Can you prevent diastasis, or abdominal separation, during pregnancy?
By; Gina Conley, B.S. Exercise Science
The answer is most likely not. By 35 weeks gestation, nearly 100% of pregnant women will have diastasis. Diastasis happens to nearly every pregnant woman that carries to term regardless of what she does during pregnancy.
Diastasis Recti Abdominis (DRA) is the separation, or rather stretching, of the linea alba, the connective tissue between the two halves of the six-pack abs, aka your rectus abdominis. This stretching is a biological function that allows for your baby to grow without your internal organs being completely crushed. Your baby needs space to grow, so your connective tissues “soften” so that they can stretch to accommodate for your baby. DRA during pregnancy is NORMAL and NECESSARY. DRA is not scary!
However, DRA that persists in the postpartum and that contributes towards non-optimal strategies for transferring load can be a problem which interferes with your ability to function. Can healing DRA in the postpartum be easier or harder based on what you do or don’t do during pregnancy? The answer is potentially!
The good news is that 60% of women spontaneously heal without any intervention. This means 60% of postpartum women’s DRA will heal all on its own while the remaining 40% will more than likely require some sort of focused intervention to help heal DRA after the 6-week period. Examples of focused intervention include but are not limited to: pelvic floor physical therapy, postpartum exercise programming geared towards returning to function, and postnatal yoga.
Let’s discuss what you can do during pregnancy to help heal in the postpartum:
1) Focus on optimal strategies for transferring load
What does this even mean? It is how well can you move and perform daily functions without compensation. Can you pick up your child without bearing down on your pelvic floor? Can you walk upstairs without your knees caving in or walk without your hips dropping? Use pregnancy as an opportunity to hone in on movement patterns, and explore without the necessity for high performance, such as a personal record or competition.
How can you make sure that you are working with optimal strategies? Check out the next two points, but ultimately move with near perfect form during your lifts. Not all squats are created equal. A shit-form squat will do more harm than good, while a near-perfect form squat will help you tremendously throughout your pregnancy.
2) Focus on alignment/posture during movement
First, we need to set up the system so that it can operate effectively. Our muscles operate best in the mid-range position, so when they lengthen and contract they are more apt to respond to any demand (very versatile). In the instance of our core (aka our stabilization systems), the optimal position is a neutral spine.
Remember that neutral is a range, not a fixed position. While there is some wiggle room, you must be mindful to avoid the following: obvious rib thrust (proud chest), anterior pelvic tilt (booty poking out), and posterior pelvic tilt (tucking the butt under) positions of the spine that do not contribute towards overall function. We heed caution because these can actually contribute towards dysfunction and discomfort.
During movement (and in most life circumstances in which you carry a load, aka your child), focus on maintaining a neutral spine with the ribs stacked over the pelvis.
What does this look like? Generally, it’s the shoulders over the hips.
Then, take a look at your ribs. If you drew a line across the bottom of your rib cage, does it tilt upwards or downwards? Does it stay relatively level?
How about your pelvis? Place your palms on your hip bones, and then your fingertips on your pubic bone. Play around until your palms and finger tips are vertically aligned with one another. This is a neutral pelvis.
Did you find that initially your fingertips were in further than your palms? This would be an anterior pelvic tilt, or butt poking out. Or did you find that initially your palms were out further than your fingertips? This would be a posterior pelvic tilt, or butt tucking under.
Now, take a look in the mirror and make a mental note of what neutral looks like for you. Neutral may not be how you normally stand and you might feel really off! I like to look in the mirror as I carry objects and various loads to SEE and FEEL what neutral feels like with a new load. How I carry my daughter on one side FEELS different than standing with two evenly weighted bags in each hand.
There is some debate on which comes first, posture or breathing; so, depending on what you were taught this order can vary. I personally think you need to set up the structure before breathing can be effective, but this is just like, my opinion, (wo)man.
3) Focus on diaphragmatic breathing
Now that we have aligned the structure, let’s focus on diaphragmatic breathing. Diaphragmatic breathing is breathing with the entire core stabilization system as a synchronized and coordinated system: your diaphragm (the roof of your abdominal cavity), your transverse abdominals (your corset abs), your multifidus (your back stabilizers), and your pelvic floor (the floor of your abdominal cavity).
When we inhale, we focus on expanding out and down with the diaphragm; this causes a response in the abs, back, and pelvic floor that respond by eccentrically loading and lengthening. Think a rubber band stretching and gathering energy.
Then, when we exhale, we focus on bringing everything up and in, starting with the pelvic floor. While the motion is up and in, everything is not literally coming in further than we started; the system is returning back to its starting points. The pelvic floor lifts up and in to its starting point, same with the abs, back, and then the diaphragm. Think about releasing the rubber band; it just returns to its original shape; it doesn’t necessarily get smaller.
Generally, exhales are relaxed and restful. However, if the demand requires more tension, then the exhales have the opportunity to be more forceful as we are were returning to that midrange position, rather than using ALL our tension/available strength.
