Abdominal separation – 7 ins and outs about “the gap”
We are women's health physio's in the Shire (Woolooware), Bondi and Cammeray and we can help you with all your questions regarding abdominal separation.
1. What is diastasis?
Diastasis (DRA) originated from the latin word for separation. Essentially the
abdominals separate to make way for your growing baby. They separate along a line of connective tissue called the linea alba. The abdominals don't split, they move apart, and the linea alba widens and becomes stretched somewhat, but it doesn't tear open. Sounds grim but it's really a very natural and painless thing the body does in order to accommodate a whole human inside of you. 100% of women in their late third trimester will have a diastasis. It's unavoidable, so there's nothing you can do to ‘avoid’ it in your pregnancy.
2. Diastasis in pregnancy is normal
Diastasis a necessary and natural process in pregnancy. Some will be bigger earlier than others. And depending on this will depend on how early and how much you have to pay attention to how you're moving. Can you prevent it? Remember diastasis in pregnancy is unavoidable. How big it is in pregnancy is likely down to uncontrollables: genetics, age (>34yrs), multiple pregnancies, size of bump, very high or very low BMI.
Your pregnancy jobs – 1. Watch for coning
You may have already heard about the term coning, or doming, as something to beware of during exercise whilst pregnant. It's basically a 'visual' of your intraabdominal pressure (IAP) pushing outwards through 'the gap.' The linea alba is a connective tissue and is not muscular so it can't control this.
Pregnant or postpartum the same applies: If you see coning, don't panic, but this is your body's way of telling you you're maybe not controlling things across the gap so well, and if you can’t change it, to back off or modify your movement to something else. Common movements that can cause coning include: abdominal specific or forward flexion movements: sit ups or sitting up in bed or from the couch. If you’re a gym-goer (and we know the shire is full of gym-goers) you might also notice it on any prone loaded positions like push ups or planks, pulling movements like rowing, or any movements if you’re hanging off a pull up bar.
Your pregnancy jobs – 2. Go and see a women’s health physio - we are in the Shire (Woolooware), Bondi Junction and Cammeray!
Not sure how to control the coning? Think there might be room for some improvement in the way you’re moving? We can help! We’re women's health physios trained in helping identify how to help you move well in later pregnancy and to spot and modify coning/doming.
Please don't fear exercise. We know that sensible exercise in pregnancy is protective against severe DRA (Benjamin et al, 2014). Only over-exercising has been linked to poorer DRA outcomes: those who are too strong or too tight... which leads me to...
Your pregnancy jobs – 3. Mobilise and Relax
Keeping your abs nice and relaxed and mobilising your thoracic spine and upper body will help to give more room for bub and help divert stress away from that connective tissue. Need ideas? We have online classes for all our women in the shire (Woolooware), Bondi and Cammeray!
3. Postpartum diastasis is unlikely due to anything you did or didn’t do
Many women will have a remaining DRA after they've given birth and anything
up to a 2cm gap is considered quite normal. Between 0-8 weeks postpartum your body does a good job of ‘natural recoil’
Most recovery will happen without you doing anything. The body's natural ability to 'spring' back or heal its own DRA stops between 6-8 weeks postpartum. This happens without you doing anything. In that time, 0-6 weeks, research has shown that outcomes in long term DRA are the same for those women who do early exercises and those who do nothing at all. Those who do a focussed and specific rehab program AFTER 6-8 weeks postpartum (like Hatch Athletic), that contains TA and abdominal loading, can reduce the distance between their abs (Keshwani et al, 2018). A reduced gap doesn't necessarily mean a flat tummy / or pre-baby tummy. Exercise can certainly help BUT it's good to manage expectations. Not all DRA will reduce or close: there are many risk factors that elude exercise such as genetics, age, size of bump, multiple pregnancies and very high/low BMI.
4. Keep it under wraps
We do recommend wrapping or binding in some form for the first 6 weeks. This can be as easy as wearing tubigrip we will give you, or very high waisted compression leggings from brands like 2XU. Although there's mixed research on the topic, there is no harm. Many women love it - it can feel very good after delivery, especially for csection mamas. Panty-style or compression shorts can be great (the less rigid the better) or good old-fashioned tubigrip works wonders. Go for size K or L - you can pick some up at our shire (Woolooware), Bondi Junction or Cammeray clinics.
Wrapping should never substitute exercises, we may start you on a program as early as one week post and build you back to where you need to be.
5. What happens after 6-8 weeks?
Please don't fret if you have a lasting DRA. We appreciate one of the biggest concerns when it comes to DRA is aesthetics: what your tummy will look like longer term. This can improve with postural changes and exercise. The good news is moderate DRA (between 2-4cm) is not strongly linked to pain or reduced function, only the more severe cases will impact on your daily life.
It's all about tension
There is absolutely nothing wrong or concerning about a diastasis IF your core control is good and you have functional coordination of your muscles surrounding and underlying your DRA / gap. This basically means: are you able to create a good amount of tension across the gap with your core muscles? Now there are many core muscles, and you might've heard of postpartum rehab being very obsessed with a muscle group called the TA, the Transversus Abdominis or Trans Abs. And yes these need to fire. But it's how you coordinate your whole core system together, in synergy, which is what we as physiotherapists look for when we assess DRA.
We look to see that you're able to coordinate your core, your pelvic floor and your diaphragm (your breathing).
6. How to assess your own DRA
Before we start, please try not to get too hung up on the measurement. There isn't a magic number of cms that will tell you if you have a functional abdominal wall or not. Lie flat on your back with your knees bent, your feet on the floor. Lift a hand towards your tummy and find the middle of your abs, start with the area just above your belly button. Lift your head and move your chin towards your chest in a mini crunch position, rolling only your upper body and shoulders off the floor. Push your fingers downwards fairly firmly.
It it ‘functional?’
Gently push your finger into the gap, what does it feel like at rest? How springy is it? You can then play with your control here…. try to turn on your deep tummy muscles (TA), or try a pelvic floor squeeze - does the gap become less springy? Do you notice your fingers rise out of the gap once your muscles switch on? Is there a decent amount of tension there? Or does it remain floppy? REMEMBER this just gives you an idea.
7. What can I do to rehab it?
Begin to load and train your abdominal wall with a progressive program designed for that specific purpose. This will include exercises to load the abs themselves and the core muscles surrounding them (TA, external and internal obliques, pelvic floor, etc etc). Your physiotherapist can help you to get started with these, or point you towards some recommended programs.
Postural changes and exercise can improve the resting tension of your linea alba and the gap.
See our womens health physio's in the shire (Woolooware), Bondi Junction or Cammeray to learn what's unique about your muscle groups - what's overactive, what’s underactive? The only way you can know these specifics is to see a physio. It might be you have to spend some concerted efforts relaxing your belly as much as training it. You can then apply this knowledge to your exercises.
Learn the cues that work for you personally that you need to achieve good tension in your core: DRA or no DRA