For years I have taught a postpartum yoga workshop on toning the deep core after birth. One of the most eye opening exercises we do right at the beginning of the workshop- a self check for Diastasis Recti.
We begin lying on our backs, with knees bent, and one hand resting on the navel- fingers together and pointed towards the pubic bone. With the abdominal muscles relaxed, students press gently but firmly into the belly towards the floor. Maintaining the pressure, we then raise the head and shoulders feeling for the response in the front abdominal muscles.
Inevitably there are cries of “Oh my God!” and “What!?” as some participants discover firm ridges of muscle to the sides of the abdomen, but a distinct space in the middle under their fingers. For some this space is only about a finger wide, for others it is more like 3 or even 4 fingers wide. “Ok.” I usually say. “Stay with me. Let’s get some information. Does that space extend down towards your pubic bone? What about up towards the ribcage? How many fingers wide is the space?”
A 2016 study found that as many as 60% of women in the US have some form of Diastasis recti during pregnancy or postpartum. Nearly all pregnant people will have some widening of the linea alba- the connective tissue line that links the surface abdominal fibers of the rectus abdominus. (Think of the “six pack” muscle. That indent in the middle? That’s the linea alba. This dense fascia is meant to stretch during pregnancy to accommodate the growing uterus and baby, but if stretched too much, or loaded too heavily the tissue can separate, leaving a space in the top layer of the abdominal wall. This can then result in challenges such as back and hip pain, organ prolapse, incontinence, and general reconnecting to the core postpartum.
Think of the core body like a soda can. There is a muscular wall surrounding the whole container, there is a top, a base, and the contents inside are under pressure. If you make a hole in one of these areas, the soda sprays out. In this case though, we’re not talking about soda, we are talking about internal organs, and in the case of the pelvic organs, urine and poop as well. Squish or stretch too far, and the container can’t support the contents inside, and things leak out.
Where does this come from? It might be easy to say it is inevitable given the intense stretching of the abdomen during pregnancy, but then why wouldn’t every woman have it? And this isn’t limited to just pregnancy. Sever weight gain or improper exercise form can also result in Diastasis Recti. So how might we better preserve our core integrity. A hint: It’s not through more crunches!
The body’s fascia adapts to the loads and strains put on it. Lean on an area for too long and it will both stretch, and then eventually reinforce to more strongly resist the load. Pull suddenly, or repeatedly, and the fascia may separate without its usual elasticity. It’s this adaptation combined with movement patterns which influences whether the front fascial line separates, or simply stretches.
If you read my recent blog post about posture during pregnancy “What the tuck” You know I am a fan of aligning the weight of the body over the legs and into the ground. This is partly because when we stand with our chronically tucked pelvic position, we thrust the weight of the body into the front line of the abdomen, asking the linea alba to bear the weight instead of the legs. Add the often accompanying rib thrust (yoga teachers how often have you told students to roll their shoulders up, down, and back, picking up the ribcage. Do you check that the back ribs are lifting too?) The linea alba runs from zyphoid process to the pubic bone, so picking the front of the ribs up pulls the top attachment- further loading the already stressed fascia. The result? The fascia thins, and becomes rigid as it tried to hold the weight which was meant to be born by the bones.
Now what if we take this already stressed fascial line, and add more load by, say, strongly activating the rectus abdominal muscles attached to it. Even more, what if we activate those muscles without supporting with the transverse abdominals and the pelvic floor? The abdominal contents come under pressure, and push outward into the front abdominals, and the vertical muscles tug strongly on already strained fascia. This is a recipe for the fascia to split. A note: this is exactly what happens when we try to sit up from a supine position, or lie straight down, especially if we have to kick the legs or have someone help us up. (No more crunching or sitting up without awareness!) And if that wasn’t enough, even without jackknifing to sit up, if we practice postures which pull on the front abdominal line too forcefully, or without awareness we run the risk of separating the fascia just from the load being placed on it. I’m thinking here of yoga poses like Wheel or Cobra, which can technically be done, but so often are done without attention to even distribution of the curvatures, that there is a very real risk of over stretching and injury.
So what can we do? Well the first may be obvious. Start aligning the body to take the pressure off the front abdominal line, and avoid sitting straight up or lying straight down. Practice rolling to the side both when getting up and down to reserve good abdominal integrity. Beyond removing the load on the front line, developing overall tone in the transverse abdominals and pelvic floor can help establish better deep support for the surface muscles as they stretch. This means finding exercises such as activated table, bird dog, or possibly supine pelvic tilts (depending on which trimester you are in). While some yoginis may want to continue practicing postures such as plank for deep core support, I caution jumping straight into this level unless you can confirm you are able to lift the navel up towards the heart without compromising the lower back. (As a note- very few can actually do this effectively in the 3rd trimester).
Another gentle toning exercise for the deep core can be to work with the breath. This is not simply breathing into the belly so it expands outwards- this could actually exacerbate a separation. Rather we can work to move the breath into the sides and back of the center body, as well as into the front. The feeling is of breathing in 360 degrees. If finding this expansion is challenging, try wrapping a yoga strap around your lower ribs and pulling on it to create some gentle pressure- then breath into the yoga strap. On the exhale, feel the body drawing back inwards, as though hugging baby gently from all directions. On the inhale, release and expand 360 again. This action of gently releasing and then supporting helps encourage supple tissue which can stretch rather than split.
And then there is the very simple, but often missed body mechanics of how we sit up or lie down during pregnancy. Too often I see students round their back and roll down the spine to the floor, or worse kick their legs to sit straight up from their back! This action loads the surface abdominals without providing any support from beneath- a recipe for creating a separation. The biggest place this happens BTW is not on the yoga mat, but in the doctors office. How many of you were given a hand to help pull you up from lying on your back for an ultrasound, or feeling baby’s position. How should we be getting up? Roll to the side, both for going down and coming up!
Ultimately, it is this deep core support which not only helps reduce the chance for a DR in the first place, but which can also help heal it postpartum. In the above-mentioned workshop, once we have discovered whether a separation exists, and how wide it might be, the next step is to reconnect to the deep Transverse abdominals and pelvic floor to gain the support the surface muscles need to close back together and re-thread together. Contrary to what is often said, a separation does not come back together by itself. But with targeted work and attention, it often does not require surgery to repair. An abdominal separation doesn’t mean a life-long injury to the core body. It simply indicates that the internal support was not there when needed. If we can find that connection, we can help the body regain the functional strength is it meant to have before, during, and following pregnancy and birth.
Key Takeaways
Our core body adapts during pregnancy, and how we stand and move can impact the integrity of our abdominal connective tissue later on.
Excessive or unbalanced loads placed on the front line of the body can contribute to stretching of the front fascial line (known as the linea alba) and may cause a separation (a condition called Diastasis Recti) leading to abdominal weakness and more challenging postpartum recovery.
Simple exercises can be done to minimize excessive loads and gently tone the support muscles to help reduce and recover from an abdominal separation
Sitting straight up or lying straight back can contribute to creating Diastasis recti. Roll to your side when going down or getting up to reduce strain.
Further toning can be done through full body breathing (which expands the back as well as the front), and also finding good balanced posture to remove excessive weight from the front abdominal connective tissue.