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Stop The Despair & Start The Repair

Stop the Despair & Start the Repair

Overcoming the Dreaded ’Diastasis Recti’ by John-W. Hughes.
LSSM, ISRM, BSc, PhD

The metamorphosis of the pre-natal woman’s body during pregnancy, from the eyes of this soon-to-be-a-dad-again, is absolutely incredible. I spend much of my time totally mesmerised by how my beautiful wife continues to navigate the minefield of challenges she is faced with each day despite the global fascial (physical) changes that have occured as the new addition to our little family is nurtured and grows within her abdomen. Like every mother she has faced the possibility of suffering with swollen ankles, lower back pain, sacroiliac joint disorder, pubic symphisis dysfunction, carpal tunnel syndrome, upper back pain, neck pain and migraines to name but a few of the problems experienced during pregnancy. She is a true athlete and her challenge unlike any other lasts for an astounding 9 months.

However, despite all the happiness and tears that come with being pregnant, the physical changes that occur don’t always correct themselves once the perfect little being they have been growing arrives for their first hug and kiss. One such change is called ‘Diastasis Recti’, and is a condition that affects as many as 2 out of 3 women to varying degrees. Diastasis Recti refers to a physical change where the connective tissue (linea alba) that binds together the opposite sides of the rectus abdominis becomes overstretched and separated as a consequence of abdominal weakeness, poor posture, hormonal changes and most significantly an increase in intra-abdominal pressure that is exerted by the growing baby inside the womb. Many of you will have heard about this problem prior to reading this blog, however you may not be aware of this condition’s intimite relationship with pelvic floor health or importance in optimal core strength, stability and health. A major concern for me as a therapist is that there are women reading this with Diastasis Recti who believe that any pelvic floor pain, incontinence or pelvic organ prolapse they are also suffering with are a natural consequence of pregnancy and that it is normal. The fact is that this is not normal and nobody should be accepting this as the OK.

Postpartum pain and dysfunction are becoming increasingly common, even amongst the fittest of women, and if any part of you thinks you may have Diastasi Recti please seek help from an appropriately qualified therapist to guide you through recovery. There is no quick fix for this condition and the road to recovery for each individual can be a long and personal one.

Education is empowerment and it is with this in mind that I am now going to introduce you to firstly, how to determine if you are suffering with Diastasis Recti and secondly, key remedial exercises that are considered abdominal safe and will not encourage further muscle separation if performed correctly.

If you’d prefer to watch a demonstration then click on the image below to see the AdvanceSRM video, which introduces you to diastasis recti and the abdominal safe remedial exercises recommended for abdominal separation.

 6 Abdominal Safe Exercises

When performing any of the 6 remedial exercises below it is important to ensure that the deep abdominals and pelvic floor muscles are gently tightened first.

 

Deep Abdominals and Pelvic Floor

1. Lie down. Bend your knees to keep a neutral curve on your back.

2. Draw in the lower abdomen (at the pubic line) as if you are trying to do up the zip on a tight pair of jeans. This will engage the deeper abdominals.

3. Simultaneously, imagine engage the pelvic floor by drawing the muscles in and up. Do this by imagining you are trying to stop the flow of urine or holding in wind.

4. Hold the tension for 5 normal breaths.

5.Repeat for 5 to 10 contractions 3 times per day.

*Top tip – Try using a belt or a yoga strap drawn in tightly around the lower tummy. When performing the above exercise a visible gap should appear between the belt/strap and the lower tummy.

1. Core Contractions

1. Sit on a chair, bench or swiss ball.

2. Take a deep breath so that the abdomen expands.

3. Exhale while contracting the abdominals back towards the spine.

4. Now hold the contraction for 30 seconds, without releasing the abdominals. Keep breathing naturally!

5.At the completion of the 30 seconds perform 10 small squeezes.

2. Seated Squeeze

1. Sit on a chair, bench or swiss ball.

2. Rest one hand on the upper abdominals and one on the lower.

3. Take a deep breath so that the abdomen expands.

4. Exhale while contracting the abdominals back towards th spine.

5. Now contract the abdominals in more deeply for 2 seconds before returning to the startin position. Keep breathing naturally!

6.Work up to 100 repetitions.

3. Head Lift

1. Lie on your back with your knees bent.

2. Engage your lower abdomen and pelvic floor.

3. Take a deep breath so that the abdomen expands.

4. Exhale while contracting the abdominals back towards the spine.

5. Tuck your chin in and raise your head and shoulders off the floor.

6. Hold for two seconds.

7.Repeat up to 10 times.

4. Upright Push-up

1. Stand facing the wall.

2. With arms straight out and shoulders width apart place your hands on the wall.

3. Take a deep breath so that the abdomen expands.

4. Exhale while contracting the abdominals back towards the spine.

5. Now bending at the elbows lower yourself towards the wall keeping the abs angaged.

6. Hold for 1 second before straigtening the arms and returning to the start position.

7.Build up to 20 repetitions.

5. Standing Wall Squat

1. Start with a Swiss ball or foam roller behind your back and pressed up against the wall.

2. Take a deep breath so that the abdomen expands.

3. Exhale while contracting the abdominals back towards the spine.

4. Engage the pelvic floor.

5. Squat down until the knees are bent to about 90 degrees.

6. Pause for a second before straightening the legs to reach a standing position while contracting the abs deeply.

7.Repeat and build up to 20 repetitions.

6. Squat with a Squeeze

1. Start with the back pressed up against the wall. Place a football, pillow or pilates block between the knees.

2. Take a deep breath so that the abdomen expands.

3. Exhale while contracting the abdominals back towards the spine.

4. Engage the pelvic floor.

5. Squat down until the knees are bent to about 90 degrees.

6. Pause for a second while squeezing the ball with the knees before straightening the legs to a standing position.

7.Repeat and build up to 20 repetitions.

Hopefully you now have a much better understanding of a range exercises that will give you a way to safely engage the abdominals without exacerbating the separation of the connective tissue running down the middle abdominals.

Only perform these exercises under the guidance of a specialist who is able to perform a screeening and assessment of your Diastasis Recti.

Under NO CIRCUMSTANCES should you consider doing or allow anyone to encourage you to carry out any of the following exercises that are known to increase intra-abdominal pressure, until your core functionality and strength is restored and the connective tissue separation has repaired sufficiently:

  DO NOT PERFORM ANY OF THESE AB EXERCISES

Any form of crunches

Oblique twists


100’sPilates


Press-ups

Reverse Leg Raises


Any type of plank

 If in doubt or you feel your abdominals spearate when doing any exercises then you must stop and seek advice.

Feel free to contact me with any questions or concerns you have and don’t hesitate to get in touch with me for an appointment should you need more tailored support.
John-W. Hughes.
LSSM, ISRM, BSc, PhD.

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