Diastasis Recti
Recti Abdominis Information:
Abdominal weakness, weight gain and hormonal changes can cause muscle separation during pregnancy, this is known as Diastasis Recti - see image below.
Once this is corrected lower back pain will improve as will posture and your ability to perform certain exercises. This will normally happen 6-8 weeks post-partum, after pregnancy the muscles will always lie slightly apart. We need to first strengthen the transverse abdominis as it plays a vital role in stabilising the spine and holding the abdominal wall flat. In pregnant ladies we have to assume that muscle separation may have started to occur after the first trimester therefore it is important to stop certain abdominal exercises like curl ups going into your second trimester.
How to check if you have Diastasis recti
Lay on the floor facing up with your knees bent and abdomen relaxed.
Place two fingers across the abdomen just below the umbilicus in the centre of the abdominals.
Gently press to feel between the two halves of muscle.
Inhale and draw the umbilicus towards the spine while gently raising your head and shoulders off the floor. Keep gentle pressure on the abdomen with your fingertips
Hold this position while breathing, you should be able to feel two bands of the rectus abdominis closing in on either side of your fingertips with the soft dip of the linea alba in the centre. If you ant feel this curl up a little more.
If the gap is wider than two fingers repeat the test with three fingers.
Your results
If the gap is less than two fingers once you can work through some low load TVA (Transverse abdominis) and rectus abdominis exercises you can progress to more demanding exercises such as half roll backs, reverse curls, abdominal curls and eventually oblique curls.
If the gap is wider than three fingers or more curl up exercises are not recommended as you could cause herniation. Suitable exercises are abdominal hollowing and pelvic tilts.
Exercises for the TVA can be initiated within 24 hours of giving birth (providing your midwife agrees), these include abdominal hollowing then a few days post-partum pelvic tilts can be introduced.
Progression of core re-conditioning
Pelvic floor/ Kegal exercises
Pelvic floor exercises with abdominal hollowing for TVA.
Pelvic floor exercises with abdominal hollowing while performing pelvic tilts.
Pelvic floor exercises with abdominal hollowing while performing partial and modified curl ups.
Maintaining the above sequence while layering more advanced abdominal exercises like crunches, the plank and the 4 point kneeling position.
These should not be attempted until at least 6-8 as weeks post-partum as there is a risk of air entering a raw placenta site and causing an embolus, you should also be able to work through 1-4 without doming occurring before progressing to this stage.
The Exercises
Pelvic floor/ Kegal exercises
PLEASE NOTE: It is important to be signed off by your midwife/ practitioner before partaking in any exercise during pregnancy or post-partum.
Pelvic floor/ Kegal exercises can be done throughout pregnancy.
You can also start to rehabilitate the pelvic floor muscles within the first 24 hours of giving birth, these should be done intensively (preferably a few times a day) for at least 8 weeks post-partum.
You should aim for 10 Slow contractions, building up to 10 second holds and 10 Fast contractions.
These can be done standing, sitting or lying (unless more than three months pregnant).
How to Perform Kegal Exercises
Lie/ sit/ stand with your feet slightly apart.
Draw up and tighten the muscles around your back passage and hold, then take the feeling around the front, lifting up through the vagina.
For slow contractions hold for a count to six, release with control, repeat for desired reps.
For fast contractions hold for a count to one, release with control, repeat for desired reps.
Abdominal hollowing
Aim to build up to 10 sets of 10 second holds and repeat three times a day or as often as possible.
With Correct postural alignment pull your belly all the way in and up at the naval without moving the rib cage, pelvis or spine. Relax half, then relax half again so you are at about 30% of the maximal voluntary contractions. This is abdominal hollowing. Hold this for ten seconds then relax and get back to that 30%, hold for ten seconds and repeat. You should be able to hold this contraction and breath through it at the same time. This can be done seated, standing or lying (no lying after the first trimester in pregnancy).
Prone Spinal Extension / Superman
This is an exercise you must progress, below shows how to progress the exercise. Make sure you can do 3 sets of 10 reps before progressing.
Start with a single leg backward leg raise – this can be a helpful exercise in the case of shoulder pain where it is difficult to raise the arms in front of the body.
Keep your leg straight as you slowly raise one leg backwards off the ground so that your toes just lift off the ground – avoid lifting your leg too high as this will hyper extend your lower back.
Lower your leg back to the ground.
Repeat this action with the other leg and continue alternating this exercise.
Progress
Extend your arms on the ground in front of your body keeping your forehead down in contact with the ground
Raise one arm and the opposite leg simultaneously so they both just lift off the ground surface, hold briefly and lower both limbs back to the ground, repeating up to 10 times in succession.
Repeat this action using the other arm and leg.
Lying pelvic tilts (First trimester and a post-partum progression only)
Aim for 1-3 sets of 12-15 reps.
Lie flat looking up with your feet flat on the floor a little less than hip width apart and your knees bent.
While maintaining abdominal hollowing posteriorly rotate your pelvis so your lower back is touching the floor. Hold and count to six while still breathing.
Modified trunk curl (This is not for pregnant women or women in early post natal stages)
The abdominal wall should be held flat with the umbilicus drawn towards the spine, if this is not possible and doming occurs when curling up then the exercise is too demanding. Aim to work towards 3 sets 10-15 reps.
Lie facing up and posteriorly tilt your pelvis.
Curl up as far as you can without doming occurring.
Grip your thighs and pull yourself 1-2 inches higher, slowly and controlled.
Hold for 1-2 seconds, eventually building up to 10 seconds for 10 reps. Your abdominals should remain flat with no doming.
If you are unable to hold for 1-2 seconds go up then try and slowly lower back, when you can lower with it being able to take 10 seconds you can move to the full holding position.
4 - point kneeling (not to be done until 6-8 weeks post-partum)
As explained above you should aim for abdominal hollowing but on all 4’s. Hips should be above the knees and your shoulders above your hands.
One you can achieve abdominal hollowing in this position you can lift and lower one arm or leg and then move on to the opposite arm and leg, all whilst performing abdominal hollowing.
If you suffer from carpel tunnel syndrome this may not be the best option for you.
Bicycle Crunch
Lie flat on the floor with the lower back pressed into the ground. Aim to work up to 3 sets 10 reps
Place your hands slightly either side of your head, do not lock your fingers or pull the head
Lift your knees to a 45 degree angle
At first slowly go through a bicycle pedal motion with the legs
Alternately touching your elbows to the opposite knee twisting back and forth through the core, keep the elbows back rather than forward to the chest as this could strain the neck
Flexibility training
When stretching throughout pregnancy and post-partum all stretches should be maintenance stretches and not held for any longer than 10-15 seconds.This is due to hormonal changes particularly the hormone Relaxin, holing a stretch for longer than this could lengthen the ligaments around the joint.
Abdominal stretches should also be avoided.