As a personal trainer with a specialty in pre/post natal fitness, ONE of the most frequently asked questions is,
"HOW DO I GET RID OF MY MUMMY TUMMY?!"
It's one of the most asked, BUT also one of the most misdiagnosed issues. To be honest, most women who have given birth, don't even know they have it. But after your beautiful baby is delivered, and you get back on the exercise train, if several months later you STILL look like you are 4 months pregnant, you may indeed have diastasis recti.
WHY DO PREGNANT WOMEN GET DIASTASIS RECTI?
Truth is, not only pregnant women can get diastasis, AND not ALL pregnant women will have a diastasis that stays after birth. Diastasis can also result from poor form used during exercising, excessive weight gain, multiple pregnancies, as well as certain exercises and sports.
Diastasis can usually be seen in the last half of pregnancy, but is most often diagnosed and seen postpartum. A small widening of the midline is totally normal in pregnancy, and not call for alarm. In fact, about 30-40% of all pregnancies will result in a diastasis. In pregnant women, a diastasis is formed as your growing uterus pushes against your abdominal wall, aka your '6-pack'. If your lower abdominals, or your transverse abdominals, are not strong enough to support the growing uterus and pushing on your rectus muscles, your '6 pack' becomes two 3 packs.
Your linea alba (connective tissue NOT muscle), will be stretched sideways, and will become the support system for your organs. With your organs now pushing thru this connective tissue, you will look pregnant. The naval is a weak spot in the abdominals and will often be where you will see and feel this separation, and see what is known as a 'mummy tummy'.
HOW CAN I TEST IF I HAVE IT?
After the birth of my second child, I KNEW something wasn't right! I was 4 months postpartum, working out, running, doing HIIT and after I lost most of the baby weight, my belly still looked like I was carrying a 4 month old fetus! I used to ask my doctor, "Did my uterus shrink yet?" He looked at me as if to ask, "Are you kidding?" I indeed had a diastasis.
I knew what I was doing wasn't cutting it. I knew it wasn't a matter of HOW intense I could work out to try to lose it, but WHAT I was doing that was NOT working, and perhaps even making it worse. As I have posted before in one of my Dailyhiit articles, I address that there are indeed certain exercises that women WHO HAVE a diastasis should avoid and/or exercises that will make it worse.Since I hadn't realized a diastasis was indeed the issue, I kept wishful thinking that it would correct itself. The first step though, is diagnosing it. In the research I did for my own diastasis recovery, I came upon the Tupler technique. I had studied this as a trainer years ago, but without experiencing it first hand on my own body, I had to get down to basics. Jill Hoefs, a MPT who was personally trained by Julie Tupler, and who I have met with and worked with on my own recovery, provides this 5 step approach to checking for diastasis:
Five Easy Steps
- Lie on your back with your knees bent.
- Place your middle three fingers in your belly button pointing in the direction of your toes.
- Relax your abdominal muscles and lift your head. If you are holding your abdominal muscles in as you check it will give you a false reading as this will make the diastasis appear smaller.
- Check yourself when you first start feeling the muscles coming together. Come up and down a few times so you can feel how the muscles work.
- Use 4 to 5 fingers, if you do not feel the two ridges of the muscles with 3 fingers. If you see the football- like ridge you may even have to use 2 hands if your diastasis is very large.
NOTE: If, when you raise your head, you simply feel your stomach muscles tighten underneath your fingertips (as opposed to tightening on each side) then you do not have a diastasis.
A midline separation of 2-2 1/2 finger width is considered problematic. With a larger diastasis, it can create several problems such as chronic lower back pain, lumbar instability, digestive problems and worse of all, hernias.
There are however a lot of misconceptions about diastasis recti as well. Many women feel that they HAVE to have surgery to repair it, and that is simply NOT true. In fact, if you go out and get the surgery, without trying to strengthen and establish that integrity back into your lower abdominals (transverse, or TVA), you could find yourself back with similar issues AFTER surgery. Not to mention the surgery is VERY painful, and there is a lot of recovery time as it is major abdominal surgery.
Although, some people with diastasis can have a hernia as well which can be painful, living with the separation for the most part is not painful at all. In fact, with the correct exercises, you can actually come close to closing the gap and repairing the damage done. Even with a C-section (as I have had in my previous 2 pregnancies), I was able to get much of my abdominal strength back and was on the road to recovery with my diastasis when I became pregnant with my third this year. With that being said, there are definite movements/exercises to AVOID with a diastasis as well as movements and exercises to incorporate that will not only strengthen your abdominals, but close the separation gap as well.
MOVEMENTS AND EXERCISES TO AVOID WITH A DIASTASIS
- Any exercise that will cause your abdominal wall to bulge out upon exertion.
- Certain yoga postures that stretch the abs like, 'cow pose', 'up-dog,' all backbends and 'belly breathing', and other quadruped exercises (hands and knees) without adequate abdominal support.
- Pilates mat and reformer exercises where you utilize the "head float' position, upper body flexion, or double leg extension. (Did you know that even Joseph Pilates HAD diastasis recti that got even worse as he aged?)
- Movements where the upper body twists and the arm on that side extends away from the body, such as "triangle pose."
- Exercises that require lying backward over a large exercise ball.
- Abdominal exercises that flex the upper spine off the floor or against the force of gravity such as: as crunches, oblique curls, "bicycles," roll ups/roll downs, etc. Basically all of these....
