31 May How do I fix my Diastasis Recti?
Late last year, I met the gorgeous Sophie Guidolin, who lives here on the GC and is a twin mum as well. We had a really interesting conversation about Diastasis recti. She told me she gets contacted constantly by women asking her how she closed her own separation, and when she posted a blog about the exercises she used, she was criticized for using a form of “crunches”.
Like most things, we are constantly learning more and more in the physiotherapy field from research. This changes how we treat conditions constantly, and it’s important to stay up to date with the current research as a health professional.
I have found the treatment of Diastasis rectus to be an interesting one. With practitioners disagreeing constantly with what should be recommended. I have tried here to give you some information regarding the current research so we can clear up some of the contradictory information you will receive when you google “how to fix my diastasis recti”.
1. SUPPORT GARMENTS
I put all of my early post-natal patients into a support garment. I myself used support garments after both my pregnancies. And yes, I had an abdominal muscle separation.
I do agree that you have to learn to use the deep stabilizing muscles and some argue that a support will make the muscles lazy. But I can tell you from first hand experience, that the second you put your tubigrip or SRC shorts, or whatever you choose to use on, your abdominals will feel better. You will feel more supported, and you will move better.
And if you are wanting the muscles to tighten up, it makes sense to me that you should try to keep them in the shortened position of where you want them to be, so that as everything tightens back up after your delivery, the muscles know what length to shorten to. We will work on the muscle strength as well, but in those early days, (generally 6-8 weeks) a support garment is ideal in my opinion.
2. AVOIDING SIT UPS.
Can I just clarify something.
Yes, in pregnancy sit ups are frowned upon. This is due to the overloading of the linea alba (the connective tissue that connects the right and left bellies of the rectus abdominus muscle (the 6 or 8 pack muscle). If you see a bulging of your tummy, this is definitely a sign that it is overloaded. Pregnant women should avoid sit ups.
HOWEVER, after you give birth it’s a different story….
THE MUCH USED, “DOING CRUNCHES WILL MAKE YOUR SEPARATION WORSE”
A recent study by Sancho, et al (2015) showed by ultrasound that doing crunches or sit ups CLOSES the abdominal separation. And if you look at the way the rectus abdominus muscle fibres run (vertically), this actually makes perfect sense. As they are running in an up and down position, if you tighten the muscles, they will pull closer together and the separation will become closer.
4. CRUNCHES AND THE PELVIC FLOOR
Crunches are something that we advise people to avoid when they have a weak pelvic floor. The increased abdominal pressure generated by contracting the rectus abdominus is thought to push down on the pelvic floor, increasing the risk of incontinence and prolapse. How do you know if this is happening to you? See a pelvic floor physiotherapist to check it with an ultrasound scan.
5. CRUNCHES AND THE CORE
The latest research of Pelvic guru Diane Lee in the states, and Professor Paul Hodges here in Australia, is showing something interesting.
After so much focus over the years on “closing the gap”, it is not the GAP that is important. It is how much you can tension the linea alba (the connective tissue that joins the right and left bellies of the rectus abdominus).
If you can switch on your pelvic floor, and your deep abdominal stabilizer (TA), and then perform a crunch, you can minimize the amount of downward pressure going through the pelvic floor.
But, ALSO, you can tension the linea alba due to the attachment to it of TA. And THIS is what is important. This is what will “flatten your tummy”, and stop your abdominal contents from pushing through the gap.
So, this is what we look at during a mummy check appointment.
Can you contract your pelvic floor? Can you hold it up during a crunch? Can you tension your linea alba?
So to me the take home lesson is this:
‘No crunches’ is not a blanket rule, it entirely depends on whether or not you are “bulging” or “coning” when you do a sit up post natally, as well as the strength of your pelvic floor (and it’s ability to maintain a contraction during a sit up). Obviously, a comprehensive abdominal program is best, but for some women, this can include crunches.
If you are concerned about a diastasis rectus, we encourage you to book an appointment with one of our physiotherapists.
Image from www.pinterest.com showing “coning” or “bulging” of the abdominals post natally.[/vc_column_text][/vc_column][/vc_row]