Post Natal Recovery: Save Your Abdominal Muscles Safely

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The widening and thinning of the mid line tissue in the abdominal muscle can frequently occur during pregnancy. But when the midline expands more than 2 to 2.5 finger-widths, you may have a condition called Diastasis recti. What can you do to save your abdominal muscles after delivery?

What is Diastasis recti?

Diastasis recti or also known as Abdominal Separation is a fairly common condition that occurs in the last half of pregnancy and after delivery when the abdominal wall has thinned and the mid line tissue no longer provides adequate support for the torso and internal organs.  This causes the left halves of Rectus Abdominis muscle to spread apart at the body’s mid line.

5 COMMON MYTHS about Diastasis Recti:

1. Diastasis recti causes permanent damage to your midline.

2. Abdominal muscles will never flatten after Diastasis recti.

3. Diastasis recti requires surgical repair.

4. The abdominal muscles will always be weaker after childbirth.

5. Everyone should wait for at least six weeks after delivery before beginning a postnatal reconditioning program.

How to Test For Diastasis Recti

This simple self-test will help you determine if you have diastasis recti and how severe it is.

1. Lie on your back with your knees bent, and the soles of your feet on the floor.

Place one hand behind your head, and the other hand on your abdomen, with your fingertips across your midline—parallel with your waistline— at the level of your belly button.

2. With your abdominal wall relaxed, gently press your fingertips into your abdomen.

Roll your upper body off the floor into a “crunch,” making sure that your ribcage moves closer to your pelvis.

3. Move your fingertips back and forth across your midline, feeling for the right and left sides of your Rectus Abdominis muscle.

Use Correct Form for an Accurate Assessment of Diastasis Recti

Make sure that you don’t simply pull your head off the mat—a common mistake. To effectively contract your abs, you need to move your ribcage closer to you pelvis. If you don’t adequately activate your abdominal wall, you might assume that you have diastasis recti. But for most, as the rib cage moves closer to the pelvis and the contraction deepens, the width of the gap at your midline will decrease.

Don’t panic if you feel a “hole” in your belly in the first few postpartum weeks. Everyone’s connective tissue at the midline is lax after childbirth. As you recover, your midline will slowly regain its former density and elasticity, and the “hole” will become shallower, and if you do the right exercises, more narrow too.

How to Notice The Signs of Diastasis Recti

A small amount of separation of midline—one to two fingers’ width—is common after most pregnancies, and is not a problem. But if the gap at your midline is:

1. More than 2 1/2 finger widths

2. Does not shrink as you deepen the work of your abdominals

3. You can see a small mound protruding at your midline

If you have any of the above, then you probably have diastasis recti and need to take a few special precautions during exercise and other activities.

Special Precautions for Women with Diastasis Recti

Avoid all activities that place stress on the midline, that stretch or overly expand the abdominal wall through everyday activities, exercise or inhalation techniques.

Some Types of Movement to Avoid

1. Movements where the upper body twists and the arm on that side reaches backward, such as a tennis serve.

2. Exercises that require lying backward over a large exercise ball.

3. Yoga postures that stretch the abs, such as “cow pose,” “up-dog,” all backbends, and ”belly breathing.”

4. All exercises that cause your abdominal wall to bulge out upon exertion.

5. Rising from a supine position by rolling up and twisting at the same time. Instead, roll first onto your side, and then use your arms to help push yourself up to a sitting position.

6. Intense coughing while your muscles are unsupported.

Movements That Are Safe:

Other postpartum exercise programs suggest that women with diastasis recti start abdominal reconditioning with “mini-crunches,” or lifting only the head, while applying manual compression with the hands across the abdomen.

Isolation of the head exerts a small amount of work on the external abdominal muscles.

Ideally, any abdominal exercises that flex the upper spine, movement should be initiated in the thorax, which will pull the rib cage closer to the pelvis. The head and shoulders should stay fairly relaxed, and basically “go along for the ride.” In Pilate’s exercises, this is aptly called the “head-float position.”

