Closing the Gap – How to Fix Diastasis Recti Part 2

A ten to twenty minute, daily exercise regimen should suffice to augment the natural healing process. If the abdominal separation is the width of 2 fingers or more, this is what I consider level 2 diastasis. While a similar routine may be enough to heal it, I like to put emphasis on changing daily behaviors so as to really avoid putting unwanted stress on the tissues in between training sessions. If you’re going to spend an entire hour of your day jogging and then go eat a cheeseburger and fries…I mean, sure, have at it but the burger and fries basically undid all of your mind numbing, boring work running, and then some. Can you tell I love running?

When you get up from sitting or lying down, or you hunch over, pick something up, lean against a counter or wall; these are all moments of opportunity where you can avoid further damage and actually help heal the separation. Up until now we have relied on reflexive activation of our muscles to get us through our daily activities. This is fine and dandy for most of us but when you suffer from any kind of core weakness, be it diastasis recti or slipped discs, you have to switch over to purposeful activation.

The very first step  in our postnatal rehab program is learning how to connect to your deep core muscles, primarily the transversus abdominus (TVA) and the anterior pelvic floor. These are the two main muscles we want to use for your “purposeful activation” or your brace. The other, bigger muscles we can allow to act reflexively once the deeper muscles are properly contracted. Creating a connection to these muscles can be difficult. While we can see and touch our biceps ass we contract them, there is no visual feedback for the deep core muscles. Some of us have a small pocket between the rectus abdominus and obliques where you can feel the TVA. But if this isn’t an option there are a few tricks on learning how to feel it contract. Some of the low impact exercises we use in our conditioning program can be used to make the mind/body connection. The TVA muscle is solely involved in stabilization so taking the body just slightly out of stabilization while concentrating on changes within your core can help give you an idea as to where the muscles is and how it feels when in use. Any exercise that requires the bigger muscles in addition to stabilize or move the torso will override any connection to the deep tissues.

There are also some breathing techniques that can help form a connection. Something simple that often works is this –

Lay down on your back, knees bent and feel flat on the floor. Take a breath and then exhale allowing for all the air to leave your lungs without pushing it out forcefully.  Before taking another breath, draw in your belly button towards your spine trying not to press your back into the floor. It helps to put your hands on your abdomen to check that your big muscles in the front are not being activated. When successful, it is your TVA being used to draw inwards. Even though this is pretty simple, it takes a lot of practice to properly activate this muscle when you are not laying down and completely focused  on it. 

Add a pelvic floor hold to the TVA  activation and you have got the brace! I suggest that you activate the pelvic floor before activating the TVA. The transversus abdominus contraction, if significant, can put pressure on the pelvic floor and make it difficult to initiate the hold.

The degree at which you need to activate depends on the movement you are performing.

If you are attempting to sit up out of bed, whether you turn over on to your side first or just sit up straight like a creepy vampire, you need to create your core brace first, and a strong one. I would suggest bracing at 75% of capacity or more.

You really have to brace for any kind of crunching motion. Same goes for any time you bend over to pick something up. If the option is there, try to bend into a deep squat to pick whatever it is up. If pelvic floor weakness is part of the issue for you, then be sure to activate your pelvic floor before squatting.

Try and avoid leaning on counters and walls. Use the moment to activate your brace and practice purposeful posture strengthening. A light brace of the TVA will do.

Sitting on the edge of a chair rather than leaning back is another small change you can make. Sitting on the edge tends to put us in proper posture. It keeps our tailbone from tucking in and rolling our pelvis upwards. In this position we can then lightly activate our brace and keep a neutral spine position.

Exercises 

We use dozens of different exercises, all with several progressions to help heal diastasis recti. Every single one involves some sort of movement. It is so rare that we are completely still during every day life, so the isometric exercises, though helpful for creating connection to muscles, are less functional for our purpose here.

