I have an extremely fit client who is 25 weeks pregnant. She is 5'2" and has a short torso. It is already apparent that she has diastasis. Her nurse practitioner said not to stress the abdomen, but I was curious if there was anything she can do to prevent further separation or should she let it go until after the baby is born? Will it be easier for her to regain her abdominal strength given her fitness level pre-baby?
Great question and something of great concern when training a pregnant woman. Let me first off give you a brief definition of diastasis recti. You have many abdominal muscles that stabilize the pelvis, low back and trunk, but you also have one, the rectus abdominus, that produces posterior rotation of the pelvis, trunk flexion, eccentrically decelerates anterior rotation of the pelvis and trunk extension. It is not part of the inner unit or “core” musculature, which most people think. The only stabilizer function it has is under heavy loads, such as with Olympic Lifting (i.e., bracing) and when getting hit in the stomach (i.e., wide receiver in football or boxer). It is a muscle that is connected together by fascia called the linea alba. This fascia is kind of like a zipper, and with diastasis recti, this zipper comes undone.
Before you can know what you can do with your client, you need to 1) get a medical clearance from her MD and 2) know the level of her diastasis recti. Have your client lie on the ground with her knees bent. Then have her perform a slight crunch, just lifting the head and shoulders off the ground. You will feel a split in the rectus abdominus. If you can only fit one finger, that is normal and you can perform most exercises with your client, paying close attention to proper inner unit activation. If you can fit two fingers, you most likely can only focus on gravity eliminated lower abdominal exercises in all planes of motion. If you can fit three fingers, then this is full on diastasis recti, and you should only perform gravity eliminated lower abdominal exercises in all planes of motion but keeping most of it to Type 1 recruitment and isometrics.
What does that mean? Some of the best lower abdominal (LA) exercises I have ever learned are by Dianne Lee and Paul Chek. You can purchase The Pelvic Girdle by Dianne Lee and/or Scientific Core Conditioning by Paul Chek. In these, you will find LA exercises that focus on inner unit recruitment that you will be able to do with your client. You want to make sure you are using exercises that target all planes of motion, as well as mostly inner unit recruitment. Some examples:
- Frontal Plane: Hanna’s 3 part side flexion
- 4 part tummy vacuum
- Transverse Plane: prone back extension or Supermans
- Horse stance vertical and horizontal exercises
- Back on ball hip extensions
- Supine lateral ball roll
Why does this happen and what can you do to prevent it from getting worse? Well, it typically happens in women who have multiple births, but sometimes it can just happen. Today, we have so called healthy people walking around exercising all the time, and that is it. Most don’t get enough sleep, they have “stinkin’ thinking,” don’t drink enough water, they eat too much, don’t eat enough or are eating convention, highly processed dead foods (take more energy from your body to break down that it actually provides), and they work out too much or not at all. So, you are what you eat, you are what you don’t excrete, you are what you drink, you are what you don’t sleep and you are what you think! When it comes time to heal or being healthy, we can’t support it because we have nothing to support it with. Where am I going with this? I feel that getting any client on the road towards being a vital human can help any condition. I would educate your client to the best of your ability on holistic living and nutrition or refer them out. A great place to start is by doing some research is at the following web sites: www.westonaprice.org and www.mercola.com.
The more you clean up her nutrition and lifestyle, the more balanced her physiology will be. Then she will have the essential nutrients to heal afterwards as well as during the birth process. If there is GI inflammation, visceroptosis, etc, the inner unit shuts down, thus allowing more compression, shearing and torsion in the low back. Also, if the organs hang down more than they should, along with the pressure of the baby, the more diastasis recti you will see.
Another area that I feel can help prevent it from getting worse is proper breathing mechanics. There is a lot of back and forth arguing going on in our industry on whether or not to brace versus hollow to stabilize. I personally believe that we do both. It just depends on how old we are (infants breathe diaphragmatically and hollow from birth to three months, belly breath and brace from three to six months and go back to diaphragmatically breathing around six months. Study the work of Lewitt, Janda and Vojta for more information on this), what position we are in and if we are under a load and how much load. But proper breathing is a precursor to both techniques. To make a long story short, if you study the mechanics of breathing and also study what can help facilitate proper breathing and how to incorporate that with your client during exercise, this can prevent the diastasis from getting worse. Some areas to look into on this are Qi Gong, the work of Lewitt, Janda, Vojta, DNS by Kolar (www.rehabpbs.com) and the work of Stuart McGill. Whichever research you go with, just remember that getting your client to breath properly, then brace or hollow will facilitate the diastasis from expanding. Good luck!