Exercising with Diastasis Recti - Four Tips for Moms

The physical changes to your body during pregnancy don't immediately disappear postpartum. One common change is diastasis recti abdominis (DRA), also known as abdominal separation. While this might sound intimidating, it's essential to recognize that DRA is a natural part of pregnancy in order to make room for your growing baby. It's also important to note that if you have abdominal separation, with the right guidance, you can regain core strength and confidence, and return to physical activity and exercise.

Understanding Diastasis Recti:

Diastasis recti, or abdominal separation, occurs as the linea alba (the connective tissue that runs vertically in the middle of your abs) widens and weakens to accommodate your growing baby. This caused your rectus abdominis (six-pack abs) to separate from each other. For some moms, the linea alba naturally tightens post-birth, bringing your rectus abdominis muscles closer together again. For others, the separation can persist, leaving a gap. The opinion about diastasis recti has shifted to such that rehabilitation is less about closing the gap, and more about being able to create tension so that your core can act as the stabilizer that it is designed to be.

Pelvic Floor Physical Therapy/Women’s Health PT

Many moms will look toward physical therapists for support. During your treatment, you'll focus on core muscle activation and breathing. This may result in your gap closing, but even if it doesn't you'll learn to have a strong and functional core so that your DRA doesn't impact your quality of life. It’s important to trust the process even if the exercises feel too basic. The basics are what create a strong fitness foundation so that you can progress and reach your postpartum fitness goals.

Exercise After Physical Therapy

After you've focused on core muscle coordination and have regained some strength, you'll be discharged from PT. You may then wonder what's next and still have questions about what exercises are safe. The key here is to realize that there is no one-size-fits-all approach. It's about personalizing your fitness program and performing exercises that allow you to have core strength and control. I've worked with many postpartum moms returning to exercise while managing abdominal separation, or after pelvic floor physical therapy and I’m happy to share my insight with you.

Tips & Strategies for Exercising with Diastasis Recti

Note, that it is recommended you work with a qualified postnatal fitness professional or see a pelvic floor physical therapist if you're looking for diagnosis or treatment.

1. Gradual Progression: Start with exercises that focus on activating your deepest core muscle the transverse abdominis. Move to coordinate that muscle activation with breath and pelvic floor. Progress to more complex movements gradually, incorporating resistance, repetitions, and different positions.

2. Manage the pressure you create within your abdominal cavity: Be mindful of everyday activities that increase your intra-abdominal pressure, such as sneezing, coughing, or lifting. Use your transverse abdominis activation strategies and breath to help manage the pressure and force on your healing abdominal wall.

3. Exercise Selection: Choose exercises that align with your core strength and function. There isn’t a definitive list of “bad exercises” or “exercises to avoid if you have diastasis recti”. Rather it should be based on your personal ability. If you can lift 20 pounds fairly easily without having to bear down or hold your breath, then that exercise may be appropriate. However if someone else goes to bench press 20 pounds and struggles and grunts and has to create a lot of pressure in the abdomen to perform the movement, then that exercise should be avoided until the core is stronger and the tissue is more healed. Most people will void high-impact or heavy-lifting activities initially. 

4. Muscle Recruitment: Pay attention to recruiting the right muscles at the right time. For example, many people think of the chest, shoulders and arms for a push-up and don’t realize that it is very much a core exercise. To stabilize the spine during a push-up your core muscles should engage. Ensure your deep abs activate for stability before movement.

Avoid back pain and incontinence

Although more research needs to be done when it comes to diastasis recti impacting pain and incontinence, many moms that I work with who are concerned about abdominal separation are also concerned about incontinence and back pain. Both of those conditions are common during and after pregnancy so their concerns are valid. Rather than fearing these conditions, I created a free 5-day program to empower you and educate you on how to have a strong and functional core in order to reduce your risk of pain and leaking when you sneeze or cough. By understanding your body and following a tailored fitness approach, you can confidently navigate your fitness journey with diastasis recti or any other condition resulting from pregnancy. 

When Can I Start to Exercise After Having a Baby?

“When can I exercise again after having the baby?”, OR “Do I have to wait until my 6-week postpartum appointment to get back to physical activity?” The answers to these questions are going to vary based on your individual situation and needs. In general, it is safe for most moms to begin connecting with their deep abs and pelvic floor muscles using breath. Low-intensity walking and mobility exercises may be beneficial for you as well. Let comfort and energy level be your guide. Remember movement is good, but you don’t want to interfere with healing, especially if you had tearing or a c-section. You should not return to anything more vigorous before a doctor can tell you that there are no medical contraindications. If bleeding increases following even light activity, that may indicate that you are doing too much and you should contact your physician.

If you are “cleared” for exercise at your postpartum visit, this means that your doctor from a medical perspective thinks you can begin to be more physically active. You should still approach exercise with a gradual and progressive approach. This is not a green light to jump into your old routine. Abdominal and pelvic floor tissues can take up to 9-12 months to heal.

If your doctor approves and you’re ready to exercise, the progression below might help you prioritize your first steps back to fitness.

1. Heal: Whether you’ve had a c-section or vaginal delivery you have tissues that need to heal. Your initial focus should be on promoting healing by getting enough water, and nutrients and resting when you can. You should not begin to exercise until you know that any tears or incisions have healed properly. You’ll also want to address any scar tissue. Part of healing may also mean addressing concerns like incontinence, the feeling of pressure or bulging in your vagina, or abdominal separation. These are all common conditions, but not normal. It may not necessarily mean that you can’t begin an exercise program simultaneously, but you should consult with a pelvic floor therapist and prioritize exercises that will help you improve those symptoms or conditions.

2. Core: Most muscles of your core are impacted by pregnancy and delivery. All moms should strengthen these muscles and ensure that they function optimally by working synergistically. This often means beginning with breath, transverse abdominis, and pelvic floor muscles.