The very first exercise I teach is the knee drop

Lay down on your back, knees bent and feet flat on floor, hip width apart. Do not use anything to support your head, we want to maintain neutral spine. You can keep your hands next to your hips or you can rest them on your abdomen to try and feel the slight activation that occurs. You can start with pelvic floor activation if this is something you need to work on. Often times it is, so it won’t hurt to start there. Lightly draw in your TVA to about 25% capacity. The movement will be the drop of one knee outwards towards the floor. The movement should be as slow as possible trying to maintain a fluid motion rather than a stop and start like motion. This takes time and practice. Go as low to the floor as possible without changing your foot position. While you are dropping your knee to the floor you want to make sure that there is no compensation for change of stability by movement of your opposite leg or your torso. Keep an eye on your stable leg and if you need to you can place a plate or piece of paper on your abdomen to give you some feedback on whether you are moving. And don’t forget to breathe! The TVA can minimize your ability to take deep breaths and often times my clients go red faced not realizing they are holding their breath.

What we want from this is to preemptively activate your stabilizer so that the motion can be carried out without compensation from any other parts of your body. You may need a reflexive increase of activation to maintain proper form. This is great. We want a bit of both purposeful and reactive contraction.

One repetition should take at least  20 seconds – 10 seconds down and 10 seconds back up. I suggest taking a break between each full rep. The relaxation phase is just as important. While we want to train the muscles to contract on command we don’t want to create a tendency to stay tense all day. So take the time to breathe and relax your muscles. 3-5 reps on each side is a good start for this exercise.

A progression to this would be to strap an ankle weight around your knee to add a bit more resistance. A more advanced version would be to create a much stronger brace and lift the “stable” foot off of the floor before beginning the knee drop. This will require involvement of your bigger muscles and so you will want to make sure you have gone through other exercises to get prepared for this one.

There are youtube videos of people flapping both knees up and down like a drunk butterfly. This does not work. Many of the exercises are slow and involve high concentration. Its boring as all hell but this is what works. remember its just 10-20 minutes per day!

Dead Bug 

There are many progression of this exercise. It is probably the most important one we use but It is important to go through the stages at the right pace.

The first stage is the heel tap 

Lay on your back, knees bent and feet flat, hands at your side. Create your brace, activating your pelvic floor and TVA. You want to maintain neutral spine, so try not to push your lower back into the floor when you draw in your abdomen. From this position you will raise one foot about 12 inches off the floor, hinging at the hips but not bending your knee. You should have about a 90 degree angle in your knee for the entire movement. When you lift your foot off of the floor, the combination of your brace and any reflexive contraction should be enough to keep the rest of your body completely still. Just like the knee drop exercise, we don’t want any compensation for the instability brought on by taking one of your points of contact off of the floor. This is what enhances the activation of the TVA.

The movement should be fairly slow but not as slow as the knee drop, maybe 2 seconds per repetition. You want to just tap your heel on the floor rather than place your foot down. This keeps the stability work going through the entire set. Start with 8-10 repetitions. When you finish with one leg, take time to relax all of your muscles. Take 3-4 deep breaths allowing for slight expansion of your abdomen. Then reset your brace and move onto the next leg.

A note about breathing

In our prenatal fitness training, and really all of our training other than postpartum, abdominal rehabilitation I encourage all of our clients to use diaphragmatic breathing as a way to enhance oxygen intake and stimulate the vagus nerve in order to bring on a relaxation effect, trigger gut/immune response and create elasticity with the abdominal tissues. BUT, too much of this kind of breath work can stretch the linea alba (tissue that has been thinned out in your abdomen) and slow the pace or even stop recovery. A few deep breaths is fine but prolonged diaphragmatic breathing may not be what you need just yet. Allow for some of the healing to happen first.

The two above exercises are a great start and I usually keep them in the mix for the entire recovery process. As you begin to move on to harder progressions, these exercises can be used as an excellent warm up.

The program must evolve. You want to increase your endurance for the brace and be able to hold it under much more pressure than a simple heel tap or knee drop. You want to do these kinds of exercises while on your knees, on your feet and while in movement. Don’t limit yourself to a program that keeps you on you on the floor.

Building solid stability and then working on elasticity will increase your functional health for the rest of our life. And if you plan on having another child, these exercises may save you from sustaining diastasis recti the second time around.

Joey

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