Prevention: Diastasis Recti, Part II

By Stephanie Stamas

So now that you’ve learned how a Diastasis Recti (DR) can be created during pregnancy, how can you prevent it from happening to you? There is currently a lot of available information on the positive benefits of aerobic exercise for the pregnant mother and the fetus, but little research focuses on the effects of exercises on abdominal muscle strength, function during pregnancy and exercises to prevent linea alba separation. While studying at Columbia University I had the privilege of conducting research with Dr. Cynthia Chiarello, who is a pioneer in examining the relationship between diastasis recti, exercise, function and prevention. A research article published by Dr. Chiarello, “The Effects of an Exercise Program on Diastasis Recti Abdominis on Pregnant Women” found a significant difference in the presence of a DR between women involved in an abdominal exercise program (12.5%) versus non-exercising women (90%)1. This conflicted with results reported in an article by Gillard & Brown that found no difference between the exercising and non-exercising groups2. Dr. Chiarello argues that the key difference between the two prescribed exercises protocols was the purposeful activation of the transversus abdominis (TA), a deep abdominal muscle that acts as the body’s natural corset (the circumference of the Coke can discussed in part I), and promotes continued linea alba approximation throughout pregnancy.

Activation of the TA is implicated in the prevention and resolution of a DR for several reasons. First, contraction of the TA acts like an internal splint, helping to stabilize your core and decrease the width of the linea alba from the inside out.  Secondly, because the linea alba is made of two fascial layers (deep & superficial), targeted strengthening for separation prevention of both layers is required. Typical abdominal exercises – crunches, curls, etc – target the rectus abdominis and oblique muscles which only strengthens the superficial fascial layer. The deep fascial layer and inner abdominal wall, which is mainly formed by the TA, is not addressed with these exercises and is under the most tensile stress with a growing uterus. The inclusion of rectus abdominis and oblique exercises should only be introduced once the TA has become adequately strengthened. In summary, strengthening the TA first should be the foundation of any pre-natal or post-natal exercise program (also, an added bonus – the TA aids in the pushing phase of labor!).

To help you begin strengthening your TA, I have created a two-phase abdominal exercise program. The first phase focuses on isolated TA activation (week 1-2) and the second phase begins to add dynamic activities on top of TA stabilization exercises (week 2-6). Click on the links below and then enter the corresponding codes to gain access to the exercise programs.

Phase 1TA activationCODE: W9KNTZK

Phase 2TA activation with dynamic activitiesCODE: HDQ7JN2

Adaptions for Pregnant Mothers
For those in their second trimester – It is recommended that you don’t lie onto your back more than 5 minutes at a time as there is a (low) chance of decreased blood flow to the uterus. So either do the exercises with your back elevated on a wedge, in modified squat position against a wall or take breaks lying on your back by switching to another exercise in a different position. If you notice that you are starting to develop a diastasis recti, be sure to splint your rectus abdominals during all exercises – cross your arms around your waist as if you were hugging yourself and pull the muscles towards midline in sync with the TA contractions.

Adaption for post-natal mothers with DR
Start with the phase I exercises all supine (lying on your back), making sure to splint your abdominals with either the sheet wrapped around your abdomen (See Part I), using your hands to manually bring the edges of the muscle bellies together or while wearing an abdominal binder. These are by no means the only exercises out there, but are foundational stepping stones required to return to crunches, planks, bicycles, etc diastasis-free and pain-free!

I’ve had great feedback from Part 1 and a lot of excited expectation for this post on prevention. I knew a lot of my friends would benefit from this series, but I couldn’t not have imagined how hungry people were for this information. I have received some excellent questions that I was not able to address in these two posts, therefore you can now look forward to Part 3! I will be answering questions that I have received and have not been able to address. Feel free to reach out to me if also you have any questions: stephanie@beyondbasicspt.com

*While abdominal exercises are generally safe during normal pregnancies, it is important to observe the ACOG precautions for exercise & consult with your physician prior to starting a new exercise program.

References
Gilleard WL, Brown J Mark M. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate post-birth period. Phys Ther. 1996; 76(7):750-762

Chiarello CM, et al. The Effects of an Exercise Program on Diastasis Recti Abdominis on Pregnant Women. J Women Health Phy Ther. 2005; 29(1):19-24

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