Signs of Midline Recovery

Diastasis recti resolves when your muscles have pulled back together to less than two finger widths, or when you can feel that your midline has become strong and elastic, at about six months postpartum. At this point, you will no longer feel a hole in your abdomen. Once your connective tissue has regained its former density and elasticity, you are no longer at risk for hernia or other associated problems.

For Best Results, Start Reconditioning Soon after Childbirth

Starting your abdominal reconditioning soon after pregnancy will yield the best results. If begin abdominal reconditioning at more than six months postpartum it is unlikely that you will be able to decrease the width of the gap at your midline. So if at all possible, start exercises that restore the abdominal wall in the initial months after childbirth.

Diastasis Recti Home Exercise Program

1. TRANSVERSE ABOMINIS ACTIVATION

While lying on your back with your knees bent draw your belly button in towards your spine. Contract your stomach muscles (as if coughing/sneezing) and hold this position.

Repeat 10 Times

Complete3 Sets

Perform 1 Time a Day

When this becomes easy and pain-free, move on to #2

2. BRACE HEEL SLIDES

While lying on your back with your knees bent, perform the transverse abdominis contraction as outlined in #1. Hold this position with your stomach and slowly slide your heel forward on the floor/bed and then slide it back. Use your stomach muscles to keep your spine from moving.

Repeat 10 Times

Complete3 Sets

Perform 1 Time a Day

When this becomes easy and pain-free, move on to #3

3. BRACE MARCHING

While lying on your back with your knees bent, perform the transverse abdominis contraction as outlined in #1. Slowly raise up one foot a few inches and then set it back down. Next, perform on your other leg. Use your stomach muscles to keep your spine from moving.

Repeat 10 Times

Complete3 Sets

Perform 1 Time a Day

When this becomes easy and pain-free, move on to #4 and #5

4. BRACE – SINGLE KNEE EXTENSION

While lying on your back with knees bent, perform the transverse abdominis contraction as outlined in #1. Slowly straighten out one knee while keeping the leg off the ground. Hold as indicated, then return to original position. Next, perform on the other leg. Keep your stomach muscles contracted.

Repeat 10 Times

Hold 5 Seconds

Complete3 Sets

Perform 1 Time a Day

5. QUADRUPED TRANSVERSE ABDOMINIS CONTRACTION

In hands and knees with the hands under the shoulders and the knees under the hips, draw your belly button in towards your spine. This is slightly more difficult than the other exercises as you’re pulling up against gravity.

Repeat 10 Times

Hold 5 Seconds

Complete3 Sets

Perform 1 Time a Day

To learn more about how physiotherapy can assist post partum recovery, you may contact Norbert Csulik at:

Mobile.: +86 186 2170 9626

WeChat ID: NorbertCsulik

Norbert is an obstetrics physiotherapist graduated from prestigious Semmelweis University, Hungary with a BS degree in physiotherapy. He has worked at Szent Janos Hospital, Maternity Division, Budapest, Hungary as an obstetric physiotherapy specialist.

In the past 5 years, he has worked for different hospitals and postpartum centers all across China, and has gained a thorough understanding of the Chinese health care system, including providing the highest standard of services and exceptional customer care.

His role as an obstetric physiotherapist is to promote health throughout the childbearing period and help woman to adjust advantageously to the physical and physiological changes of pregnancy and the postnatal period, so the stress of childbearing is minimized.

Prenatally and postnatally he advices on physical activities associated with both, work and leisure, he is a specialist in selecting and teaching appropriate exercises to gain and maintain fitness and well-being and assesses and treats musculo-skeletal problems related to pregnancy.

Shanghai Baijia Maternity Hospital

Address: 1045 Hong Mei Lu

Tel: 021 6728 5299

Web: http://e.shbjfc.com

WeChat ID: SH-Baijia100