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.
After a bit of an end of pregnancy slow down (!) on the blog front I thought it would be an opportune time to write some post natal exercise posts to both remind myself & give some direction to anyone beginning the journey of reconnecting with their non-pregnant selves!
With any exercise programme, post natal or otherwise the ability to breathe correctly during exercise is essential to having a fully functioning core. Reconnecting with your breath will provide the foundation to both your core’s recovery rate & help you to progress with bigger more integrated core movement patterns (A.K.A sorting out the mummy tummy!). Whatever birthing experience you had or however fit you were/are post partum reconnecting with your breath is where you need to begin. The nature of pregnancy – with the baby in the tummy thing (!) – can create a disconnect with the way we breathe due to the expanding uterus squashing the diaphragm resulting in there being less room for your lungs to expand – so it is vital to relearn this essential function.
Try this – find a quiet space to practice lying down with a neutral spine & pelvis.
Inhale (the expansion): Breathe wide into your ribs, try to do this 3 dimensionally so use the floor against your back as a reference, don’t just flare the ribs outward. Your abdominal wall will expand. Try to relax your shoulders, neck & jaw.
Exhale (the compression): As you breathe out feel your ribcage contract & lower, your abdominal wall & lumbar/thoracic muscles (see the pic) will tension. Think about connecting with your pelvic floor by drawing it up (think picking up a tissue with your vagina) from your vagina to your anus.
Once you feel you have the full core connection try this sitting & then standing making sure to integrate the pelvic floor contraction on each exhale & fully relax/release it on each inhale.
For some women, it will come as a relief knowing that all is required on the exercise front is a bit of breathing to get started but for others wanting to just get the running shoes back on & pick up where they left off, it may pose more of a frustration or perceived limitation to getting their bodies back. Understanding why we need to start with the breath is key to accepting your journey to hot mumness (technical term!) – safe in the knowledge that you’re going to reclaim (& maybe even improve on) the body you want both aesthetically & functionally without having to pee your way through a kettlebell workout because you haven’t addressed proper pelvic floor & core restoration!
So – at a glance list of ‘Why’s’:
Costal breath patterns (as directed above) will help take pressure away from healing abdominal & pelvic floor tissue.
Develops your MUCH NEEDED pelvic floor reconnection.
Increases your oxygenated blood to help healing abdominal & pelvic tissues.
Strengthens & supports your post partum abdominals, back & pelvis.
Helps aid valuable relaxation which in turn will help balance the hormone levels that control weight.
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