Pulling it all together: Physical Therapy and Diastasis Recti

The last few months have been a lesson of limits for me as I face the reality that I am a 32 year old mother runner, and my body will never be the same as it was before baby.  But that’s what aging is, isn’t it? And I’m really ok with it.  Cadence is the best extension of me that there ever was, and if she’s my youth, I could not be more proud than to have her carry on my legacy.  But before I go off on a mortality binge, let me say that things are really looking up!

IMG_20160806_130528

Every sacrifice is worth it for this sweetness!

In May, I was diagnosed with a hernia and had surgery for it.  It turns out that it was not really a hernia, and instead I have ab separation.  The surgeon was all doom and gloom about my state as an ab separated mother runner, but I have since met with two great physical therapists who told me that I am in fact very strong and set me up with strength exercises to make sure that I stay strong.

So what is happening with my abdominals then? From what I understand in meeting with the two physical therapists, my recti abdominus muscles (the six pack muscles) are working together when I engage them.  That’s great news!  There is a gap, but it is not significant, and my oblique and transverse muscles are all very strong.  The linea alba is the tendinous median line that runs down the middle of the recti abdominus, and in my case, that is what was stretched during pregnancy. 

 

Interestingly, a lot of women experience diastasis recti (DR) below the umbilicus (belly button), but in my case, all of mine is above the umbilicus.  When diastasis recti is below the belly button, some women experience a “pooch” that no amount of working out is able to resolve.  The abdominals are all connected to the pelvic floor, and a lot of women with diastatis recti also experience incontinence.  That is why exercises like kegels are so important to engage the pelvic floor.  It’s all connected!  If I had lower abdominal diastasis recti, it would also make running more challenging (no!).  In my case, the diastasis recti is only present from the belly button up, which is why I can feel my intestines down the center  of my abs (still sounds weird).  If it weren’t for that little detail, I wouldn’t notice a thing.  😉

I visited two different physical therapists on two separate days.  One of the physical therapists focused more on breathing techniques to help me engage my core properly, and the other reviewed my form in multiple strength exercises.  They both had different approaches, but the suggestions were all very promising (and I even got a few tips for running!).  I was assured that I would be just fine having a second baby.  It’s a good thing for me to address strengthening my core while I can.  When we decide to get pregnant for baby #2, I’ll just have to focus on the proper strength work to heal properly postpartum again.  That’s the great thing about our amazing bodies!

IMG_20160804_081222

Physical Therapist office with a complete pilates studio!

My primary takeaways from physical therapy were proper breathing and proper form.

Breathing: The foundation for proper breathing is to take a deep breath in, allowing the rib cage to expand while abdominals are relaxed, then as you exhale pull the belly toward the spine and engage the pelvic floor muscle. Here is a great site explaining diaphragmatic breathing, also called belly breathing.

My assignment is “belly breathe” two times a day for 10 breaths:

  1. lying with knees bent
  2. sitting in a chair with feet on the ground
  3. on all fours

Another breathing technique to remember during my training is to exhale during the hardest part of a workout (ex: exhale when lifting, inhale when lowering).  This means that I am supposed to slow down my strength training in order to coordinate breathing (I am guilty of speeding through a work out just to get it done!).

IMG_20160809_082424.jpg

Clam shells are my new favorite exercise to help my gait

Strength Training: Engage the deep abdominals just before and as you push/pull/lift any resistance — this includes lifting the baby or any other type of weight.  I was not given specific strength training exercises, rather my current strength form was evaluated to make sure that I am properly engaging my abs to work together during all of my activities.  Examples of core work that I currently do are planks, side planks, crunches (different variations), bridges, etc.  Some women with DR are instructed not to do crunches, but my abs are actually firing properly.  I also have some side-to-side work, that is not always recommended for DR, but my PT said that given the location of my DR, it is good to get the obliques strong.

IMG_20160724_130910

Workout buddies

I felt so encouraged in meeting the the physical therapists, and I recommend that anyone unsure of their status post-baby should go see a SPECIALIST in this area.  I think that women, especially in the U.S., feel like they should bounce right back to pre-baby shape (whether that means returning to work right away, fitting into jeans, or getting that PR), and we don’t give ourselves the space to properly heal and process the trauma that our bodies have experienced through pregnancy, labor, and breastfeeding.

Did you feel like you were expected to bounce right back after you delivered your baby?

What are your favorite core exercises?

3 thoughts on “Pulling it all together: Physical Therapy and Diastasis Recti

  1. Hi! I came across your blog while researching DR. I have it after the birth of my second daughter. I am very similar in build to you. I was so fit before and during my pregnancy. I had abs of steel. Now not so much. I have about a three finger gap from ribs to pubic bone. I am almost 18 months postpartum. I have made gains in strength but I feel my abs are holding me back. I am so bloated and uncomfortable at the end of the day too. I’m looking at having them surgically repaired. I just wanted to see how you are doing with your DR and if you’ve noticed that it’s gotten better overtime. Do you have any other symptoms other than the bulge?

    Liked by 1 person

    • Hi Rhiana, Good work doing your research and exercises! I’m sorry to hear that it still isn’t great for you. I do still have a gap, and doctors tell me that that is my new normal (until I get pregnant again, and then it will get worse. wah wah). I have been able to get my ab strength back, but I don’t think there is much else that I can do to bring my abs closer. And with that, I do still have the weakened fascia where my intestines bulge and have to be pushed back in. It’s about a half inch in diameter. :-/ But having a baby is so worth it! Best of luck to you! You’ll have to let me know if you get surgery and the results.

      Like

      • Thank you for replying! I belong to a DR support group on Facebook. It’s a closed group and you must request to become a member. We share exercise ideas, success stories, surgery experiences and offer support. It’s nice not to feel alone. If you’re interested you should join! I’m glad your DR isn’t affecting you too much!

        Liked by 1 person

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s