With all the talk of what NOT to do to make diastasis worse, we have to address what can be done to help strengthen the abdominal wall after pregnancy, and even help CLOSE the abdominal separation, and rebuild the abs we all love and want. The key is to understand you have to condition your abdominals from the INSIDE out. All the crunches in the world will not get you flat abs if you do not correct the underlying problem. Don't get me wrong, you may strengthen your abdominals from doing traditional ab exercises, but with a diastasis, you will still have a 'bulge' that will make you look pregnant. It's also never to late to help correct the problem. Whether you gave birth 6 months ago or 6 years ago, you can still help repair your diastasis.
EXERCISES TO HELP CLOSE A DIASTASIS & STRENGTHEN YOUR ABDOMINALS CORRECTLY AND SAFELY
Julie Tupler developed a research based program to help close a diastasis. I started her program when I was about 12 months postpartum with my 2nd (I should have started a lot sooner!). It was working great, and my separation was getting smaller and so was my waist! I could actually see and feel the difference. THEN, low and behold I got pregnant with my 3rd and current pregnancy, but I am continuing to do it thru delivery.
This 4 step approach to close a diastasis consists of:
Exercises: Elevator, Contracting and Headlifts
Splinting: wearing and holding
Using your transverse in EVERYTHING YOU DO
Get up and down correctly from a back-lying postion
Exercises 1-3 above are the MOST important in starting your recovery. In her program, it's recommended you do several sets a day of these 3. In terms of wearing a splint, I wore and wear mine as much as possible. There are MANY on the market right now, so depending on which one you go with will determine how it's worn. The 'splint' should be worn at all time, even when you sleep! I know, I know, say it ain't so. BUT, it helps to keep your transverse in place and engaged. Wearing it also reminds you of how you are to sit, stand, walk, pick up anything, bend over etc. She recommends wearing it also while doing the exercises above. The splint on the model below is what mine looks like:
#3 is using your Transverse(i.e. holding it in) in EVERYTHING THING YOU DO! This goes for sneezing, coughing, laughing, getting up and down, exercising, getting in and out of bed (part of #4), picking up your baby, any weight etc., and even going to the bathroom. This will make a HUGE difference, but it's something you MUST CONSTANTLY KEEP IN MIND. We are a society who are ALWAYS IN A RUSH! This is something you may not think about, but it truly does make a difference. In my boot camp classes I must say, "CONTRACT YOUR CORE!" a MILLION times. NO matter what you are doing, this is a big one.
#4 getting up and down correctly from lying position is another overlooked step. How many times do you pike up from a lying position to get up faster? When going to bed, how many times do you just go from a sitting on your butt to just lowering your back down? This is the proper way to get up and down with being able to engage your transverse at the same time.
As I mentioned, we must strengthen from the inside out. The key to "FLAT" abs, is to strengthen that inner most & deepest abdominal muscle, the Transverse abdominis, (TVA). When you only train the obliques and rectus abdominis, they can overpower the weaker TVA causing your belly to bulge. Think about it like buttoning a shirt from the top down. If the bottom few buttons on your shirt are missing or loose, you will never get that complete and tight closure. Training your TVA and learning how to engage it properly during exercise is the goal. If you are doing traditional abdominal work like crunches, sit ups, bicycle crunches etc., and let your abdominals 'balloon' or bulge/inflate during the exercise, that is how you are training your abs and therefore, not engaging those lower transverse, where the focus really needs to be. With continuous error performing exercises such as these, you are making the separation even worse and creating postural problems, lower back issues and pelvic instability.
Another problem that I see in my classes is in performing traditional push ups, planks, Mt. Climbers etc. If you are NOT engaging the TVA, and NOT using those main core muscles to help stabilize you, your lower back will sink in and cause pain during and after the exercise, further promoting a 'belly' bulge. It's often recommended that if you HAVE a diastasis, the proper protocal is to address the issue first and complete the above recovery exercises BEFORE you start working out again as usual. I have to be honest with you here. I did NOT stop exercising thru my recovery. I even finished 2 months of Beachbody's INSANITY and continued doing Dailyhiit workouts as well. The only difference was that I was VERY aware of activating my TVA throughout the routines, and if something was contraindicated in terms of exercises I should be avoiding, I did.
I do know a few women though who ONLY did the Tupler technique and nothing else until their diastasis closed. It took longer for mine to get smaller, but I also kept my sanity by being able to exercise as needed and destress. To me, this trumped anything else. You have to do what's right for you.
Now you may read this and think, "AH HELL NO! THAT IS TOO MUCH WORK!" I can tell you from my own experience, it's like ANYTHING ELSE! Anything that is worth it, doesn't come easy. But just like with any other exercise routine, whether you are starting out or progressing, in 4 weeks from now, you will WISH you had already started! I started noticing a difference in less then 4 weeks. It just takes time. Believe me, it IS worth it and will work if you DO the work.
Speaking from experience, and going thru 2 pregnancies and births already, my body has taken a beating (we will get into that in another time, LOL!). Not only has it changed a lot, but certain things just aren't the same as they were 4 1/2 years ago! But what's great, is that I am stronger and fitter now then I ever was! Yes, there are still parts of my body that are still a 'work in progress'. But when I look at the 2 beautiful girls I've birthed, I couldn't be prouder of my journey and how far I've come. I am a strong woman. I am FAR from perfect. I know I have a LOT of work to do again once I deliver this baby, but I am ready. I would do it over and over again too. I have no doubts I can make it happen. Believe in yourself, and know that ANYTHING is possible.