3. Function: Being a mom is physically demanding. Part of your return to fitness should be mastering repetitive movements like hip hinges or getting up off of the floor (think deadlifts and lunges), strengthening muscles that impact posture (think back and glutes, and focusing on mobility (think upper back, ankles, hamstrings and hip flexors).

4. Strength: After you have foundational core strength and have mastered movement patterns, you can begin to think about gradually progressing your program. This could include adding more resistance, moving to moderate to high-impact activity, and performing more demanding abdominal exercises like rotations or exercises in positions against gravity.

Other considerations of when it’s best for you to begin to exercise include sleep (ability to recover), support from family/friends, and mental state. Hopefully, this doesn’t sound overwhelming because there are many positives to postpartum exercise like establishing a healthy lifestyle for your family, and training in a way that you can become stronger than you were before pregnancy. And remember, exercise as a mom is not a luxury, it is essential in meeting the physical and emotional demands of motherhood.

3 Holiday Fit Tips

As if your to-do list wasn’t long enough already, now add maintaining the holiday gathering calendar, planning/prepping more meals, and making sure your kids experience family traditions...phew, it’s no wonder our perspective on fitness changes a bit this time of year. Here are a few reminders as we approach the holiday season.

1. January is not your start date: From November through December life gets busy and fitness might be a lower priority, but do yourself a favor and don’t see these last two months of the year as pointless when it comes to workouts. Sure it’s easier to ramp up fitness in January, but you don’t want to enter 2022 feeling like you’re starting over or that you’re “getting back on track”. If you know the end of 2021 will mean less consistency with exercise, instead look at it as your off-season; a chance to maintain what you’ve built, try different types of exercise, enjoy shorter movement sessions, and prepare your body for a surge in a couple of months.

2. Embrace the dark (and cold): whether you work out early in the morning or in the evening, chances are it’s going to be dark and cold. Acknowledge the challenge, but don’t let it become an excuse. Brighten up your home workout area, enlist an accountability partner, lay out your clothes the night before...whatever it takes to embrace the change of season and not let it sabotage your goal to stay active.

3. Exercise is not an exchange for indulging: During the holidays meals tend to be heavier and alcohol might be more frequent. Indulging a bit more is often part of tradition and good times with friends and family. If you’re choosing to indulge, it’s important to be OK with it and not fill yourself with guilt and stress. Don’t fall into the thinking that exercise is there to make up for eating more than usual. Continue to fuel your workouts with good nutrition and if you’re making the choice to have that extra dessert or glass of wine, accept it and enjoy it, knowing that your healthy habits over long periods of time will help you maintain your baseline.

As you can see, for your fitness routine to survive the holidays, it takes a little bit of a mental shift and recognizing that this is a temporary time period and adjustments should be made. So enjoy the family traditions, acknowledge the challenges, and change your perspective on what fitness means to you during this time. If you’d like some guidance with your holiday fitness plans or want to set yourself up for success in the New Year, schedule your personal exercise consult.

3 Ways to Incorporate Pelvic Floor Training into Your Strength Routine

Your pelvic floor muscles can be considered the basement of your core and play a key role in managing intra-abdominal pressure (pressure within your abdominal cavity that helps stabilize your spine). When your pelvic floor muscles work with the rest of the core to manage the pressure, you'll feel stable and strong. When one area of your core is weak, your ability to manage and create pressure for stability changes. During pregnancy breathing, abdominal muscles/wall, and pelvic floor are impacted by the changes to your body-which is why training each of them properly is so important.

Pelvic floor muscles also play important roles in sexual function, organ support, and sphincteric control (holding urine, gas and poop). During the natal period (pregnancy and postpartum), weakness or overactivity of these muscles can impact your core strength and function, as well as cause conditions such as urinary and fecal incontinence, or pain with intercourse. By now most of us have heard of kegels, and some of you may even manage to fit in a few sets while brushing your teeth or driving. However, like most muscles in our body, pelvic floor muscles need to be functional during movement and not just at rest. The best way to do this is to coordinate the activation of your pelvic floor muscles with other core muscles during movement. Here are some ways to train those muscles with common exercises:

1. During squats: As you descend into a squat this is when your pelvic floor muscles should relax. During this lowering movement, you will inhale. As you ascend up to standing with an exhale, this is when you can contract your pelvic floor muscles (think of trying to tighten your vagina around a tampon). Additionally press through your heels to activate glutes, and draw in your belly button (to hit your transverse muscles).

2. During a front dumbbell raise: As you lift the dumbbell exhale and draw in your belly button (to hit your transverse muscles), while at the same time visualizing your pelvic floor rising along with your arm toward your belly button. As you lower the dumbbell, gently release your abdominal contraction and relax your pelvic floor.

3. Wall sit: While you're holding your wall sit (back against the wall, knees bent at 90 degrees with your knees over your ankles), challenge yourself for endurance pelvic floor contractions-one set of three 8-12 seconds long holds (make sure you’re not holding your breath, just the pelvic floor lift). And then follow that with a wall sit of quick pelvic floor contractions-strong flickers of your muscles for 10-15 reps. Think quick “contract, relax, contract, relax”. (similar to an orgasm)

For most pregnant people, pelvic floor training is recommended and will help you maintain a strong and functional core. Remember to always relax between contractions...you don’t want a tight pelvic floor during delivery.

It can be helpful for everyone to get a pelvic floor assessment postpartum, as many people will need to retrain the muscles, and although common, pelvic floor dysfunction is not normal. Weakness is not the only concern, sometimes birth trauma can lead to overactive or spasmed muscles...so don’t just jump back into kegels.

Happy training! If you’d like a strength program that incorporates pelvic floor, get started with Active Mom Fitness!