I have had an enlightening few weeks studying Munira Hundani’s new course ‘Diastasis Rectus Abdominus and the Postpartum Core’ which for me, presented a fascinating new framework for both assessment and exercise prescription of the post partum core.
Diastasis Rectus Abdominus (DRA) is a widening of the linea alba (the midline of the abdominal wall) experienced by women during and after pregnancy. Whilst it is normal to experience some degree of separation it should generally resolve naturally postnatally however in approximately 1/3 of women the excessive and prolonged widening prevails adding to a sense of disconnection and dysfunctionality .
Commonly the protocol for fitness instructors, like myself, for dealing with DRA is to present a long list of things to avoid to prevent further widening of ‘the gap’. These might include lifting heavy weights (e.g children), sit-ups, plank, boat pose (Navasana) jack knives, russian twists etc for fear of causing too much Intra Abdominal Pressure (IAP) and worse still increasing the gap. The assessment of the DRA would usually be conducted primarily in supine using a head lift protocol and exercise prescription would typically be progressed dependant on the inter recti distance (or width of the gap)
Hudani’s work paints a much more positive picture for the treatment of DRA as well as a much bigger focus on the individualised journey that success should take accessed via the initial assessment. Crucially she demonstrates how clinical research shows that there is little to no correlation between the DRA itself and formally associated issues such as lower back pain or indeed the ‘type’ of exercise a woman should do. Rather than point the blame at ‘the gap’ she explains that the inter recti distance is just a another part of the abdominal wall that has widened as a whole, coupled with altered breathing and core connection strategies resulting in a mis-management of IAP. She goes on to emphasise the importance of IAP and how harnessing it using the diaphragm and the Transversus Abdominus (TVA) is the key to success.
So what does this mean for women with DRA? Well, by assessing the DRA in positions which prompt more IAP (i.e standing or sitting as opposed to supine – which, she explains, is particularly unproductive for those with increased circumferential laxity) it helps to illicit a better provocation of TVA’s true ability to activate and therefore a ‘way in’ to strategise a stepwise approach for that individual. The idea of using and creating IAP to strengthen the core automatically reduces the fear factor around creating too much IAP. Once the re-training of the diaphragm and TVA has successfully been achieved the list of formally avoided exercises are the very ones which need to be integrated in to optimise core and indeed whole body strength. This means your favourite yoga class, HIIT workouts or Pilates classes are once more back on the table.
If you have been affected by diastasis and are looking for ways to help progress do get in touch via the contacts page for more information.