Think about it as if you were going to prepare to jump. Inhaling is like dropping into that jumping position with your hips and knees are bent. Your arms are swung backwards, you’re gathering all your energy to jump up onto a box by moving downwards. Now, a gentle or relaxed exhale would be just returning to the starting position. You’re just standing now, and have the ability to both move back down or you could just jump from here (not as effective, but you could still respond). Now, let’s say you do want to jump, you would inhale, energetically load the entire body, then exhale with MUCH more tension as you extended upwards and landed on the surface in front of you. Yu would then need to reset, and start again if you wanted to jump.
If I created that same tension EVERY SINGLE TIME I jumped, even when I didn’t need to jump, I would be decreasing my reaction time to an actual demand to jump.
How to Breath Drill
The drill we like to use in our studio to help pregnant moms learn to diaphragmatically breath is to wrap a theraband (or any thin resistance band, your hands would do fine too if neither of those is available) around the bra strap line, and to sit on a partially deflated pilates ball.
First, focus on inhaling and expanding into the theraband, both sideways and backwards. Don’t focus as much on expanding forward into the belly. Exhale, allow the ribs to relax and come back to center, releasing the tension in the band. Repeat this for ten breaths, focusing solely on the ribs expanding and relaxing.
Next, focus on inhaling and expanding into the deflated ball. Feel your pelvic floor push into the ball during an inhale, and then gently lift away as if you were picking up a blueberry with your vagina, but don’t crush it! Repeat this for ten breaths, focusing only on the pelvic floor expanding and relaxing.
Finally, try to sync the two together. Inhale, as both ribs and pelvic floor expand outwards. Exhale, as both ribs and pelvic floor relax and return to their starting point. Repeat this for ten breaths.
Now incorporate that breathing into your movement.
4) Minimize excessive abdominal flexion and extension
Generally, excessive abdominal flexion and extension tend to aggravate the linea alba (that connective tissue that stretches for your baby to grow). The more aggravated this tissue gets, the more severe the damage may be in the postpartum, which may make it much harder to heal.
What type of movements tend to involve excessive flexion and extension? Generally, these movements include kipping pull ups, toes to bar, American kettlebell swings, traditional core exercises, such as sit ups or crunches, back extensions yoga postures, such as wheel, upward facing dog, or dancer.
But other movements you may have not considered would be poor posture and poorly performance lifts/movements. If you generally move in an anterior or posterior pelvic tilt with either a thrusted or pushed back rib cage, then you’re living in an excessive abdominal flexion or extension state. Take a look in the mirror again and focus on how you are moving; are your ribs aligned with your pelvis?
5) Minimize or avoid movements that cause abdominal coning
If you are coning or doming in your abdomen (where the center of your abs pokes upwards), then you are using a non-optimal strategy to transfer loads (aka you are moving poorly). Coning does not automatically mean never do [insert movement here] ever again during this pregnancy, it means that we need to relook at what strategy you are using to move.
Are you aligned well in this position? How is your posture starting from your feet? Making minor adjustments may make all the difference. Some movements require more of a lean forward, while others require more of a lean backwards (from the hips) to set up better.
For example, when rowing, we find that maintaining a more upright posture as opposed to leaning backwards when you finish the pull, supports the core better throughout pregnancy. So, if a pregnant mom was rowing, and found she was coning, we would see if adjusting to a more upright posture would help her core.
Now you’ve adjusted position, but still coning. Now what? Focus on breathing. Are you syncing breath with movement? Maybe you need to increase the tension for the exhale. Exhale with exertion, so on the hard part of the movement.
Let’s use the rowing example again. When our pregnant mama is rowing, she stays more upright and now she also focuses on a strong exhale as she pulls back. Now she is using her breath coordinated with movement to help her core.
Other tools that you could try to use would be to decrease the range of motion (as we did with the rowing example), lighten the weight, introduce a tactile tool to help reinforce some movement principle such as, a Pilates ball between the knees to activate the adductors (inner thigh) that helps to activate the pelvic floor and the rest of the core stabilization system.
Now, if you have gone through your entire list of methods to try to return to an optimal strategy and still coning, it may be time to put the movement to the side until the postpartum. Explore a new movement!
Diastasis is a normal response to pregnancy; every pregnant woman who carries past 35 weeks will have diastasis recti abdominis. However, not every postpartum woman will maintain a diastasis past 6 weeks postpartum! There are strategies you can utilize during pregnancy to try to minimize the severity of diastasis in the postpartum, but there are some factors that are outside of your control such as your genetics and your personal anatomy.
Super confused? Come see us in the studio for one of our classes (that are practically a personal training session without the price tag) or schedule a one-on-one consult with one of our coaches.
Lee, D., Lee, L., & Mclaughlin, L. (2008). Stability, continence and breathing: The role of fascia following pregnancy and delivery. Journal of Bodywork and Movement Therapies, 12(4), 333–348. doi: 10.1016/j.jbmt.2008.05.003
Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bø, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine, 50(17), 1092–1096. doi: 10.1136/bjsports-2016-096065