Kegel exercises to increase the strength of my pelvic floor muscles. I am noticing a huge improvement already. My abdominals are slowly coming back together, my posture is better, I am aware of my TVA and pelvic floor working together during my rehab exercises, and I finally have hope that all of the “no-no exercises” in CrossFit will one day return to my workouts. Even my belly button looks better! My plan is to commit to this work consistently for at least 12 weeks before I begin to lift overhead, run, or return to bar work.
I now recommend to my pregnant patients, yoginis, and Crossfitters to cease doing planks, push ups, sit ups, and any forward folding core exercises after the 1st trimester. I educate women on core exercises safe during pregnancy that can reduce the likelihood of developing DR. I highly recommend wearing a belly band or corset postpartum, and recommend Kinesio Taping during pregnancy and postpartum for DR. I also teach kegel exercises and promote kegel weights to all women.
I would love to get a workshop together for women who are interested on learning more about prevention and healing DR. We would perform exercises, discuss anatomy, products and protocols, dos & don’ts, and any other concerns. I feel my knowledge of the body coupled with my personal experience has shed light on a new focus for me with coaching, yoga, and chiropractic. Please let us know if you would be interested in attending!